Download Basic Epidemiologic Concepts

Community Medicine V
Dr. Mehrdad Askarian MD, MPH
Professor of Community Medicine
Atherosclerosis
&
Hypertension
Atherosclerosis
• Introduction
– Most common cause of death in most
countries
– One third of MI patients die (half of them
during the 1st hr of MI and before
hospitalization)
Atherosclerosis
• Prevalence
– 12 million death/yr in the world.
– Half of deaths in all developed and developing
countries.
– Early mortality rate of males is 2 times of
women.
– In women, sign and symptoms appear 10
years later than males.
Atherosclerosis
• Risk factors
– Group 1: their modification causes lowering
risk of disease acquisition
• Cigarette smoking
Atherosclerosis
• Risk factors
– Group 1: their modification causes lowering
risk of disease acquisition
• Cigarette smoking
• High LDL Cholesterol
Atherosclerosis
• Risk factors
– Group 1: their modification causes lowering
risk of disease acquisition
• Cigarette smoking
• High LDL Cholesterol
• High fat and Cholesterol diet
Atherosclerosis
• Risk factors
– Group 1: their modification causes lowering
risk of disease acquisition
•
•
•
•
Cigarette smoking
High LDL Cholesterol
High fat and Cholesterol diet
Hypertension (HTN)
Atherosclerosis
• Risk factors
– Group 1: their modification causes lowering
risk of disease acquisition
•
•
•
•
•
Cigarette smoking
High LDL Cholesterol
High fat and Cholesterol diet
Hypertension (HTN)
Left Ventricular Hypertrophy (LVH)
Atherosclerosis
• Risk factors
– Group 1: their modification causes lowering
risk of disease acquisition
•
•
•
•
•
•
Cigarette smoking
High LDL Cholesterol
High fat and Cholesterol diet
Hypertension (HTN)
Left Ventricular Hypertrophy (LVH)
Hypercoagulable state (high blood fibrinogen level)
Atherosclerosis
• Risk factors
– Group 2: their modification is most probable to
lower risk of disease acquisition
• Diabetes Mellitus
Atherosclerosis
• Risk factors
– Group 2: their modification is most probable to
lower risk of disease acquisition
• Diabetes Mellitus
• Immobilization
Atherosclerosis
• Risk factors
– Group 2: their modification is most probable to
lower risk of disease acquisition
• Diabetes Mellitus
• Immobilization
• Low HDL Cholesterol
Atherosclerosis
• Risk factors
– Group 2: their modification is most probable to
lower risk of disease acquisition
•
•
•
•
Diabetes Mellitus
Immobilization
Low HDL Cholesterol
High Triglyceride, high LDL
Atherosclerosis
• Risk factors
– Group 2: their modification is most probable to
lower risk of disease acquisition
•
•
•
•
•
Diabetes Mellitus
Immobilization
Low HDL Cholesterol
High Triglyceride, high LDL
Obesity
Atherosclerosis
• Risk factors
– Group 2: their modification is most probable to
lower risk of disease acquisition
•
•
•
•
•
•
Diabetes Mellitus
Immobilization
Low HDL Cholesterol
High Triglyceride, high LDL
Obesity
Menopause
Atherosclerosis
• Risk factors
– Group 3: their modification may cause
lowering risk of disease acquisition
• Psychosocial factors
Atherosclerosis
• Risk factors
– Group 3: their modification may cause
lowering risk of disease acquisition
• Psychosocial factors
• High levels of blood lipoprotein (a)
Atherosclerosis
• Risk factors
– Group 3: their modification may cause
lowering risk of disease acquisition
•
•
•
•
Psychosocial factors
High levels of blood lipoprotein (a)
High levels of homocysteine
No alcohol consumption
Atherosclerosis
• Risk factors
– Group 4: their modification is not possible,
lowering risk of disease acquisition
• Age > 45y/o in males and >55 y/o in females
Atherosclerosis
• Risk factors
– Group 4: their modification doesn’t cause
lowering risk of disease acquisition
• Age > 45y/o in males and >55 y/o in females
• Male gender
Atherosclerosis
• Risk factors
– Group 4: their modification doesn’t cause
lowering risk of disease acquisition
• Age > 45y/o in males and >55 y/o in females
• Male gender
• Low socioeconomic class
Atherosclerosis
• Risk factors
– Group 4: their modification doesn’t cause
lowering risk of disease acquisition
•
•
•
•
Age > 45y/o in males and >55 y/o in females
Male gender
Low socioeconomic class
Family history of early onset coronary artery
disease
Cholesterol
• Blood cholesterol level more than
160mg/dl has a strong correlation with
CAD and death rate due to it and other
causes of mortality, totally.
• High saturated TG intake in presence of
normal blood level of cholesterol is
associated with high prevalence of CAD.
• Each 1% decrease of cholesterol can
cause 2-5% decrease risk of CAD.
Cholesterol
• In Iran
– Total cholesterol in 41% of males and 47% of
females was 200 mg/dl or higher.
– Hypertriglyceridemia in 32% of population
– High LDL (>130 mg/dl) in 51%
– Low HDL (<35 mg/dl) levels in 6% of
population.
