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CHD Prevention and Risk Asssessment : Old concepts new context?. Dr Paul D MacIntyre Director of Cardiology, RHH. Why Prevent CHD ?. P remature Mortality <65yrs of age Avoid chronic disease Quality of life Economic costs Delay or prevent We all die ! CVD v Cancer.

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chd prevention and risk asssessment old concepts new context

CHD Prevention and Risk Asssessment:Old concepts new context?

Dr Paul D MacIntyre

Director of Cardiology, RHH

why prevent chd
Why Prevent CHD ?
  • Premature Mortality <65yrs of age
    • Avoid chronic disease
          • Quality of life
          • Economic costs
        • Delay or prevent
        • We all die !
          • CVD v Cancer
prevention of chd 3 silos
Prevention of CHD:3 Silos
  • Low risk primary prevention
  • High risk primary prevention
  • Secondary prevention
risk factors for cvd
Risk Factors for CVD
  • Modifiable
    • Smoking
    • Physical Activity
    • Obesity
  • Medical Conditions
    • Hypertension
    • Diabetes
    • Hyperlipidemia
    • Chronic Kidney Disease
  • Non Modifiable
    • Age
    • Sex
    • Family History
    • Socio economic status
      • Ethnicity
      • Relative poverty
      • Lack of hope
low risk primary prevention
Low Risk Primary Prevention
  • General population at low risk of CHD
  • Public Health measures to improve lifestyle
    • Smoking
    • Diet
    • Exercise
  • Prioritise children
    • Childhood Obesity
  • Needs both population and individual approach
population risk
Population Risk

Physical activity

Cholesterol

Mean

population risk1
Population risk
  • Public Health policy
  • Partnership working
    • Health Services
    • Central government
    • Local authorities
    • Primary care
    • Voluntary sector
  • Create environmental change
    • Smoking ban in public places
    • Plain packaging of cigarettes
    • Healthy eating
    • Environmental change to facilitate physical activity
  • Social Determinants of Health
public health measures healthy eating
Public Health measuresHealthy Eating
  • Food labelling
  • Restrictions
    • Ban Junk food from public sector
  • Engage with the food industry
    • Junk Tax
    • Fat Tax
  • Fruit shops in public sector buildings
smoking
Smoking
  • Stop starting and start stopping
  • Young
  • Programmes for low income
  • Hospital Smoking cessation services including NRT
  • Primary care services
physical activity
Physical Activity
  • Inactivity doubles risk of CVD
  • Physical activity for Health
    • Adults accumulate 30 mins of moderate intensity exercise most days of week
    • Children 60 mins
  • Physical activity for fitness
    • 3 x 20 mins of vigorous intensity exercise per week
  • ? Intensity Level required for CVD protection
barriers to exercise
Barriers to Exercise

Master Tom MacIntyre

slide14
Diet
  • Noddy’s guide
    • Cut the crap
      • Accessibility
      • Cost
      • Convenience
    • Reduce portion size
    • Eat fruit and vegetables
high risk primary prevention
High risk primary prevention
  • Anticipatory care
  • Case finding
  • High risk registers
    • Structured
    • Opportunistic
    • Outreach
  • Social deprivation
  • Risk assessment
  • Risk factor modification
high risk primary prevention1
High risk primary prevention
  • ?Already have the disease
  • JBS2 guidelines
    • ≥ 20% 10yr risk of CVD on Framingham score
    • Health inequalities
      • ASSIGN risk calculator for Scotland
      • Prof Tunstal-Pedoe
      • Social Deprivation and Family History
      • SIGN 97
      • Health behaviour change
      • Statin and aspirin prescription
predict
Predict
  • Prof Rod Jackson
  • Predict
  • Absolute risk
  • Unique identifier
  • 90 % penetration in primary care
    • >400,000
  • IT issues resolved
  • Outcome data
secondary prevention
Secondary prevention
  • Step change
    • Menu based Cardiac Rehabilitation
    • Multidisciplinary team
    • Components
      • Education
      • Medical risk factor modification
      • Optimise pharmacological treatment
      • Health Behaviour Change interventions
        • Smoking
        • Diet
        • Exercise
        • Stress, anxiety and depression
    • Does it work?
    • Chronic disease management
secondary prevention1
Secondary prevention
  • Chronic Stable CHD
    • Primary care setting
    • Medical risk factor modification
    • Optimise treatment
    • Chronic disease management programmes
    • Health behaviour change
      • Smoking cessation services
      • Diet
      • Exercise referral
      • Health coach model
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