Coronary Artery Disease

Prevention in
Coronary Artery Disease
2011
Treating the Turkish Patient:
Is he different?
Prof. Mehdi Zoghi-Ege University, İzmir
καλωσόρισμα
WELCOME
 Cardiovascular disease (CVD)
is a major cause of death
throughout the world.
5
HIV
AIDS
14
Pulmonary
Akc hast.
disease
19
İnfeksiyonlar
Infections
24
Kanser
Cancer
52
KVH
CVD
0
10
20
30
40
50
60
The World Health Report 2004
Primary health care :
Now more than ever
Percentage of the population
citing health as their main
concern before other issues,
such as financial problems,
housing or crime.
Health is among the top
personal concerns !
The world health report 2008
 1 of every 3 deaths
Total CVD†
$368
Heart disease
$239
Coronary
heart disease
$133
Hypertension
$56
Stroke
$54
Congestive heart
failure
$29
0
50
100
150
200
250
300
350
400
Billions of dollars
CVD=Cardiovascular disease
NHLBI. www.nhlbi.nih.gov
Coronary Artery Disease
(CAD) in Turkey
• New CAD: 300.000/year
• CAD Mortality: 170.000/year
• STEMI: 80.000/year
Turkish Adult Risk factor Study
A. Onat Atherosclerosis Risk Factors 2001;156,1-10
Think about where you're going to be in
Death per 100,000 population
2050
50
40
45,2
Over 60 y
Over 80 y
30
20
8,5
10
0
1999
Death per 100,000 population
2050
100
90
80
70
60
50
40
30
20
10
0
97
Over 60 y
Over 80 y
30
45,2
8,5
1999
2050 (estimate)
• The underling pathology is atherosclerosis,
which develops over many years and is
usually advanced by the time symptoms
occur, generally in middle age.
 The major risk factors for
CVD are well established,
with the principal three
modifiable factors being
hypertension,
dyslipidemia and
smoking.
Primary prevention can help prevent
80% of coronary heart disease.
Two complementary strategies that are
usually advocated for primary prevention:
The population strategy aims to reduce the
burden of disease in the whole community
while conferring small benefits to each
individual.
The high-risk strategy, provides large benefits
to the few individuals who are most
vulnerable but the benefits to the whole
community may be relatively limited
because the beneficiaries are few.
Risk prediction charts enable the
estimation of total cardiovascular risk of
people in the first category.
Total cardiovascular risk means the likelihood of a person
developing an atherosclerotic cardiovascular event over a
defined period of time.
Both community-based primary
prevention and secondary
prevention are needed for
effective CVD prevention and
control
ON TARGET
55 yrs
Cigarette smoking, Family history (+)
BP: 135/80 mmHg,
TC: 280 mg/dl, LDL-C: 130 mg/dl, HDL-C:35 mg/dl,
Blood glucose: 90 mg/dl, microalbuminuria (-)
ECG: Normal
Echocardiography: Normal
ON TARGET
10-year risk for developing CHD
http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof
ON TARGET
Individual counseling and provision of care may have to be
prioritized according to cardiovascular risk.
Risk <10%
Individuals in this category are at low risk.
Conservative management focusing on lifestyle
interventions is suggested.
Risk 10% to <20%
Individuals in this category are at moderate risk
of fatal or non-fatal vascular events.
Monitor risk profile every 6–12 months.
Risk >20%
Individuals in this category are at high risk of
fatal or non-fatal vascular events.
Monitor risk profile every 3–6 months.
Risk factor screening
Adults should know the levels and significance of risk factors as routinely PRESENTATION NAME
assessed by their primary care provider.
Company name
Prevention in
Coronary Artery Disease
2011
Turkish Patient: Is he different?
EUROASPIRE : European Action on Secondary
and Primary Prevention by Intervention to
Reduce Events
The EUROASPIRE III survey was
conducted in 2006-2007 in 22
countries in Europe to describe
risk factors, lifestyle and
therapeutic management of
patients with coronary heart
disease (CHD), compliance with
current guidelines, and to
document changes over time.
