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Epidemiology of Cardiovascular Disease Epidemiology of Cardiovascular Disease

Epidemiology of Cardiovascular Disease - PowerPoint Presentation

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Epidemiology of Cardiovascular Disease - PPT Presentation

EPID 624 Epidemiology of Chronic Diseases Sara Sigur Presentation Overview Background IncidencePrevalence Attributes associated with cardiovascular disease Costs Interventions Current and future research ID: 737969

disease heart www http heart disease http www chronic cholesterol commed vcu pdf cvd women chd mortality risk factors men high incidence

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Slide1

Epidemiology of Cardiovascular Disease

EPID 624 – Epidemiology of Chronic Diseases

Sara SigurSlide2

Presentation Overview

Background

Incidence/Prevalence

Attributes associated with cardiovascular disease

Costs

Interventions

Current and future researchSlide3

Background

Including incidence/prevalenceSlide4

Four Main Diseases

Coronary heart disease (CHD)

Heart failure (HF)

Stroke

Peripheral artery disease (PAD)Slide5

Coronary Heart Disease

also known as ischemic heart disease, coronary artery disease

attributed to reduced blood flow to the heart

most often caused by atherosclerosis

results in angina (chest pain), myocardial infarction (a.k.a. heart attack), and deathSlide6

Atherosclerosis

thickening of artery walls —> narrowing of arteries —> decreased blood flow —> increased risk of embolism (blood clot)

factors that contribute to development:

inflammation

calcification

deposit of fat/cholesterol

process begins in childhood; fetal factors may be involvedSlide7

Incidence of CHD

“Every 43 seconds, someone in the United States has a heart attack” - Center for Disease Control

Every year there are approximately 1.2 million new or recurrent heart attacks in the U.S. Slide8

Prevalence of CHD

An estimated 80 million Americans have one or more CVD

CHD accounts for 52% of CVD deaths

death rates from CHD peaked in 1963 and have steadily been decreasing since 1968

26% decline in death rates from CVD overall from 1995-2005Slide9

Heart Failure

inability of either left or right ventricle to properly fill with or eject blood secondary to damaged or weakened heart muscles

shortness of breath + fatigue —> decreased exercise tolerance + fluid retention —> pulmonary and peripheral edema —> decreased quality of life

left vs right heart failure Slide10

Incidence and Prevalence of HF

Approximately 25% of men and 45% of women will develop HF within 6 years of having a heart attack

HF is the one CVD that is increasing in incidence, prevalence, and mortality

CVD is the leading cause of disability in the U.S.Slide11

Attributes associated with CVDSlide12

Race/Ethnicity

- CVD - leading cause of death in U.S. for whites, blacks, and American Indians

- Age-adjusted CVD mortality rates (per 100,000)

438 for African American men

325 for white men

319 for AA women

230 for white women

- Hispanics and Asian Americans appear to be at lower risk of heart disease and stroke mortality than whites

http://www.cdc.gov/heartdisease/family_history.htmSlide13

Age

Mortality greater among older adults

increases independent of other known risk factors

55% of heart attacks are in those 65+; 85% of deaths from MI are in those 65+

CHD incidence rates in women after menopause are 2-3x higher than those women pre-menopausal of the

same ageSlide14

Sex

Age-adjusted mortality 45% higher in men

Still leading cause of death in U.S. women

CHD incidence for women lags behind men by 10 years Slide15
Slide16

Geography

http://www.cdc.gov/dhdsp/maps/national_maps/hd_hospitalization_all.htmSlide17

http://www.cdc.gov/dhdsp/maps/national_maps/hd65_all.htmSlide18

http://www.cdc.gov/dhdsp/maps/sd_poverty.htmSlide19

Socioeconomic Status

CHD incidence and mortality higher in those of lower SES

so far, greatest decline in CHD mortality has been seen in white men/women with the highest levels of education/income

living in “deprived” neighborhoods linked with increased risk factorsSlide20

Global Perspective

Mortality rates remain higher in U.S. than many other industrialized nations

2020 Projections:

Latin America, the Middle East, and sub-Saharan Africa will have 3x the occurrence of heart disease from 1990-2020

rates in developing countries will increase 120% for women, 137% for menSlide21

Adverse Behaviors

Poor diet

Lack of physical activity

Smoking

Alcohol consumption

All which can contribute to…obesity, diabetes, high blood pressure, high cholesterolSlide22

Cost

$151.6 billion = 2004 estimated cost of medical care, lost earnings, and lost productivity

$475 billion = 2009 estimated direct and indirect costs of CVD per AHA

HF specifically - high hospitalization rates and poor prognosis, strain on Medicare

