new trends in heart disease
Download
Skip this Video
Download Presentation
New Trends in Heart Disease

Loading in 2 Seconds...

play fullscreen
1 / 66

New Trends in Heart Disease - PowerPoint PPT Presentation


  • 72 Views
  • Uploaded on

New Trends in Heart Disease. Prof Chu-Pak Lau Cardiology Division University of Hong Kong Queen Mary Hospital. Public Health Conference 6 March 2004. Global Burden of CVS disease Bonow RO et al Circ 2002; 106:1602-1605. CVS death toll : 14.7M in 1990 to 17M 1999

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' New Trends in Heart Disease' - gore


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
new trends in heart disease

New Trends in Heart Disease

Prof Chu-Pak Lau

Cardiology Division

University of Hong Kong

Queen Mary Hospital

Public Health Conference

6 March 2004

global burden of cvs disease bonow ro et al circ 2002 106 1602 1605
Global Burden of CVS diseaseBonow RO et al Circ 2002; 106:1602-1605
  • CVS death toll :

14.7M in 1990 to 17M 1999

  • Main burden due to CAD, is the leading cause of death worldwide (30%). CVA second leading cause
  • WHO : 1 Billion people overweight

18M children <5 are overweight

  • 60% of the world population is physically inactive
  • DM : 150M people, will double in 2025
  • Tobacco consumption still increasing
slide3
Coronary Artery Disease

Heart Failure

Atrial Fibrillation

sino monica project circulation 2001 103 462 468 1
Sino-MONICA Project.Circulation 2001; 103:462-468(1)
  • 7 Year project (1987-1993)
  • WHO project
  • Collaboration with BIHLBD
sino monica project circulation 2001 103 462 468 2
Sino-MONICA Project.Circulation 2001; 103:462-468(2)
  • Incidence and mortality of CVS disease is low but those of CVA were high
  • Great disparity in incidence

CVS : 108.7/100,000 to 3.3/100,000 for men

CVA : 553.3/100,000 to 33/100,000

3. Geographical difference :

North > South

e.g. Beijing 70.3 vs Guangdong 59.7/100,000

special features of heart disease of women
Special Features of Heart Disease of Women
  • Older
  • Delayed presentation
  • Higher mortality rate
  • Triple vessel disease and smaller vessel size
  • Higher CABG risk
  • Suboptimal response to PTCA
  • Despite a lower CAD risk, HK women have mortality from strokes comparable to the US
modifiable risk factors
Modifiable Risk Factors

Hypertension

Hypercholesterolemia

Diabetes mellitus

Homocysteine

C-Reactive Protein

Exercise

Obesity

Cigarette smoking

slide16

BP, Cholesterol and Stroke in Eastern Asia Eastern Stroke and Coronary Heart Disease Collaborative Research Group Lancet 1998; 352; 1801-1807

obesity
Obesity

Prevalence in the US in American white (1999-2000)

Obesity : BMI > 30

CDC 1999-2000

mortality from cad in hk 45yrs dept of health annual report 1997 2001 2
Mortality from CAD in HK (<45yrs)(Dept of Health Annual Report 1997-2001) (2)

% of Heath Disease <45 years

%

slide24

The Role of Platelets in Inflammation and Plaque Stability

Activated platelets

Inflammatory modulators

CD40L

Platelet-derived growth factor

Platelet factor 4

RANTES

Thrombospondin

Transforming growth factor-

Nitric Oxide

Plaque rupture

& thrombosis

Libby P. Circulation 2001:103:1718-1720

novel risk factors as predictors of peripheral arterial disease

Lipoprotein(a)

Homocysteine

VCAM-1

Fibrinogen

LDL-C

ICAM-1

hs-CRP

TC:HDL-C

CRP + TC: HDL-C

0 1.0 2.0 4.0 6.0

Novel Risk Factors as Predictors of Peripheral Arterial Disease

Relative Risk of Incident Peripheral Arterial Disease

(Adjusted for age, smoking, DM, HTN, family history, exercise level, and BMI)

