EPIDEMIOLOGY
and overview of
cardiac DISEASE
INTRODUCTION
 The 20th century saw
unparalleled increase in life
expectancy & major shift in
the cause of illness
throughout the world
GLOBAL BURDEN OF CVD.
 A century ago, CVD death <10%
 Today, approximately 30% of deaths
worldwide including nearly 40% in high
income countries and about 28% in low
and middle income countries
-Braunwald’s Heart Disease 2008
EPIDEMIOLOGICALTRANSITIONS
Stage
Typical
proportion of
deaths
caused by
CVD %
Predominant
types of CVD
Pestilence and
Famine
<10
Rheumatic heart
disease,
cardiomyopathies
Receding
Pandemics
10-35
Rheumatic
valvular disease,
HT,CHD, Stroke
Contd…
Degenerative & 35 – 65
Manmade
diseases
CHD, Stroke
40 – 50
CHD, Stroke,
CHF.
Delayed
degenerative
Diseases
PREVALENCE OF CHD-US
Age in years
Male
%
Female
%
40-49
07
05
50-59
13
08
60-69
16
11
70-79
22
14
PREVALENCE
 The prevalence of CHD is about
7.4% in men and 4.5% in women.
 The prevalence is higher in lower
socio-economic groups.
 Of note, mortality from CHD is falling but
morbidity appears to be rising.
EPIDEMIOLOGY OF IHD
MORTALITY RATES-UK
 CHD is the most common cause
of death (and premature death) in
the UK
 1 in 5 men and 1 in 6 women die
from CHD
Contd…
 There are 101,000 deaths from CHD in
the UK each year.
 Death rates from CHD have fallen by
46% for people under 65 years in the
last 10 years in UK, Australia (48%) and
Norway (54%).
 Death from CHD is more likely during
winter.
MORBIDITY RATES IN UK
 The average incidence of Myocardial
Infarction is 600 per 100,000 in men
aged 30-69 and 200 per 100,000 in
women. The incidence increases with
age
 There are about 52,000 new cases of
Angina per year in all men living in the
UK and about 43,000 new cases in
women
PREVALENCE OF CVD-UK
Disease
Age
%
Heart attack
Men
Women
04 %
02%
Men
08%
55-64yrs
Angina
Women
Men
05 %
17%
65-74 yrs
Women
08%
NEWS ALERT
Aug 13, 2009 The heart of the matter
 Premature heart attack is common in Indians
compared to the Western population
 Beyond the age of 50, the risk of heart attack
per year approximately 2-3 per 1000
Contd…
Aug 13, 2009.The Hindu
 one in 200 deaths of adults over age 40
occurs due to Sudden Cardiac Arrest
Contd…
November 4 , 2006 The Hindu
 MYSORE: Incidence of heart disease
has doubled in India during the last 20
years on account of changes in lifestyle
and economic development.
Contd…
 Dr Rajesh Pande (Cardiovascular
disease in India and the impact of
lifestyle and food habits)
 80 % of global CVD related deaths now
occur in low and middle-income nations,
which covers most countries in Asia
INCIDENCE OF MI IN URBAN INDIA
Gender
Incidence
Prevalence
Mortality
Male
06/1000
Urban -35–90/1000
Rural -17–45/1000
40 % in
Urban
Female
02/1000
Urban -28–93/1000
Rural -13–43/1000
30 % in
Rural.
PREVALENCE IN CHENNAI
Year
Urban
%
Rural
%
1960
2
1970
6.5
2
1980
7.0
2.5
1990
9.7
4
2000
10.5
4.5
OUR FUTURE
 The World Health Organization
estimated that 60 % of the world's
cardiac patients will be Indian by 2010
 50 % of CVD-related deaths in India
occur below the age of 70, compared
with just 22 % in the West
Contd…
 CVD will increase rapidly in India and
this country will be host to more than half
the cases of heart disease in the world
within the next 15 years
RESEARCH EXCERPTS
 South Asians have elevated levels of
LDL cholesterol and triglycerides, while
also suffering from a deficiency in HDL
cholesterol
 South Asians seem more naturally
vulnerable to heart disease than other
ethnic groups
Contd…
 The disease occurs at a much younger
age in Indians as compared to those in
North America and Western Europe
 In general, the incidence of all rhythm
problems is 8-10 per 1000 people
VITAL STATISTICS-WHO
 2 million people die of CVD in India
every year
 32 % are in the age group 35-44.
 Four Indians die of a heart ailment every
minute
prevalence of major risk
factors for CVD.
 Diabetes 11.9%
 hypertension 25.4%
 dyslipidaemia 40.2%
 hypertriglyceridaemia 28.3%
 overweight 60.2% and
 metabolic syndrome 34.1%.
Contd…
 Use of tobacco in any form was present
in 22.9% of men and 0.5% of women
 79% of the subjects followed a sedentary
lifestyle.
--Natl Med J India. 2008 Jan-Feb
CURRENT WORLDWIDE
VARIATIONS
 Currently 85 % of the world’s population
lives in low and middle income countries.
 About 30 % of the world’s population
lives in East Asia and the pacific islands
and another 22 % live in south Asia.
CORONARY ARTERY DISEASE
IN WOMEN
 Stroke and MI- Number one killer of
women with 500,000 deaths per year
 First myocardial infarction in women
is more severe and more lethal than
they are in men.
Contd…
Women’s mortality rate at 6
months post myocardial
infarction double that of men
Coronary artery bypass surgery
operative mortality 4.5%
women, 2.6% men
Contd…
Menopause often cause increase
in total cholesterol and LDL
 Framingham Study: Risk of CAD
doubles with onset of menopause
 Heart disease or cardiopathy is an
umbrella term for a variety of different
diseases affecting the heart
 Cardiovascular disease is any of a
number of specific diseases that affect
the heart itself and/or the blood vessel
system, especially the veins and arteries
leading to and from the heart.
Types of cardiovascular
disease
 Atherosclerosis
 Ischaemic heart disease
 Heart failure
 Hypertensive heart disease
 Include:Left ventricular hypertrophy
 Coronary heart disease
 (Congestive) heart failure
 Hypertensive cardiomyopathy
 Cardiac arrhythmias

 Inflammatory heart disease
 Valvular heart disease
Risk factors
 hypertension, diabetes, high cholesterol
(hypercholesterolemia, hyperlipidemia),
obesity, sedentary lifestyle, male gender,
increasing age, drinking excessive
amounts of alcohol, long-term stress,
smoking and heredity
 high C-protein levels & high
homocysteine levels
Signs and symptoms
 · chest pain or abdominal distress
 · cough
 · cyanosis
 · enlarged veins in the neck
 · fainting
 · loss of appetite
 · palpitations
 · shortness of breath
 · swelling in the legs
 · weakness and fatigue
Diagnosis
History
Physical examination
 blood and urine tests
 · cardiac catheterization, a special X-ray
done with a contrast agent to look at the
heart and its blood supply
 · chest X-ray
 · echocardiogram, which uses sound
waves to view the beating heart
 · electrocardiogram, or EKG, which
shows the electrical activity of the heart
 · stress EKG tests, in which the person
CONCLUSION
 It is possible that the efficient transfer of
low-cost preventive and therapeutic
strategies may alter the natural course of
the epidemiological transition in every
part of the world and thus reduce the
excess global burden of preventable
CVD