1. University College London
New frontiers in Diabetes management
New frontiers in Diabetes management
Call for action to prevent CV disease & diabetes in Asia: New strategies for intervention
Key-slides prepared and presented at CDMC on April 20, 2013 in Hanoi, Vietnam by
John Deanfield, MD
University College London
London, United Kingdom

2. A fall of 55% since baseline
Death Rates from All Circulatory Disease in England
180
A fall of 55% since baseline
160
140
Target:
40%
minimum reduction
from
120
100
Death / 100,000 population 80 60 40
Immortality
Guaranteed by 2026 20
1993/5
1995/7
1997/9
2001/3
2003/5
2005/7
2007/9
1999/2001
2009/11
2009/11
B/L
Progress
target
Source: ONS (ICD ; ICD10 I00-I99)

3. Evolution of Atherosclerosis
Genetic
Environmental
Clinical Events 20 40 60
Age (yrs)

4. Forecasting Future CVD in USA
900
800
700
600
500
Billions 2008 $
400
300
200
100
Indirect
Direct
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Heidenreich Circ 2011; 123:

5. Coronary Heart Disease Mortality in Beijing 1984-1999
2500
1822 Extra deaths Attributable
to Risk Factor Changes
2000
Cholesterol %
1000
Diabetes %
BMI 4%
Smoking 1%
500
642 fewer deaths by treatments
AMI treatments %
Hypertension treatment %
Secondary prevetion %
Heart failure %
Aspirin for Angina %
Angina: CABG & PTCA %
-500
-1000
1984
1999
Critchley J. Circulation, 2004;110:

6. Potential Impact of Annual 0.5% RF Reduction on CHD Deaths in China:
Cheng BMC Public Health 2009, 9:

7. Potentially Modifiable Risk Factors and MI : INTERHEART Study
15152 Cases Controls in 262 Centres in 52 Countries
9 RFs acounted for 90% of MI in men and 94% in women 3
Odds
Ratio 2 1 DM BP
Stress
Fr/Veg
Smoking
Obesity
Phys Act.
Alcohol 60
ApoB/ApoA1 40
PAR
(%) 20
-20
Yusuf Lancet September

8. Diabetes in China :
Yang NEJM 8 8

9. BMI and Diabetes Prevalence: DECODA Study
Ma Ann. N.Y. Acad. Sci (2013) 64–91

10. Diabetes in Asia: Age 20-79yrs
Death from Diabetes
Chan JAMA 2009; 301:

11. Diabetes in Asia: Age 20-79yrs
Death from Diabetes
Obesity • Beta cell function
Visceral fat • Developmental factors
Diet • Genetic susceptability
Smoking • Other factors eg. Thalassaemia
Chan JAMA 2009; 301:

12. Mortality from NCDs in Asian Women
Rajadurai, J. et al. Nat. Rev. Cardiol. 9, 464–477 (2012)

13. Incremental Benefit of Intensive Lowering of LDL and Blood Pressure
0.8
P<0.001 for trend
0.6
0.4
Change Percent Atheroma Volume
0.2
0.0
LDL <70
SBP <120
LDL <70
SBP >120
LDL >70
SBP <120
LDL >70
SBP >120
Chhatriwalla, Nicholls J Amer Coll Cardiol 2009

14. BMI and Hypertension: Johns Hopkins Precursor Study
508 of 1337 subjects developed hypertension over 46 years
Shihab Circulation. 2012; 126:

15. Cost effectiveness of interventions for CVD, DM, and tobacco use
Ortegón BMJ 2012; 344

16. Impact of Metabolic Syndrome in Youth on cIMT
Magnussen J Am Coll Cardiol 2012; 60: 1631–9

17. Potential Benefit of CV RF treatment in Obesity
Excess Total CHD Events
Excess Deaths from CHD
100000
100000
Average projection
Treatment for DBP and LDL
Treatment for DBP, LDL and HDL
10000
10000
1000
1000
No. of excess events
No. of excess events
100
100 10
Average projection
Treatment for DBP and LDL
Treatment for DBP, LDL and HDL 10 1 1
2021
2023
2025
2027
2029
2031
2033
2035
2021
2023
2025
2027
2029
2031
2033
2035
Year
Year
Bibbins-Domingo NEJM 2007; 357:

18. CV disease is preventable
“Life-long Rx likely to be cost-effective and often cost saving”
Circulation 2011;124:

19. CV Risk Management Strategies
Lifetime approach to CV management is key to tackling the increasing population risk
Emerging obesity and resulting diabetes is a particular issue for Asia
Developing countries need to increase national capacity, effective treatments and improve primary prevention