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CVD Prevention Charlie Shaeffer, MD, FACC Cardiovascular Deaths by Region in 1990:Global Burdon of Disease Study, 1990 Predicted Due to CHD Due to Stroke Increase by 2002 No. (x 106) (%) (%) (%) Established market economies 3.2 53 25 15 Former socialist economies 2.1 50 31 26 India 2.3 52 20 111 China 2.6 30 50 77 Other Asia and Islands 1.3 34 29 106 Sub-Saharan Africa 0.8 26 47 114 Latin America and Caribbean 0.8 44 32 120 Middle Eastern Crescent 1.3 47 16 129 Cardiovascular Deaths, 1990 “Cardiovascular death and incidence in China and India more than doubled between 1990 and 2000.” Yusuf: WCC May 2002 Urbanization ? Child Deaths and Infection ? Tobacco Use ? Physical Activity ? Fat Consumption ? Stress Yusuf: WCC May 2002 Worldwide Tobacco Mortality 1998 – 4,000,000 deaths/year 2030 – 10,000,000 deaths/year 1/3 of all deaths Half of these deaths will be in the 35-65 age group, with an average loss of 20-25 years of life Non Cigarette Smokers All Cigarette Smokers 10 0 79 114 64 122 44 135 Angina Pectoris Myocardial Infarction Sudden Death OBS. EXP. Summary of NCEP ATP III* Guidelines –LDL-C Goals *National Cholesterol Education Program Adult Treatment Panel III. ? Therapeutic lifestyle changes include: (1) dietary changes: reduced intake of saturated fats and cholesterol and enhanced LDL lowering with plant stanols/sterols and increased soluble fiber; (2) weight reduction; and (3) increased physical activity. ?Coronary heart disease. §CHD risk equivalents comprise: diabetes, multiple risk factors that confer a 10-year risk for CHD 20%, and other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease). ?Major risk factors (exclusive of LDL-C) that modify LDL-C goals include cigarette smoking, hypertension (BP ?140/90 mmHg or on antihypertensive medication), low HDL cholesterol (40 mg/dL), family history of premature CHD (CHD in male first-degree relative 55