Heart Diseases :

Burden and Risk Management

Prof. Rishi Sethi

MD;DM;FACC;FESC;FSCAI;FAPSIC;MAMS

Department of Cardiology
King Georges Medical University.
Lucknow.India.

Inspired by:-

Global Burden of
Cardiovascular Disease

Global Mortality from Coronary

Artery Disease

Relative Mortality Rates

Economic Burden of
Cardiovascular Diseases

 Four non-communicable disorders (NCD) together

contribute to
59% of global mortality (31.7 million deaths) and
43% of the global burden of disease in.
The Cardiovascular diseases alone accounts for 34%
of all deaths in women and 28% in men.
The World Health Report estimates that in 85% of the
CV burden arose from the low and middle income
countries.
The World Health Report. Making a Difference. Geneva: World
Health Organization; 1999.

Cardiovascular diseases
Risk factors
&
prevention

In Terms of Attributable
Deaths
Raised blood pressure (13 per cent of global
deaths is attributed),
Tobacco use (9 per cent),
Raised blood glucose (6 per cent),
Physical inactivity (6 per cent) and
Overweight and obesity (5 per cent).

Global Atlas on Cardiovascular Disease Prevention and Control.

Mendis S, Puska P, Norrving B editors. World Health Organization (in
collaboration with the World Heart Federation and World Stroke
Organization), Geneva 2011.

Prominent Risk Factors for CV

Diseases

Smoking
Hypertension
Dyslipidemia
Metabolic Syndrome
Mental Stress

Modifiable risk factors

Hypertension (high blood

pressure)
Globally, nearly one
billion people have
hypertension.
The silent killer"
because it often has
no warning signs or
symptoms.
People with
hypertension are
more likely to
develop
complications of
diabetes.

World Health Organization. Regional Office for Southeast Asia.

Hypertension fact sheet

 Encourage an optimal blood pressure

of less then 120/80 mm Hg through
lifestyle approaches.
Pharmacologic therapy is indicated
when blood pressure is > 140/90 mm
Hg

Tobacco use
Cause nearly 10 per cent of all CVD.
Higher risk in female smokers, young men, and
heavy smokers.
Currently about 1 billion smokers in the world
today.
Within two years of quitting, the risk of coronary
heart disease is substantially reduced, and within
15 years the risk of CVD returns to that of a nonsmoker

Teo KK, Ounpuu S, Hawken S, et al. INTERHEART Study

Investigators. Tobacco use and risk of myocardial infarction in 52
countries in the INTERHEART study: a case-control study. Lancet.
2006;368(9536):647658.

HOW SMOKING HARMS THE

CARDIOVASCULAR SYSTEM
Chemicals in cigarette smoke cause the cells
that line blood vessels to become swollen and
inflamed.
This can narrow the blood vessels and can lead
to many cardiovascular conditions
Atherosclerosis
Coronary Heart Disease
Stroke
Peripheral Arterial Disease (PAD)
Abdominal Aortic Aneurysm

"Poor man's risk factor": correlation between high

sensitivity C-reactive protein and socio-economic class
in patients of acute coronary syndrome.
Sethi R1,Puri A,Makhija A,Singhal A,Ahuja A,Mukerjee
S,Dwivedi SK,Narain VS,Saran RK,Puri VK.
Indian heart Journal 01/2008;60(3):205-9

Abstract
OBJECTIVE:
Inflammation has been proposed as one of the factors responsible for the development of coronary artery
disease (CAD) and high sensitivity C-reactive protein (hs CRP) at present is the strongest marker of
inflammation. We did a study to assess the correlation of hs-CRP with socio-economic status (SES) in patients of
CAD presenting as acute coronary syndrome (ACS).
METHODS:
Baseline hs-CRP of 490 patients of ACS was estimated by turbidimetric immunoassay. Patients were stratified
by levels of hs-CRP into low (<1 mg/L); intermediate (1-3 mg/L) or high (>3 mg/L) groups and in tertiles of 00.39 mg/L, 0.4-1.1 mg/L and >1.1 mg/L, respectively. Classification of patient into upper (21.4%), middle (45.37
percent) and lower (33.3%) SES was based on Kuppuswami Index which includes education, income and
profession. Presence or absence of traditional risk factors for CAD diabetes, hypertension, dyslipidemia and
smoking was recorded in each patient.
RESULTS:
Mean levels of hs-CRP in lower, middle and upper SES were 2.3 +/- 2.1 mg/L, 0.8 +/- 1.7 mg/L and 1.2 +/- 1.5
mg/L, respectively. hs-CRP levels were significantly higher in low SES compared with both upper SES (p =
0.033) and middle SES (p = 0.001). Prevalence of more than one traditional CAD risk factors was seen in
13.5%, 37.5% and 67.67 percent; in patient of lower, middle and upper SES. It was observed that multiple risk
factors had a linear correlation with increasing SES. Of the four traditional risk factors of CAD, smoking was the
only factor which was significantly higher in lower SES (73%) as compared to middle (51.67 percent;) and
upper (39.4%) SES. We found that 62.3%, 20.8% and 26.5% patients of low, middle and upper SES had hs-CRP
values in the highest tertile. Median value of the Framingham risk score in low, middle and upper SES as 11, 14
and 18, respectively. We observed that at each category of Framingham risk, low SES had higher hs-CRP.
CONCLUSION:
We conclude from our study that patient of lower SES have significantly higher levels of hs-CRP despite the
fact that they have lesser traditional risk factors and lower Framingham risk. These findings add credit to our
belief that inflammation may be an important link in the pathophysiology of atherosclerosis and its
complications especially in patients of low SES who do not have traditional risk factors.

