Epidemic of cardiovascular disease global and us trends any lessons for honduras
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Epidemic of Cardiovascular disease Global and US trends Any Lessons for Honduras?. Dr. Thomas G. Allison Cardiovascular Diseases and Internal Medicine Mayo Clinic Rochester, MN. Disclosures. Conflicts of interest: none Off-label use of drugs or devices: none. Developing countries.

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Epidemic of cardiovascular disease global and us trends any lessons for honduras l.jpg

Epidemic of Cardiovascular disease Global and US trendsAny Lessons for Honduras?

Dr. Thomas G. Allison

Cardiovascular Diseases and Internal Medicine

Mayo Clinic

Rochester, MN


Disclosures l.jpg
Disclosures

  • Conflicts of interest: none

  • Off-label use of drugs or devices: none


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Developing countries

  • 80% of worldwide CV deaths

  • Occur at a younger age

  • 2010 – 70% of the elderly will live in the developing world

Global Burden of Cardiovascular Disease

Total deaths – 57 million

2002 statistics

Cardiovascular

HIV

TB

Malaria

16.7 million

5 million

Lopez. Lancet 2006; Reddy. NEJM 2004


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International Comparison

(Men ages 35-74)



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Lowest

Highest


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Haiti: 55 years

Guyana: 63 years

Bolivia: 65 years

Honduras: 67 years

Brazil: 70 years

Peru: 71 years

Jamaica: 72 years

Paraguay: 72 years

Columbia: 73 years

Mexico: 74 years

Argentina: 75 years

Uruguay: 75 years

Panama: 76 years

Costa Rica: 77 years

Chile: 77 years

Cuba: 78 years

USA: 78 years

Canada: 80 years

Life Expectancy in the Americas


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Modified Model of the Epidemiological Transition as it Pertains to Cardiovascular Disease

Yusef et al. Circulation 2001;104:276-2753


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Stage 1: Age of Pestilence and Famine Pertains to Cardiovascular Disease


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Stage 1: Haiti Pertains to Cardiovascular Disease

Life expectancy = 55 years


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Causes of Death Haiti 2002 Pertains to Cardiovascular Disease


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Stage 2: Age of Receding Pandemics Pertains to Cardiovascular Disease


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Stage 2: Bolivia Pertains to Cardiovascular Disease

Life expectancy = 65 years


Causes of death bolivia 2002 l.jpg
Causes of Death Bolivia 2002 Pertains to Cardiovascular Disease


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Stage 3: Age of Degenerative and Man-Made Diseases Pertains to Cardiovascular Disease


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Stage 3: Jamaica Pertains to Cardiovascular Disease

Life expectancy = 72 years


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Causes of Death Jamaica 2002 Pertains to Cardiovascular Disease


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Unknown Pertains to Cardiovascular Disease

Injury

Other non-communicable diseases

Chronic obstructive pulmonary disease

Cerebro-cardiovascular disease

Cancer

Maternal and perinatal conditions

Communicable diseases

Proportion of deaths (%)

Year

Changing Distribution of the Causes ofDeath in Peoples Republic of China

Yang. Lancet, 2008


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Stage 4: Age of Delayed Degenerative Diseases Pertains to Cardiovascular Disease


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Causes of Death USA 2002 Pertains to Cardiovascular Disease


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Age-adjusted US CVD Disease Trends Pertains to Cardiovascular Disease

Years

1996-2004

Nemetz et al. Arch Intern Med 2008;163:264-270

  • Despite decrease in Heart Disease Mortality

  • Heart disease remains highly prevalent

  • #1 Cause of death in US

  • #1 Contributor to US health care costs


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Hospital discharges for cardiovascular diseases. Pertains to Cardiovascular Disease(United States: 1970-2006). Note: Hospital discharges include people discharged alive, dead and status unknown. Source: NCHS and NHLBI.


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Total Cost = 344.9 billion dollars Pertains to Cardiovascular Disease

Estimated direct and indirect costs (in billions of dollars) of major cardiovascular diseases and stroke (United States: 2009). Source: NHLBI.