3 most prominent factors influencing economic burden:

revascularization procedures

hospital care

prescription medications

http://www.commed.vcu.edu/Chronic_Disease/Heart/prevstrat_21Cent.pdfSlide23

http://www.commed.vcu.edu/Chronic_Disease/2010/orprevhtataglance.pdfSlide24

Interventions

Primary, secondary, tertiary, community-levelSlide25

Primary Prevention

Control of modifiable risk factors

decrease cholesterol/systolic BP/smoking/physical inactivity

recent efforts in this area have accounted for 44% decline in CHD mortality

efforts partially offset by increases in BMI and diabetes

Environmental changes

Million Hearts Initiative

http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvsnatpolicy.pdfSlide26

http://millionhearts.hhs.gov/about-million-hearts/million-hearts.htmlSlide27

Secondary Prevention

Screening for high blood pressure/cholesterol

Electrocardiograms for high risk individualsSlide28

Tertiary Prevention

Revascularization - stents, coronary artery bypass grafts

Cardiac rehab - prevention of complications through diet, exercise, weight control, and smoking cessation

Medications - statins, diuretics, beta blockers

Mechanical assist devices - pacemakers, LVADSlide29

Community-level

use education and environmental changes to promote positive lifestyle and behavior changes

North Karelia Project

began in 1972

studied risk factor interventions

interventions directed at the media and food producers/distributors Slide30

http://www.commed.vcu.edu/Chronic_Disease/Heart/2014/commguideAHA2013.pdfSlide31

Healthy People 2020

Many goals related to heart disease, including:

reduce proportion of adults with hypertension (from 29.9 to 26.9%)

reduce proportion of adults with high total blood cholesterol levels (from 15.0 to 13.5%)

https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke/objectives?topicId=21Slide32

Research

Current/Future/Issues Slide33

Framingham Heart Study

began in 1948, conducted by National Heart Institute

primary aim: identify factors and characteristics contributing to CVD

enrolled ~5,200 men and women with no overt signs/symptoms of disease, examining them every two years

allowed for the identification of key risk factors

http://www.framinghamheartstudy.org/about-fhs/history.phpSlide34

Gene/Stem Cell Therapy

Interest in using both therapies to aid in repair of damaged tissue

controversial

needs further study in humans

http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvschallenges2011.pdfSlide35

Link Between Cholesterol and CVD

Landmark study published in 1966

Looked at link between HDL and heart disease

Importance of looking to past research to advance current knowledge

http://www.commed.vcu.edu/Chronic_Disease/Heart/revisiitingpastrsch.pdfSlide36

Cholesterol in Children

Report from National Center for Health Statistics analyzing data from NHANES

Children 6-19 years old

Key findings:

Approximately 1/5 children and adolescents had at least one abnormal cholesterol measure (high total cholesterol, low HDL cholesterol, or high non-HDL cholesterol)

Those who were obese had 5x prevalence of low HDL levels compared to normal weight

American Academy of Pediatrics recommends monitoring cholesterol in all children

Long-term monitoring may inform public health interventions and prevent CVD as an adult

http://www.cdc.gov/nchs/data/databriefs/db228.htmSlide37

Diet Considerations

U.S. Dietary Guidelines Advisory Committee released 2015

Dietary Guidelines

recommendations

May see dietary cholesterol removed from list of “nutrients of concerns”

Eliminate a limit on total fat consumption

type more important that quantity

http://www.commed.vcu.edu/Chronic_Disease/Heart/2016/BMJEditFoodObj.pdfSlide38

Gaps in Knowledge

Role of genetics - inflammatory biomarkers and signaling pathways

Public health implementation science - role of social networks, transportation, media, etc.

more community-based studies needed

Population-based prevention research

especially for minority populations, women/children

http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvsnatpolicy.pdfSlide39

Gaps, cont.

Understanding of causes of HF is still not well known; prognosis still very poor

Optimal range for BP meds and lipid-lowering meds still unclear

too lenient vs too aggressive

http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvschallenges2011.pdfSlide40

Other Road Blocks

Delayed clinical implementation

ability to understand applicability of new findings/technologies

beta blockers - routinely prescribed 25 years after publication of definitive randomized trials on their benefits for post MI survivors

COST

of research itself - difficult and expensive to conduct large-scale randomized trials

of different primary prevention methods - prescribing more meds does not seem to be cost effective

Current agricultural policies

http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvschallenges2011.pdf

http://www.commed.vcu.edu/Chronic_Disease/Heart/2012/cvsnatpolicy.pdfSlide41

http://www.commed.vcu.edu/Chronic_Disease/Heart/2015/altresearchstrat..pdfSlide42

References

Remington, P. L.,

Brownson

, R. C., & Wegner, M. V. (2010). 

Chronic disease epidemiology and control

. Washington, DC: American Public Health Association.Slide43

Questions?