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WHO CVD Atlas. 2002. WHO Stroke Atlas. 2002. The Burden of CVD in Asia: Stroke Deaths by Country, 2002 2.

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Presentation on theme: "WHO CVD Atlas. 2002. WHO Stroke Atlas. 2002. The Burden of CVD in Asia: Stroke Deaths by Country, 2002 2."— Presentation transcript:

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2 WHO CVD Atlas WHO Stroke Atlas The Burden of CVD in Asia: Stroke Deaths by Country,

3 WHO CVD Atlas WHO Stroke Atlas The Burden of CVD in Asia: CHD Deaths by Country,

4 Age-Standardized Stroke and CHD Death Rates by Country, 2002 Ueshima H et al. Circulation. 2008;118:

5 Stroke Type in China Sino-MONICA-Beijing project indicate from 1984 to 2004 – the incidence of hemorrhagic stroke declined by 1.7% annually – the incidence of ischemic stroke increased by 8.7% annually Stroke subtypes in urban areas ICH = Intracranial hemorrhage, SAH = subarachnoid hemorrhage, undet = undetermined Jiang et al. Stroke. 2006;37: Zhao et al. Stroke. 2008;39: Beijing Shanghai Ischemic ICH SAH Undet 5

6 Projected Stroke and CHD Increase to 2030: Effect of Population Aging and Risk-Factor Changes in China Moran et al. Circ Cardiovasc Qual Outcomes. 2010;3;

7 Burden of Diabetes in Asia Chan JC et al. JAMA. 2009;301: AfricaEMMEEuropeNorth America SACASEAWestern Pacific AfricaEMMEEuropeNorth America SACASEAWestern Pacific No. with Diabetes Age group, y No. With Diabetes (millions) 600, , , , , ,000 0 Deaths Attributable to Diabetes, Ages Years Men Women No. of Deaths 7

8 Asia Eastern Europe Established Market Economies Major Cerebrovascular Events P < Cumulative Incidence High Cumulative Incidence of Stroke in Asians With Type 2 Diabetes 8 Clarke PM et al. PLoS Med. 7:e doi: /journal.pmed

9 Increase in Age-Standardized Mean Total Cholesterol Levels in East and Southeast Asia and Pacific Region, Farzadfar et al. Lancet. 2011;377: Southeast Asia: Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Maldives, Myanmar, Philippines, Sri Lanka, Thailand, Timor-Leste, Vietnam East Asia: China, Hong Kong (China), Macau (China), Democratic People’s Republic of Korea, Taiwan, Brunei, Darussalam, Japan, Republic of Korea, Singapore, islands of Oceania 9 Men Women

10 Relationship of CHD Mortality With Usual Total Cholesterol by Age: Prospective Studies Collaboration Age at risk 1 mmol/L  total cholesterol 15%  risk 18%  risk 28%  risk 42%  risk 56%  risk Usual total cholesterol (mmol/L) 4·05·06·07·08·0 0· Hazard ratio (floating absolute risks & 95% CI) 900,000 participants from 61 prospective cohort studies (10% from Japan or China) Prospective Studies Collaboration. Lancet. 2007;370: Overall, 1 mmol/L lower total cholesterol  risk by 1/3 10

11 Association of Stroke Mortality With Usual Total Cholesterol by Age: Prospective Studies Collaboration Prospective Studies Collaboration. Lancet. 2007;370: Usual Total Cholesterol, mmol/L ( ) ( ) ( ) ( ) Age at risk: 4·05·06·07·08· Hazard Ratio (floating absolute risks & 95% CI) HR (95% CI) per 1 mmol/L  11

12 Relationship of Cholesterol Level to CV Mortality in Asians: Asia Pacific Cohort Studies Collaboration 29 cohorts 352,033 individuals – 283,544 Asians – 68,489 Australians/New Zealanders 2 million person-years of follow-up 4841 cardiovascular deaths 12 Zhang X et al. Int J Epidemiol. 2003;32:

13 Association Between Usual Cholesterol Level and CHD Death or Nonfatal MI: Asia Pacific Cohort Studies Collaboration Zhang X et al. Int J Epidemiol. 2003;32: Mean usual total cholesterol (mmol/L) MI = myocardial infarction CHD death in the entire study population Hazard ratio 1 mmol/L lower total cholesterol associated with 35% (26%-44%) lower coronary death CHD death or nonfatal MI in the entire study population 13

14 Association Between Usual Cholesterol Level and Stroke: Asia Pacific Cohort Studies Collaboration Mean usual total cholesterol (mmol/L) Zhang X et al. Int J Epidemiol. 2003;32: Fatal stroke in the entire study population Fatal or nonfatal stroke in the entire study population Hazard ratio 14

15 Association Between Usual Cholesterol Level and Ischemic Stroke: Asia Pacific Cohort Studies Collaboration Mean usual total cholesterol (mmol/L) Zhang X et al. Int J Epidemiol. 2003;32: Analyses are stratified by study and sex and adjusted for age at risk, systolic blood pressure (BP), and smoking. Fatal or nonfatal ischemic stroke Fatal ischemic stroke Hazard ratio 1 mmol/L lower total cholesterol associated with 25% (13%-40%) lower ischemic stroke (fatal or nonfatal) 15

16 Association Between Usual Cholesterol Level and Hemorrhagic Stroke: Asia Pacific Cohort Studies Collaboration Analyses are stratified by study and sex, and adjusted for age at risk, systolic BP, and smoking. Zhang X et al. Int J Epidemiol. 2003;32: Fatal hemorrhagic stroke Mean usual total cholesterol (mmol/L) Hazard ratio Fatal or nonfatal hemorrhagic stroke 1 mmol/L lower total cholesterol associated with 20% (8%-30%) higher hemorrhagic stroke (fatal) 16

17 Summary Stroke is the leading cause of death in the East Asia and Western Pacific region CV risk factors and CV mortality are projected to increase Increased cholesterol levels are a major cause of the high risk for ischemic stroke in Asian Pacific countries 17


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