NEW RISK FACTORS FOR HEART DISEASE
January 2005
Peter King, MD, FACP, FACC Director, Hong Kong Heart Centre Adventist Health Hong Kong
A GLOBAL SNAPSHOT OF HEART DISEASE 9 9 9 9 9
Heart disease and stroke no longer disease of old men in developed countries Disease of women, young adults, even children Leading cause of all death in all developed countries and most developing countries 17 million deaths due to heart disease in 2003; 1/3 of all deaths in the world 75% deaths from heart disease in poor regions; major burden of communicable disease
HEART DISEASE IS NEW KILLER
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Responsible for 45% of all deaths in 2002 Global epidemic - no single continent, race, civilization spared Same risk factors for all
Heart Disease is More Than a Health Problem
Major financial implications for governments, businesses and individuals Health care costs for smoking-related illnesses US$200 billion per year globally 4-5% health budgets spent on diabetes-related illnesses US$24 billion in health care costs in 1995 directly related to physical inactivity in the USA Tobacco epidemic linked with smuggling, big businesses and politics Safe, effective, affordable medications require action from government and pharmaceutical industry
What have these 4 men in common?
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They are all prominent men They all suffered and were treated for a heart condition
INCREASE DEMAND FOR HEART CARE
• Due to “ baby boomers” reaching prevalent age • 1 out of 2 men require care for heart disease in lifetime • 1 out of 3 women require care for heart disease in lifetime
ASIA FACING ALARMING RISE IN HEART DISEASE ¾ ¾ ¾ ¾
Major threat to Asia countries Number of Asians die from heart disease greater than Western world Risk factors in Asian same as in Caucasian population Risk factors similar in men/women
“WESTERNIZATION” OF DIET & LIFESTYLE IN ASIA
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1 in 5 adults diabetes
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High cholesterol common in urban areas
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Hypertension common in urban areas
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Smoking rates highest in Asian men
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Obesity common in urban areas
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Physical labor switched to sedentary work
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Diet high in fats, meats, sugar
HIGHER RISK FOR HEART DISEASE IN ASIA THEN THE WEST
¾ Predominantly young population in Asia ¾ Diabetes-related risk of heart disease 4 times greater in younger Asian ¾ Younger smokers twice as likely to die from heart disease as nonsmokers ¾ Victims in the prime of lives, with high social and economic loss ¾ Prevention a priority for Asian countries
HEART DISEASE IN CHINA FACTS & FIGURES
Mortality rate increase from 86.2 per 100,000 in 1957 to 214.3 per 100,000 in 1990 60 million people with hypertension 61% of adult males and 7 % females smoke cigarettes 35% men and 40% women in Beijing overweight 1.5 million stroke deaths each year • 1.3 million new stroke patients each year Heart disease claims 2.5 million lives each year
Major Risk Factors for Heart Disease
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High blood pressure High cholesterol Smoking Diabetes Obesity Physical inactivity Unhealthy diet
Risk Factors for Heart Disease
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Begin in youth, linked to urbanization and globalization Encouraged by influence of mass advertising and social pressure Can be prevented or controlled, most people with risk factors not treated or inadequately treated
Obesity
NEW RISK FACTORS FOR HEART DISEASE
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C-Reactive Protein Lipoprotein (a) Homocysteine Kidney Disease Infection ? Lack of Antioxidant ?
NEW RISK FACTORS FOR HEART DISEASE C-Reactive Protein (CRP) z z z z
Inflammation plays a role in atherosclerosis Substance produced by the liver in response to inflammation Blood level related to likelihood of heart attack, stroke and peripheral vascular disease Assays help guide prevention therapy
NEW RISK FACTORS FOR HEART DISEASE C-Reactive Protein (CRP) z z z
Average of 2 separate values, obtained 2 weeks apart Guide preventive therapy, statin and aspirin Twice as effective as cholesterol screening in predicting a heart attack
Low risk Moderate risk High risk
< 1.0 mg / dl 1.0 – 3.0 mg / dl > 3.0 mg / dl
NEW RISK FACTORS FOR HEART DISEASE Lipoprotein (a) z z z z
Fat particle increases clotting Measurement warranted in individuals with premature heart disease or a strong family history LP(a) > 30 mg/dl high risk for heart disease Niacin most effective drug
NEW RISK FACTORS OF HEART DISEASE Homocysteine
An amino acid produced in the body Direct relationship between homocysteine levels and heart disease, stroke and peripheral vascular disease Associated with thickening, narrowing and scarring of walls of arteries Reasonable to give folic acid with vitamin B-6 and B-12 Checked as routinely as cholesterol
Homocysteine Measurement
Homocysteine
Classification
15
NEW RISK FACTORS FOR HEART DISEASE Kidney Disease
Strong relationship to heart disease Yearly death rate of 20–25% from heart disease Diabetes 40% kidney patient Hypertension 30% kidney patient Drugs reduce risk of heart disease
NEW RISK FACTORS FOR HEART DISEASE Infection z z z
Respiratory or urinary tract infection frequently precede heart attack or stroke 5 times heart attack in the 1st 3 days of respiratory infection 3 times stroke in the 1st 3 days of respiratory infection
NEW RISK FACTORS FOR HEART DISEASE Lack of Antioxidants
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Antioxidant can slow, prevent atherothrombosis Latest studies show no difference between treatment with Vitamin E or C Not recommended for prevention of heart disease
B-TYPE NATRIURETIC PEPTIDE (BNP)
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Hormone secreted from ventricles in response to heart failure 81% accurate in diagnosing heart failure Level increase when heart failure worsens, decrease when heart failure stable Helps to determine if you have heart failure, rather than another condition Helps your doctor to treat Test takes 15 minutes
BNP RESULTS
BNP
Indication
300
pg/ml
Mild heart failure
>600
pg/ml
Moderate heart failure
>900
pg/ml
Severe heart failure
STRATEGIES TO REDUCE RISK FACTORS FOR HEART DISEASE
Learning your family medical history Eating a heart-healthy diet Improving your cholesterol ratio Controlling homocysteine levels Exercise regularly Controlling diabetes Controlling high blood pressure A healthy weight Managing your stress Quitting smoking (or not starting to smoke) Controlling depression
The above strategy help slow progression if heart disease has already developed
DIAGNOSIS METHODS FOR HEART DISEASE
History & Physical Exam Blood Tests ECG Exercise Stress Test Echocardiogram / Stress Test Holter Monitor Radioisotope Imaging Ultrafast CT MRI Coronary Angiography
ECG
Ultrasound
Echo cardio
Echo
CT scanner
Coronary artery calcification
CT coronary arteries
CT coronary arteries
CT coronary arteries
Coronary Artery
The heart
MRI scanner
MR coronary arteries
LIMA graft
Cardiac Catheterization
Coronary arteries angiogram
Coronary Artery Blockage
TREATMENT OF HEART DISEASE
Medication Balloon Angioplasty (with or without stenting) Bypass Surgery Minimally Invasive Bypass Surgery
Stent Insertion
Drug Coated Stents
