1. Coronary Heart Disease Prevalence DR. MOHAMMED O. AL-RUKBAN Assistant Professor Department of Family and Community Medicine College of Medicine, King Saud University

2. What issues do you hope this course will address?What issues do you hope this course will address? Expectations

3. The Heart

4. Heart Attach

6. Leading Causes of Death for All Males and Females United States: 2000 A Total CVD BCancer CChronic Lower Respiratory Diseases D Accidents EDiabetes Mellitus FAlzheimer’s Disease GInfluenza and Pneumonia

7. P 8 Percentage Breakdown of Deaths from Cardiovascular Diseases United States: 2000

8. Deaths From Diseases of the Heart United States: 1979-2000

9. ISD Scotland http://www.isdscotland.org/chdstroke Coronary heart disease incidence by sex, crude rates per 100,000, Scotland, 1994-2003

10. ISD Scotland (2004)

11. World Health Organization (2004)

12. Office for National Statistics (2005) www.heartstats.org

13. World Health Organization (2004)

16. 19801990198520001995 Coronary Heart Disease Coronary Heart Disease Death Rates, 1980- 2000 Age-adjusted rate per 100,000

17. 19801990198520001995 Coronary Heart Disease CHD 2010 target Coronary Heart Disease and Stroke Death Rates, 1980-2000 Age-adjusted rate per 100,000

18. Coronary Heart Disease Death Rates, 2000 Total Black, Not Hispanic Asian or Pacific Islander American Indian or Alaska Native White, Not Hispanic Male Female 2010 target Age-adjusted rate per 100,000

19. Coronary Heart Disease Death Rates, 2000 Relative Risk Black, Not Hispanic Hispanic Asian or Pacific Islander Pacific Islander American Indian or Alaska Native White, Not Hispanic Male Female Relative risk compared to the total population Greater Risk Less Risk

20. CVD Risk Factors 2010 target BaselineMost recent Age-adjusted percent ObesityCurrent smoker Moderate activity Adults OverweightCurrent smoker Moderate activity Adolescents 0 10 40 20 30 50 Percent

21. Serum Cholesterol Levels > 240 mg/dL, Adults 20 and Older Total Mexican American Black, Not Hispanic White, Not Hispanic 2010 target Age-adjusted percent FemaleMaleFemaleMaleFemaleMaleFemaleMale 1988-941999-2000

22. Hypertension Prevalence in Adults, 1999-2000 Total Black, Not Hispanic Mexican American White, Not Hispanic Age-adjusted percent High school graduate Less than high school At least some college 2010 target 20 years and older25 years and older

23. 21% 29% 724 883 Proportion due to diabetes Heart Disease Deaths (thousands) Projected Increase in Total Heart Disease Deaths Related to Increased Diabetes Prevalence

24. Total Black, Not HispanicWhite, Not Hispanic Mexican American Obesity in Adults 20 and Older 1988-941999-2000 2010 target Age-adjusted percent

25. Cardiovascular Disease Mortality Trends United States: 1979-2000

26. Age-Adjusted Death Rates for Coronary Heart Disease, Stroke, Lung and Breast Cancer United States: 2000

27. P 13 Prevalence of Coronary Heart Disease by Age and Sex United States: 1988-94

28. P 8 Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex United States: 1988-94

29. P 13 Annual Rate of First Heart Attacks by Age, Sex and Race United States: 1987-94

30. P 39 Trends in Cardiovascular Operations and Procedures United States: 1979-2000

31. Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke United States: 2003

32. What about Saudi Arabia?

33. Coronary Heart disease in SA (944), out of 17232 were diagnosed to have CAD (5.5%).(944), out of 17232 were diagnosed to have CAD (5.5%). 4.9% of the subjects has reported anginal chest pain and 0.4% gave history consistent with previous MI. 4.9% of the subjects has reported anginal chest pain and 0.4% gave history consistent with previous MI. Male subjects have reported significantly more cases of MI than female subjects (p=0.027).Male subjects have reported significantly more cases of MI than female subjects (p=0.027). The prevalence of MI diagnosed by ECG was 1.1%.The prevalence of MI diagnosed by ECG was 1.1%. The prevalence of CAD in males and females were 6.6% and 4.4%. The prevalence of CAD in males and females were 6.6% and 4.4%. The prevalence was 6.2% in urban areas, and 4% in rural areas.The prevalence was 6.2% in urban areas, and 4% in rural areas. The prevalence was in increasing order from youngest to eldest groups.The prevalence was in increasing order from youngest to eldest groups. The body mass index (BMI) of patient with CAD had higher values than patients without CAD.The body mass index (BMI) of patient with CAD had higher values than patients without CAD. Patients with CAD showed wider waist circumference than patients without CAD.Patients with CAD showed wider waist circumference than patients without CAD.

34. Coronary Heart disease in SA Systolic and diastolic blood pressures (BP) were significantly higher in patients with CAD than without those of CAD.Systolic and diastolic blood pressures (BP) were significantly higher in patients with CAD than without those of CAD. The percentage of smokers and ex-smokers were significantly higher in subjects with CAD category than the subjects without CAD.The percentage of smokers and ex-smokers were significantly higher in subjects with CAD category than the subjects without CAD. Mean fasting blood sugar and serum TG level were significantly higher in subjects with CAD than without CAD.Mean fasting blood sugar and serum TG level were significantly higher in subjects with CAD than without CAD. Mean TC level was also significantly higher in subjects with CAD.Mean TC level was also significantly higher in subjects with CAD. Mean high density lipoprotein-cholesterol (HDL-C) values were statistically lower in subjects with CAD as compared to subject without CAD.Mean high density lipoprotein-cholesterol (HDL-C) values were statistically lower in subjects with CAD as compared to subject without CAD. Mean low-density lipoprotein (LDL-C) values were almost the same in both with CAD and without CAD groups.Mean low-density lipoprotein (LDL-C) values were almost the same in both with CAD and without CAD groups.

35. MI in Young population Approximately 4% of patients with myocardial infarction are <40 years old.Approximately 4% of patients with myocardial infarction are <40 years old. The incidence of CAD increases with age.The incidence of CAD increases with age. There was a total number of 130 patients, with male to female ratio of 4:1.There was a total number of 130 patients, with male to female ratio of 4:1. Mean age for males was 37.2 years and for females was 35.6 years.Mean age for males was 37.2 years and for females was 35.6 years. Cigarette smoking was present in 94% of males and 69% of females.Cigarette smoking was present in 94% of males and 69% of females. A positive family history was present in 77% of males and 73% of females.A positive family history was present in 77% of males and 73% of females. Hypertension was found in 11.5% of males, but none of the females.Hypertension was found in 11.5% of males, but none of the females.

36. MI in Young population Diabetes mellitus was found in 4.8% of males and 7.7% of females.Diabetes mellitus was found in 4.8% of males and 7.7% of females. Mean cholesterol level was 6.9 mmol in males and 6.7 mmol in females.Mean cholesterol level was 6.9 mmol in males and 6.7 mmol in females. Mean triglyceride level was 2.7 mmol in males and 2.8 mmol in females.Mean triglyceride level was 2.7 mmol in males and 2.8 mmol in females. Coronary angiograms revealed left anterior descending coronary artery (LAD) involvement in 60 male patients and in 14 female.Coronary angiograms revealed left anterior descending coronary artery (LAD) involvement in 60 male patients and in 14 female. The right coronary artery (RCA) was involved in 30 males and 4 females.The right coronary artery (RCA) was involved in 30 males and 4 females. Combined LAD and RCA involvement was found in 10 males and 2 females.Combined LAD and RCA involvement was found in 10 males and 2 females.