Ridker et al. JAMA 2001;285:2481-2485

aha cdc recommendations for clinical and public health practice
AHA/CDC Recommendations for Clinical and Public Health Practice

Clinical Practice

  • Measurement of hs-CRP is an independent marker of risk and, in those judged at intermediate risk by global risk assessment (10%-20% CHD/10 yr) may help direct further evaluation & therapy in primary prevention of CHD. The benefits of such therapy based on this strategy remain uncertain. (Class IIa, Level of Evidence B)
  • Measurement of hs-CRP may be used at discretion of the physician as part of global risk assessment in adults without known CVD. The benefits of such therapy based on this strategy remain uncertain. (Class IIb, Level of Evidence C)

AHA/CDC Statement. Circulation 2003; 107:499–511

hong kong cardiovascular risk factor prevalence study 2 crisps2

Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2)

Bernard Cheung

Department of Medicine

University of Hong Kong

weight
Weight
  • Body weight increased by 0.54±0.14 kg (p<0.001)
  • There was no significant change in body mass index (BMI)
  • Waist circumference increasedfrom 78.3±0.3 to 80.5±0.3 cm (p<0.001)
bmi 25 is associated with diabetes or 3 1 2 0 4 7 and hypertension or 3 5 2 5 5 0
BMI25 is associated with diabetes (OR 3.1 [2.0-4.7]) and hypertension (OR 3.5 [2.5-5.0])

Overweight, diabetes and hypertension

conclusions
Conclusions
  • In the CRIPS2 cohort, hypertension (27%), diabetes (15%), hypercholesterolaemia (46%) and overweight (35%) are common
  • As these risk factors can be modified by diet and lifestyle, the prevention of cardiovascular disease requires a community approach
slide34
Coronary Artery Disease
  • Heart Failure

Atrial Fibrillation

heart failure how big is the problem really
Heart Failure : How Big is the Problem Really?
  • 4,790,000 Americans have heart failure
    • Based on extrapolation of NHANES data
  • 550,000 new cases each year
    • Based on extrapolation of 44-year Framingham data
  • HF contributed to 287,200 deaths in 1999
    • Primary cause in 54,913
  • HF deaths have increased by 145% in 20years
    • Age-adjusted rates have not changed
    • Mortality rates may be declining
  • Hospital discharges increased from 377,000 to 962,000 between 1979 and 1999
    • Age adjusted rates and length of stay are declining
slide37

65+

45-64

a new epidemiology of ventricular dysfunction
A New Epidemiology of Ventricular Dysfunction

The Old Epidemiology of CHF :

  • Included only symptomatic LV failure
  • Often excluded persons > 75 years old
  • Did not characterize ventricular function

The New Epidemiology of Ventricular Dysfunction :

  • Includes assessment of ventricular structure and systolic / diastolic function
  • No age limits
slide40
Community Echo Survey of Systolic and Diastolic LV DysfunctionRedfield MM et al, JAMA 2003; 289: 194-202

Pts & Methods

1997-2000 : 2042 subjects of Olmsted County were screened with echo and Doppler, and followed for ~5yrs

Results

CHF : 2.2%

Systolic Dysfunction : 6%

EF > 50% : 44%

Diastolic Dysfu : Mild 20.6%

Mod 6.6%

Severe 0.7%

pharmacotherapy
Pharmacotherapy
  • ACEI
  • Angiotensin II blockers
  • Betablockers
  • Aldosterone antagonist
  • Newer agents
prevalence of heart failure with preserved ef
Prevalence of Heart Failure with Preserved EF

EF>

45%

EF>

50%

N=269

EF>

45%

N=338

EF>

40%

N=782

EF>

50%

N=137

EF>

50%

N=73

main problems of electrical alterations
Main Problems of Electrical Alterations

1. PR prolongation (improper LV filling)

2. Interventricular asynchrony (RV-LV asynchrony)

3. Intraventricular asynchrony (regional LV asynchrony)

Results in :