1. Belgium
2. Bulgaria
3. Croatia
4. Cyprus
5. Czech Republic
6. Finland
7. France
8. Germany
9. Greece
10.Hungary
11.Ireland
12.Italy
13.Latvia
14.Lithuania
15.The Netherlands
16.Poland
17.Romania
18.Russian Federation
19.Slovenia
20.Spain
21.Turkey
22.United Kingdom
EUROASPIRE : European Action on Secondary
and Primary Prevention by Intervention to Reduce
Events
Eur J Cardiovasc Prev Rehabil. 2009 Apr;16(2):121-37
1. Belgium
2. Bulgaria
3. Croatia
4. Cyprus
5. Czech Republic
6. Finland
7. France
8. Germany
9. Greece
10.Hungary
11.Ireland
12.Italy
13.Latvia
14.Lithuania
15.The Netherlands
16.Poland
17.Romania
18.Russian Federation
19.Slovenia
20.Spain
21.Turkey
22.United Kingdom
Records from Turkish centers:
Compared to the EUROASPIRE III data,
classical risk factors did not exhibit
remarkable differences.
Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72
EUROASPIRE III survey-Turkish Data
The most important differences were
observed in the higher rates of
the following:
• Young patients with myocardial
infarction (<50 years, 20% vs. 12.7%),
• Persistence in smoking (23.1% vs. 17.2%),
• İmmobility,
• Low HDL-cholesterol
• Insufficient follow-up by physicians after
the index event (12% vs. 2.2%),
and
• Insufficient patient education.
Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72
HDL was low in half of pts
Europe
(n=8966)
Turkey
(n=338)
Obesity
35,3
35,5
High BP
56.0
55.2
High Cholesterol
51.1
48.3
Low HDL
36.7
50.2
Diabetes
34.8
33.6
Risk Factor
Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72
HDL
Female:46.0 vs 49.5 mgr/dl
Male: 39.4 vs 43.3 mgr/dl
1. Romania
2. South Cyprus
3. Turkey
.
.
.
.
Tokgözoğlu L et al. Turk Kardiyol Dern Ars. 2010;38(3):164-72
2 Reasons for Low
HDL
in Turkish Population
International Physical Activity
Questionnaire
Europe
(n=8966)
Turkey
(n=338)
Low
54.4
23.1
High
39.4
10.5
Physical Activity
PREvention and CONtrol
Program for Cardiovascular
Diseases in TuRkish POpuLation
(PRE-CONTROL)
1) The level and distribution of
cardiovascular risk factors in our
population,
2) The knowledge and awareness of
participants about CVD
3) The evaluation of the effectiveness of
prevention education program on
awareness of CVD in urban
population of Turkey
EUROPREVENT 2011
 A 24-item questionnaire form was used for
detecting cardiovascular risk factors and
the awareness of participants about CVD
which was concerning personal and family
history of disease, education levels,
lifestyle factors and heart attack or
stroke medications.
 The Joint British Societies’ cardiovascular
disease risk prediction chart was used for
investigating cardiovascular risk levels (low
risk < 10%; intermediate risk 10-20%; high
risk > 20%) of participants.
 Education programs feed-back data were
collected by questionnaires and individual
interviews of participants after 2 weeks of
education seminars by telephone surveys.
Total cardiovascular risk
Moderate-High
Low
80
70
60
50
76,4
40
30
20
10
0
23,6
Risk Score %
ÖMER Kozan, MEHDİ Zoghi, GÜLAY Güven Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü,
OKTAY Ergene on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011
Although the cardiovascular risk is high (moderate or
high risk rate was 74.6%) the knowledge and
awareness of the risk factors for cardiovascular
disease are low in our community.
L
RO
T
ON
-C
E
PR
• Only 21% of participants with
cardiovascular risk score more than 10%
have visited any physician within last
year.
The awareness of cardiovascular diseases and risk
factors was significantly increased following our
education programs.
 Community-based educational
L
RO
T
ON
-C
E
PR
programs are helpful to increase public
awareness, health promotion and
management of cardiovascular
diseases.
ÖMER Kozan, MEHDİ Zoghi, GÜLAY Güven Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü,
OKTAY Ergene on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011
You can’t change
everything
Risk Factor
5%
10%
Sex:
Male
Male
Age (yrs):
36
50
Smoker:
-
-
Diabetes:
-
-
Blood Pressure:
130/80
130/80
Total Cholestrol
200
200
HDL Cholesterol:
36
36
Brigitte Bardot
Marlon Brando
Gregory Peck
Madonna
Ajda Pekkan (Famous Turkish Pop Singer)
Demis Roussos
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