QUITTING SMOKING CUTS CVD

RISKS
Even though we dont know exactly which smokers will
develop CVD from smoking, the best thing all smokers
can do for their hearts is to quit.
Smokers who quit start to improve their heart health
and reduce their risk for CVD immediately.
Within a year, the risk of heart attack drops
dramatically, and even people who have already had a
heart attack can cut their risk of having another if they
quit smoking.
Within five years of quitting, smokers lower their risk of
stroke to about that of a person who has never smoked.

 Counseling, nicotine replacement,

and other pharmacotherapy as
indicated in conjunction with a
behavioral program or other formal
smoking cessation programme.

Raised blood glucose

(Diabetes)

CVD accounts for about 60 per cent of all

mortality in people with diabetes.
Diabetics also have a poorer prognosis after
cardiovascular events compared to people
without diabetes.
Lack of early detection and care for diabetes
results in severe complications, including heart
attacks.

Global Atlas on Cardiovascular Disease Prevention and Control. Mendis

S, Puska P, Norrving B editors. World Health Organization (in
collaboration with the World Heart Federation and World Stroke
Organization), Geneva 2011.

 Primary care access to measurement of

blood glucose and cardiovascular risk
assessment as well as essential medicines
including insulin can improve health
outcomes of people with diabetes.
Target HbA1C<7%, if this can be
accomplished without significant
hypoglycemia

Physical inactivity
Defined as less than five times 30 minutes of
moderate activity per week, or less than three
times 20 minutes of vigorous activity per week,
or equivalent.
Approximately 3.2 million deaths and each year
are attributable to insufficient physical activity.
20 to 30 per cent increased risk of all cause
mortality compared to those who are physically
active.
Higher prevalence in high-income countries.

Unhealthy diet
High dietary intakes of
Saturated fat,
Trans-fats and salt, and
Low intake of fruits, vegetables and fish are
linked to cardiovascular risk.

Frequent consumption of high-energy

foods, such as processed foods that
are high in fats and sugars, promotes
obesity compared to low-energy foods.

 WHO recommends a population salt intake of less

than 5 grams/person/day to help the prevention
of CVD.
Elimination of trans-fat and replacement of
saturated with polyunsaturated vegetable oils
lowers coronary heart disease risk
A healthy diet can contribute to a healthy body
weight, a desirable lipid profile and a desirable
blood pressure.

Cholesterol/lipids
Globally, one third of ischaemic heart disease is
attributable to high cholesterol.
prevalence of raised total cholesterol among
adults is around 9.7 percent.
Global prevalence of raised total cholesterol
among adults was 39 percent.

We are Different..

Indian Heart J. 2002;54:59-66

Lancet 2000;356:279-84

Evidence
Asian Indian living in USA *
54% men had HDL <40mg%.

People of Indian origin with TG >150mg%.**

Males - 43%.
Females 24%

*Indian Heart J. 1996;48:343-353

**Indian Heart J. 2000;52:407-410

Compared to Western Population

TG

JAPI 2004;52:137-142

L
D
H

JAPI 2004;52:137-142

The prevalence of low HDL

Asian Indians -62.8% of the nondiabetic and 67.4% of
the diabetic).
Central and northern Europeans (20.3 and 37.3%)
Japanese (25.7 and 34.1%)
Qingdao Chinese (15.7 and 17.0%)
Clin Endocrinol Meta 2010;95(4):17931801

Studies Conducted in our own State -UP

UPCSI-LIPID Study
Participating Centers:

SGPGIMS, Lucknow- Prof. Nakul Sinha, Dr. Aditya Kapoor, Dr. Satyendra Tewari, Dr.
Sudeep Kumar
KGMU, Lucknow- Prof R.K. Saran, Prof. VS Narain
LPS Institute of Cardiology, Kanpur- Prof. RPS Bharadwaj, Prof. RK Bansal
MLN Medical College, Allahabad- Prof. PC Saxena
BHU, Varanasi- Prof. PR Gupta
BRD Medical College, Gorakhpur- Prof. Mukul Mishra
MLB Medical College, Jhansi- Prof. Praveen Jain
Heart Line Hospital, Varanasi- Dr PR Sinha

Young patients (<45 years) with CAD

TG 175.38 mg%
LDL- 112.43 mg%
HDL- 40.92 mg%

Overweight and obesity

Worldwide, at least 2.8 million people die each
year as a result of being overweight or obese.
In 2012, 34 percent of adults over the age of 20
were overweight.
Worldwide, at least 2.8 million people die each
year as a result of being overweight or obese.

The World Health Report. Making a Difference. Geneva: World

Health Organization.

 To achieve optimal health, the median BMI for

adult populations should be in the range of 2123
kg/m2.

Weight loss of as little as 10 lbs reduces blood pressure

Non-modifiable risk factors:

Age
As a person gets older, the heart
undergoes subtle physiologic
changes, even in the absence of
disease.
When a condition like CVD affects the
heart, these age-related changes
may compound the problem or its
treatment.

Gender
A man is at greater risk of heart disease than a
pre-menopausal woman.
Once past the menopause, a womans risk is
similar to a mans.
Risk of stroke, however, is similar for men and
women.

Family history
If a first-degree blood relative has had coronary
heart disease or stroke before the age of 55 years
(for a male relative) or 65 years (for a female
relative), the risk increases.

Thank You