1. Khawar Kazmi

2. The Evil WHO report 2003

3. DEATHS FROM CORONARY HEART DISEASE WHO Atlas of Heart Disease & Stroke 2004

5. Lower consumption of energy rich foods and fats, higher consumption of complex carbohydrates Increased expenditure of energy (high levels of physical activity during daily usual activities Greater social integration due to maintenance of traditional lifestyles Proximal Determination of Behavior Level of economic development Education Income distribution Social organization Global Influences (e.g trade promotion and cultural diffusion Interactions of environmental factors and tobacco use with genetic predisposition Higher consumption of energy rich foods, refined carbohydrates, processed foods, salt and fats Lower energy expenditure due to low levels of physical activity Greater social isolation, psychosocial stress Crowded housing Programming Factors: e.g. Intrauterine environment Predisposing risk factors: e.g. Obesity in childhood & early adulthood Classical risk factors: e.g. Cholesterol Blood Pressure Glucose Psychosocial factors Susceptibility of plaques to rupture Knowledge of prevention Access to care Coronary Heart Disease Ischemic strokes Peripheral arterial Disease Hypertensive Heart Disease Hemorrhagic strokes Chronic renal failure Vascular dementia(?) Development of Risk Factors Modifying Influences Clinical Events (+) (-) Rural Lifestyle Urban Lifestyle Epidemiological Transition CIRCULATION 2001;104:2855-64

6. Cardiovascular Diseases Axis ( Axis of Evil) CVD EXPRESSION BEHAVIOURS Diet, Physical Activity & Tobacco Use Obesity and Tobacco

7. Risk Factors start in Childhood and Youth Worldwide 22 million children under five years are obese and many more are overweight. 14% of 13 to 15 year old students around the world currently smoke cigarettes. In USA physical activity decreases precipitously esp. in girls beginning around 10 years. WHO Atlas of Heart Disease & Stroke 2004

8. Children, Adolescents and Obesity Obese Children are at approximately a 3 – fold higher risk for HTN than non – obese children. The risk of developing type 2 DM is clearly linked to the increasing prevalence of obesity, with increasing cases of type 2 DM in children. Cohort studies show that obesity can be tracked from childhood to adulthood, where morbidity is very evident. Obesity in adolescents is directly associated with increased morbidity and mortality in adult life independent of adult body weight. Unhealthy diet is one of the leading causes of CVD. This unhealthy life style is more and more adopted at early age. WHF fact sheet 2003, BMJ 2001;322:1094-5

9. Aga Khan University CARDIOLOGY PROGRAM SMART HEART PROGRAM First institution based CVD prevention program Evolving into a comprehensive multifaceted program including secondary, primary and primordial prevention www.akunet.org/smartheart

10. ACME HEALTH HABITS Research capacity building Aga Khan University SMART HEART PROGRAM Primary & Primordial Prevention - A Continued Medical Education Program - Healthy Eating, physical Activity and Living with no Tobacco: A family Health initiative - Health Awareness By Imparting lifestyle Training to School Children

11. Aga Khan University SMART HEART PROGRAM HABITS (Health Awareness By Imparting lifestyle Training to School children ) Objective Stimulate thinking process Healthy Behaviors Empowerment Through Knowledge Plan Data Collection Intervention through a Teaching module

12. HABITS - Pilot September to December 2005

15. Total # of grade VI Children: 105 (CAS:78, AMI: 27) # consented for the study: 101 Mean Age: 11.4 yrs. Boys to Girls ratio: 1.2 (57/48) HABITS – Pilot September – November 2005 Preliminary Results

16. HABITS - Pilot BMI(98)Waist(98) (< 71 cm)

17. There was significant association between days of physical activity and BMI(P=0.003) as well as between duration of sedentary activity and waist circumference (p=0.001) HABITS - Pilot 98.9% had normal blood pressure of < 120/80 59% indulged in daily physical activities, 33.3% were active less than 6 days a week and 2.9% did not participate in any physical activity 22.9% spent more than 2 hrs and 30.5% 1-2 hrs in sedentary activities apart from studying Blood Pressure & Physical Activity

18. HABITS - Pilot 21.9% had tried cigarettes and 30.5% were exposed to passive smoking 40% responded positively on the use of Shisha. Most were unaware of it being a form of tobacco 2.9% were using “Chalia” on daily basis with 4.8% consuming it on weekly basis Tobacco and Diet 60% reported eating out on weekly basis 16.2% were snacking more than twice daily 31% had soft drinks every day 12.4% used vegetables every day

19. HABITS - Pilot Spot Blood Test Results (92)(87)

20. Aga Khan University SMART HEART PROGRAM HABITS ( Health Awareness By Imparting lifestyle Training to School children )

21. CVD poses a huge challenge with Obesity being the largest emerging global epidemic. Yes, it is possible to nip the evil in the bud but to achieve that All health care providers including public and private institutions, NGOs and professional bodies need to join hands and work together. There is an imminent need for leadership to create a common platform and to provide direction.