1.  Stroke volume

2.  Contractility

3. MR

slide46

Before

After

CRT or Reverse Remodelling ?

crt trials
CRT Trials

6m HW (m)

Echo (LVED in mm)

LVEF (%)

*Significant Improvement

slide49
Coronary Artery Disease

Heart Failure

  • Atrial Fibrillation
af incidence resource implication
AF : Incidence/resource implication

In USA :

2 million; 160,000 new cases/yr

3-5% population >60yr

1.5 million primary reasons for consultation

1.4 million hospital discharges

130,000 A&E visits

6.6 billion US$ Medicare

prevalence of af in elderly ryder benjamin ajc 1999
Prevalence of AF in ElderlyRyder & Benjamin AJC 1999

(%)

Countries

Age (yrs)

USA

(70-80)

Netherlands

(70-80)

UK

(70-80)

Hong Kong

(60-94)

Japan

(>40)

Himalaya

(>15)

af and mortality framingham heart study benjamin et al circulation 1998 98 946 952

Men : 1yr Cx

(%)

5

AF

No AF

4

3

2

1

0

CHD

CVA

Total

AF and Mortality : Framingham Heart StudyBenjamin et al Circulation 1998; 98:946-952

Methods :

5209 subjects, age 55-94, follow-up for 40yrs. AF documented by biennial ECG

Result :

AF increases mortality by 50% in men and 100% women

Conclusion :

Maintenance of sinus rhythm may decrease mortality

slide54

HF

AF

at af affect survival
AT/AF Affect Survival ?

Mortality (%)

Framingham2

SOLVD3

DIG4

VA-CHF5

MiddleKauff1

  • Middlekauff HR et al Circulation 1991; 84:40-48
  • Benjamin EJ et al Circulation 1998; 98:946-952
  • Dries DL et al JACC 1998; 32 : 695-703
  • Mathew J et al Chest 2000; 118: 914-922
  • Carlson PE et al Circulation 1993; 87 (supple) : VI 102-110
emergence of new epidemics of cvs disease
Emergence of New Epidemics of CVS Disease

Two new epidemics of cardiovascular disease are emerging : heart failure and atrial fibrillation

E. Braunwald

therapeutic strategies in af
Therapeutic Strategies in AF

Maintain SR

Rate Control

vs

  • Necessary for all therapy
  • Minimal S/E
  • Symptomatic benefit
  • EF

? ET

  • Theoretically sound
  • After restoring SR
  • EF
  • ET
  • atrial function

?  stroke

strategies for af management in chf
Strategies for AF Management in CHF
  • Drug
  • Ablate & pace
  • Pulmonary vein ablation
  • Atrial defibrillators
  • Main cause of AF is HT
global approach to reduce cvs cva death
Global Approach to Reduce CVS/CVA Death
  • International cooperation
  • Research and Education
  • Targeted primary prevention strategies

e.g. tobacco use, hypertension control, affordable clinical algorithm

  • Advocacy e.g. World Heart Day
  • Availability of cost-effective meds
the hong kong ami registry 1995 1996 woo ks et al for the hk ami task force
The Hong Kong AMI Registry 1995-1996 Woo KS et al for the HK-AMI Task Force

Background :

A territory wide survey of all cases of AMI admitted into hospital. Initiated by the HK College of Cardiology

Subject and Methods :

A total of 3334 AMI (diagnosis by symptom, ECG and enzyme) were prospectively entered into a centralized data base, and uniformity and accuracy of data were audited by a research coordinator. In-hospital mortality complication were examined 96.2% were ethnically Chinese

demographics of ami in hk 95 96
Demographics of AMI in HK (95-96)

Sex

Age

(%)

Sex

Age

Female

72.9 yrs

Male

64.8 yrs

ami incidence mortality in us 1975 1995 goldberg rj et al circulation 1999 33 1533 1539
AMI Incidence & Mortality in US (1975-1995)Goldberg RJ Et al Circulation 1999; 33: 1533-1539

Mortality (%)

Incidence /100,000

ad