Cigarette smoking
• The most important factor to cause early death
in 35-69 y/o people in developed countries.
(cause of 30% of deaths in this age group.
• About 50% increase in mortality rate due to
CAD.
• Each 10 increases 18% mortality in males and
31% in females.
• 37% of nonsmokers are passive smokers which
increases CAD by 30% in this group.
Cigarette smoking
• In Iran:
– 27% of males in age groups of 15-69 y/o
– 3% of females in age groups of 15-69 y/o,
smoke.
– 66% of respondents started smoking around
15-24 y/o.
– Cost of smoking in Iran estimated to be 9.2
milliard Rials annually.
Hypertension
• Strong positive linear correlation between
level of systolic and diastolic blood
pressure and CAD exists, in presence of
normal levels of blood pressure.
• With controlling of blood pressure levels,
we can prevent CAD, CVA and CHF.
Diabetes mellitus
• Important risk factor for atherosclerosis
(both IDDM and NIDDM).
• Atherosclerosis is the leading cause of
mortality in 80% of diabetic patients.
• IDDM increases risk of mortality due to
CAD by 300%.
• Death rates increases due to
cardiovascular diseases in NIDDM males
by 2 and females by 4 times.
Obesity
• BMI≥27 is indicative of obesity
• Risk factors of obesity is related to degree
of obesity and fat distribution.
• Abdominal obesity less than 0.9 in males
and less than 0.8 in women is suggested.
• Obesity increases risk of CAD by 2 times
in males and by 2.5 times in females.
• Obesity has been detected in 36% of
males and 52% of females inTehran.
Low Physical Activity
• Increases risk of CAD by 2 times.
• 80% of males and 85% of females in
Tehran did not reported any physical
activity except than their job.
Prevention of CVD
• Smoking cessation
• Low fat diet and healthy diet from 2 y/o on.
– In which total fat intake per day should not be
exceeds to 20% of calorie intake.
– Decrease saturated fat to 8-10% of daily fat
intake.
– And decrease cholesterol intake to less than
300 mg/day.
• Decrease salt intake (NaCl)
Prevention of CVD
• Increase fresh fruit and vegetables to 5 times a
day.
• Increase physical activity to 30 minutes/day as
an average intensity, 3 times a week.
• 21<BMI<25
• Measuring Blood pressure levels every other
years (at least)
• Measuring cholesterol levels and HDL every 5
years for those with the age of 20 or more.
Hypertension
• Levels of blood pressure in which patient
has increased risk of mortality and
morbidity. (Systolic BP ≥ 140 mmHg and
diastolic BP of ≥90 mmHg).
• Is one of the major causes of CAD and
CVD
• Most common cause of renal failure
• Law of halves
Hypertension
• High risk groups
– Blacks > Whites (prevalence and
complications)
– females < males (before 55 y/o) (lower
complications)
– BP level is inversely related to level of
education and economic status.
Hypertension
• In Iran:
– Diastolic HTN in more than 14% of 12-69 y/o
population.
– Diastolic HTN in more than 34% of 35-69 y/o
population.
Hypertension
• Prevention and control
– Primary prevention & Secondary prevention
• Healthy diet, low salt, low saturated fat and
cholesterol
• Increase intake of fresh vegetables and fruits
• Appropriate calorie intake and prevention of
obesity.
• Increase activity to 3 days in a week and 30
minutes for each time.
• Avoiding Cigarette smoking
• BP<140/90 and <130/85 in diabetics
Lipids Modification
• In persons without risk factor or one risk
factor, except for DM, LDL: 130-159.
• In persons with 2 risk factors except for
DM and probability of CAD during next 10
yrs lower than 20% , LDL<130 mg/dL
• In persons with DM and probability of CAD
during next 10 yrs greater than 20% ,
LDL<100 mg/dL.
Hypertension
• Limitations for controlling of Hypertension
– Not to follow physician’s orders
• Communication problems
• Psycho-behavioral problems
• Side effects of drugs
Hypertension
• Limitations for controlling of Hypertension
– Not to follow physician’s orders
• Communication problems
• Psycho-behavioral problems
• Side effects of drugs
• Limited knowledge of physicians regarding
importance of BP control.
Hypertension
• Inadequate response to drug prescription
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
– Secondary hypertension
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
– Secondary hypertension
– Drug interaction
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
– Secondary hypertension
– Drug interaction
• Associated disorders
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
– Secondary hypertension
– Drug interaction
• Associated disorders
– Renal failure
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
– Secondary hypertension
– Drug interaction
• Associated disorders
– Renal failure
– obesity
Hypertension
• Inadequate response to drug prescription
– Inappropriate prescription of drug
– Secondary hypertension
– Drug interaction
• Associated disorders
– Renal failure
– obesity
• Economical limitations
Hypertension
• Recommendations for controlling hypertension
in Iran:
– To increase knowledge of physicians and all other
HCWs with the disease and its complications.
– To increase knowledge of physicians regarding new
treatments and objectives of treatment.
– To aware population regarding the disease and its
complications
– Calculating the rate of hypertension in different
groups of population
– To create centers for screening and offering
treatments and guidance of patients.
Any
Comments or
Questions?