Cardiovascular Diseases in Family Medicine János Nemcsik MD, PhD
Why is prevention of CV diseases needed? •
Atherosclerotic CVD, especially CHD, remains the leading cause of premature death worldwide.
•
CVD affects both men and women; of all deaths that occur before the age of 75 years in Europe, 42% are due to CVD in women and 38% in men.
•
CVD mortality is changing, with declining age-standardized rates in most European countries, which remain high in Eastern Europe.
•
Prevention works: 50% of the reductions seen in CHD mortality is related to changes in risk factors, and 40% to improved treatments.
specialist of internal medicine, family medicine, occupational medicine
Department of Family Medicine Semmelweis University Budapest NGNB Med. Medical Services Ltd. 1148 Budapest, Örs vezér tér 23. Email:
[email protected]
CV Mortality in Europe
Mortality: Cardiovascular diseases and diabetes, deaths per 100,000
Man Woman Man Woman
44
38
42
31
45
31
45
37
38
34
46
35
37
29
44
34
32
29
24
21
40
39
29
30
45
57
(%)
http://apps.who.int/gho/data/?vid=2510 male female Hungary 416 241 USA 190 122 Spain 140 86 France 128 69 Russia 772 414 Mali 419 393
AHA. 1997 Heart and Stroke Statistical Update* KSH 1999
Risk Factors for Cardiovascular Disease Modifiable Modifiable
Non-modifiable Non-modifiable
–– Smoking Smoking
– – Personal Personal history history of of CHD CHD
–– Dyslipidaemia Dyslipidaemia
– – Family Family history history of of CHD CHD
•• raised raised LDL-C LDL-C •• low low HDL-C HDL-C •• raised raised triglycerides triglycerides –– Raised Raised blood pressure
– – Age Age – – Gender Gender
–– Diabetes Diabetes mellitus mellitus –– Obesity Obesity –– Dietary Dietary factors factors –– Thrombogenic Thrombogenic factors factors –– Lack Lack of of exercise exercise –– Excess Excess alcohol alcohol consumption consumption Adapted from: Pyö Pyörälä K et al. Eur Heart J 1994; 1994;15 15:1300 :1300– –1331.
1
Levels of Risk Risk Associated with Smoking, Hypertension and Hypercholesterolaemia
Principles of effective communication to facilitate behavioural change
Hypertension Hypertension (SBP (SBP >195 >195 mmHg) mmHg)
x3 x3 x9 x9
x4.5 x4.5
x16 x16 x1.6 x1.6 Smoking Smoking
x6
x4 x4 Serum Serum cholesterol cholesterol level level (>8.5 (>8.5 mmol/L, mmol/L, 330 330 mg/dL) mg/dL) Eur Heart J. 2012 Jul;33(13):1635-701.
Adapted Adapted from from Poulter Poulter N N et et al., al., 1993 1993
Preventive medicine European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) Eur Heart J. 2012 Jul;33(13):1635-701. can be downloaded free
How to stay healthy? • No use of tobacco. • Adequate physical activity: at least 30 min five times a week. • Healthy eating habits. • No overweight. • Blood pressure below 140/90 mmHg. • Blood cholesterol below 5 mmol/L (190 mg/dL). • Normal glucose metabolism. • Avoidance of excessive stress.
2
Psychosocial risk factors
SCORE: 10-year risk of fatal CV disease in high-risk population
Contribute both to the risk of developing CVD and the worsening of clinical course and prognosis of CVD: -low socio-economic status -lack of social support -stress at work and in family life -depression, anxiety, hostility -type D personality
SCORE: 10-year risk of fatal CV disease in low-risk population
Calculate score at: www.hearscore.org
Risk stratification: very high CV risk 1. Coronary artery disease, cerebrovascular disease or peripheral artery disease 2. Diabetes mellitus: type 1 /2 with one or more CV risk factors and/or target organ damage (micro/macroalbuminuria) 3. Chronic renal insufficiency (GFR8.0 mmol/l -blood pressure >180/110 mmHg -DM without target organ damage -glomerular filtration rate 30-59 ml/min/1.73 m2 -score of ≥ 5% and < 10% of 10-year risk of fatal CVD
3
Risk stratification: high CV risk At least one, severe risk factor: -Subclinical atherosclerosis: - presence of a calcified plaque -Familiarity- early CV episode: < 55 /< 65 year -Left ventricular hypertrophy -Metabolic syndrome
Hypertension Management
Risk stratification: high CV risk Global cardiometabolic risk factors: ≥ 3 traditional risk factors (smoking, abdominal obesity, hypertension, hypercholesterinemia and/or high LDL, low HDL) and ≥ 1 „residual” risk factor (IFG/IGT, elevated Tg, elevated uric acid, sleep apnoe) is present, even if the total risk score is