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Transition Factors 1 Pertains to Cardiovascular Disease→ 2

Population growth

Older population

Sanitation – water quality

Immunization

Antibiotics

Increased mechanization

of food production

More processed food

Increased salt intake

Hypertension

Hypertensive heart disease

Hemorrhagic stroke


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Transition Factors 2 Pertains to Cardiovascular Disease→ 3

Changing economy

Affluence

Mass media

Cigarette smoking

Reduced physical

activity

Increased caloric intake

More meat consumption

Obesity

Diabetes

Hyperlipidemia

Ischemic Stroke

MI


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Incubation Period for Chronic Disease Pertains to Cardiovascular Disease


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Transition Factors 3 Pertains to Cardiovascular Disease→ 4

More educated public

Increased spending on medical care

Secondary prevention practices

Primary prevention practices

Improved survival from MI

Reduced MI, stroke at young ages


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CHD Trends Pertains to Cardiovascular Disease

McGovern et al, Circulation 2001;104:19-24


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Pre-1985 due largely to lifestyle changes Pertains to Cardiovascular Disease

Smoking cessation

59%  25%

Decreased dietary fat intake

Increased leisure-time physical activity

Post-1985 due largely to medical management

Coronary care units

Electrical defibrillators

Thrombolysis

Emergent angioplasty

Medical Rx

Aspirin, beta-blockers, ACE-inhibitors, statins

Reduction in CVD Death Rate in US

[Primary Prevention]

[Secondary Prevention]

McGovern et al. Circulation 2001;104:19-24


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CAD Prevalence in Patients Who Died of Pertains to Cardiovascular DiseaseUnnaturalCauses in Olmsted County, MN and Had Autopsy

Nemetz et al. Arch Intern Med 2008;168:264-270


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Causes of Death Honduras versus US Pertains to Cardiovascular DiseaseWhere is Honduras in the Epidemiologic Transition?

Source: Death and Daly estimates by cause, 2002

http://www.who.int/entity/healthinfo/statistics/bodfbddeathdalyestimates.xls


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Causes of Death Honduras 2002 Pertains to Cardiovascular Disease


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Honduras versus US Pertains to Cardiovascular DiseaseStatistics

  • Life expectancy at birth

    • Honduras: M = 67/F = 73 US: M = 75/F = 80

  • Healthy life expectancy at birth

    • Honduras: M = 56/F = 61 US: M = 67/F = 71

  • Probability of dying between 15-60 years

    • Honduras: M = 22.9%/F = 13.3%

    • US: M = 13.7%/F = 8.0%


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Honduras versus US Statistics Pertains to Cardiovascular Disease

  • Total expenditure on health per capita

    • Honduras: $241 US: $6,714

  • Gross national income per capita

    • Honduras: $3,240 US: $44,070

  • Total expenditure on health as % of GDP

    • Honduras: 7.4% US: 15.3%

World Health Statistics 2008

Financial data from 2006


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Risk Factors in Honduras Pertains to Cardiovascular Disease

  • No data on hyperlipidemia for Honduras

  • Hypertension highly prevalent throughout Latin American and Caribbean

    • No specific figures for Honduras

    • Greater for persons of African descent

  • 1 survey on diabetes in Tegucigalpa

    • Prevalence 7.8%; 42% unrecognized

  • 1 survey 2005-6 on females aged 15-49 for tobacco use and obesity

    • Urban > rural for both

      • Tobacco use 3.7 versus 0.6%

      • Obesity 23 versus 14%


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Risk Factors, Honduras Pertains to Cardiovascular Disease


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Risk Factors, Honduras Pertains to Cardiovascular Disease


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Conclusions Pertains to Cardiovascular Disease

  • Honduras is moving into the age of man-made and degenerative diseases

  • All risk factors will be increasing

  • Honduras may not afford US high-tech strategies for CVD prevention


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$5,000 USD Pertains to Cardiovascular Disease

$93,000 USD

In US we treat coronary disease with devices

$26,000 USD


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$19.95 USD Pertains to Cardiovascular Disease

$8.09 USD

$5.95 USD

Some less expensive devices to treat coronary disease


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Greetings from Rochester, MN Pertains to Cardiovascular Disease

(winter)


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  • Comments? Pertains to Cardiovascular Disease

  • Questions?


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