1. Global burden of Cardiovascular Diseases
Andrew M Tonkin, MD

2. PROJECTED GLOBAL BURDEN OF CVD
Global CVD
B. Neal et al. Eur. Heart J 2002

3. GLOBAL BURDEN OF DISEASE: COMMON CVD RISK FACTORS
Risk factor Exposure Variable Theoretical Contribution Minimum to GBD
High BP Usual SBP 115mmHg (SD6) 4.4%
Tobacco Smoking impact ratio; No use 4.1% oral tobacco use
High cholesterol Usual TC 3.8mmol/L (SD0.6) 2.8%
High BMI BMI 21kg/m2 (SD1) 2.3%
Low fruit and Intake daily 600g (SD50) 1.8% veg. Intake
Inactivity Categories >2.5h/week, mod. 1.3%
M. Ezzati et al. Lancet 2003;362:271-80
Global CVD

4. EPIDEMIOLOGIC TRANSTION
Age
Pestilence and famine
Receding pandemics
Degenerative “man-made” diseases
Delayed degenerative diseases
Predominant CVD
Rheumatic
heart disease
Hypertension-
related
diseases
CHD, stroke, diabetes at young ages
CHD, stroke at older ages
% of deaths due to CVD
5-10
10-35
35-65
<50
Current examples
Sub-Saharan
Africa
Rural China
Urban India
North America, Australasia
Global CVD
From S Yusuf et al. Circulation 2001;104:

6. DRIVERS OF THE CVD EPIDEMIC
Urbanisation
Global trade and marketing developments
Tobacco industry
Physical inactivity
Tobacco use, inappropriate diet and physical inactivity (expressed through unfavourable lipid profiles, overweight and raised BP) explain at least 75% of new CHD cases
Global CVD

7. CHD TRENDS IN BEIJING 1984 TO 1999
Critchley J et al. Circulation 2004;110:
Global CVD

8. CURRENT AND PROJECTED POPULATION PERCENTAGES FOR 2000, 2020 AND 2040
S. Leeder 2003

9. CVD IN AUSTRALIA: 11% TOTAL HEALTH SPENDING

10. USE OF MEDICATION IN STROKE AND CHD%
WHO PREMISE project, 2002
Global CVD

12. ANTIHYPERTENSIVE DRUGS
Available
Affordable
Locally manufactured
57%
67%
30%
48%
45%
91%
89%
74%
64% 7%
83%
46%
100%
96%
92%
88%
71%
70%
Africa
Americas
Eastern
Europe
South-East
Western
Mediterranean
Asia
Pacific
Percentage of countries in each region where drugs are available,
affordable to low income groups, or manufactured locally
WHO 2001
Global CVD

13. POLYPILL: EFFECTS AFTER TWO YEARS, AGE 55-64
RRR (95% CI) (%)
Factor Agent Reduction IHD Stroke
LDL-C Statin 1.8 mmol/L 61 (51,71) 17 (9-25)
BP Three agents, 11 mmHg 46 (39-68) 63 (55-70) half dose DBP
Platelet funct. ASA (75mg) Not quant. 32 (23-40) 16 (7-25)
Homocysteine Folic acid, 3 μmol/L 16 (11-20) 24 (15-33) (0.5mg)
Combined All 88 (84-91) 80 (71-87)
BMJ, 28 June 2003
Polypill

16. FIVE-YEAR HARD CHD EVENTS Deciles based on Framingham function
HHP Japanese American Men
Deciles based on Framingham function
Absolute risk
D'Agostino, Sr, R. B. et al. JAMA 2001;286:

17. FRAMEWORK CONVENTION ON TOBACCO CONTROL
Key provisions encourage countries to:
Enact comprehensive bans on tobacco advertising, promotion and sponsorship;
Obligate placement of rotating health warnings on tobacco packaging that cover at least 30% (but ideally ≥ 50%) of principal display areas;
Ban use of deceptive terms such as “light” and “mild”;
Protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places;
Combat smuggling, including placing of final destination markings on packs;
Increase tobacco taxes
Tobacco

18. PUBLIC HEALTH POLICY Comprehensive health programs led by primary care
Appropriate balance between primary and secondary prevention
Particularly population approaches (Only 5% in wealthy countries at ideal cholesterol, BP, weight)
Also high-risk approaches to primary prevention (although latter may increase inequalities)
Acute management and secondary prevention
Surveillance and monitoring
Global CVD

19. NCD PREVENTION AND CONTROL
94%
88%
88%
76%
65%
39%
Percentage of countries with integration of components of NCD prevention
and control programmes in primary health care
WHO 2001
Global CVD

20. PRIORITIES FOR DEVELOPING COUNTRIES
Control strategies, initially based on extrapolation from knowledge from other population, e.g. tobacco control: whole population initiatives
Cross-sectional surveys (ecological comparisons), case-control studies and prospective longitudinal studies for incidence data
Workforce training and capacity building
Low cost, high yield interventions
CHD prevention

21. PRIORITIES FOR DEVELOPED COUNTRIES
Prevention including implementation of proven strategies
Chronic disease strategies
Health inequalities
Primary care strategies
Strategies to combat overweight
CHD prevention