CARDIOVASCULAR DISEASES (CVD)/

CORONARY HEART DISEASES(CHD)

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 SLO
• CVD & it’s Classification
• Problem statement
• Risk factors
• Web of causation of CVD
• Prevention of CVD
• CHD
• Intervention Trials

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 CVD are group of disorders that affect the circulatory system i.e.
Heart and blood vessels and include:

• Coronary artery disease: Disease of blood vessels supplying the heart.

• Cerebrovascular disease: Disease of blood vessels supplying the Brain.

• Peripheral arterial disease: Disease of blood vessels supplying the Limb

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CONTD…….

• Rheumatic heart disease: Disease caused due to the damage to the heart muscles
and heart valves due to Rheumatic Fever.

• Congenital Heart Disease: Malformation of cardiac structure existing since birth.

• Deep vein thrombosis and Pulmonary embolism: Blood clot in the deep leg veins
that may get dislodged and get transported to the heart and lungs

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 Classification
of CVD

Due to
Others
Atherosclerosis

Disease of the
Cerebrovascular Congenital Cardiac Cardiomyopathi
IHD aorta and RHD
disease Heart disease arrhythmias es
arteries

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 PROBLEM STATEMENT

• World: Of the 57 million death due to NCD in 2016, CVD related deaths accounted
for about 17.9 million deaths(44%)

• SEA Region: In 2015, about 28%(3.8 million) deaths due to CVD and accounted for
more than 43% of the total NCD related deaths.

• India: CVD accounted for 27%(161,865) of the total numbers of deaths of

599,500due to NCD in India.

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 RISK FACTORS FOR CVD
• It helps healthcare professionals decide on who to subject for screening for the
CVD.
• Risk factors may be classified as :
Major Risk Factors
Tobacco dependence Elevated C-Reactive Protein
Overweight/Obesity Raised LDL/Low HDL
Physical Inactivity High blood pressure
Dietary risk factors Elevated blood glucose

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CONTD…..
Contributing Risk Factors:
Socioeconomic status.
Elevated Prothrombotic factors:
Fibrinogen, plasminogen activator inhibitor(PAI-1)
Markers of Infection or Inflammation
Raised Homocysteine
Elevated Lipoprotein
Psychological Factors

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CONTD…

RISK FACTORS MAY BE FURTHER CLASSIFIED AS:

• Non modifiable risk factors: cannot be changed or controlled even with intervention,
thus are not amenable to prevention, but are useful in finding out which group of
people who are at high risk to develop IHD.

Age, Sex, Family History, Genetic factors

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Contd..
• Modifiable risk factors: These are behaviour related predisposing traits that make a
person likely to develop IHD. These can be reduced or controlled by modification of
lifestyle of an individual.
Elevated Blood Pressure Physical Inactivity
Cholesterol or lipid metabolism Excessive weight or Obesity
Diet Smoking or Tobacco consumption
Diabetes Socioeconomic factors
Psychological Stress Alcohol
Drugs

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 ABCDE OF CARDIOVASCULAR RISK FACTORS

• A- Age and other non modifiable risk factors

• B- Blood pressure
• C- Cholesterol levels, Current smoking
• D- Diabetes and Diet
• E- Excess weight and other modifiable lifestyle factors.

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 THE RISK FACTORS FOR CVD CAN BE SUMMARIZED AS FOLLOWS:
• Social determinants:
Globalization
Urbanization
Ageing
Education
Housing
• Behavioural risk factors:
Tobacco use in any form Psychological stress
Unhealthy diet Physical inactivity
alcohol use 12
CONTD…..
Metabolic risk factors:
Obesity
Uncontrolled high blood pressure
High blood LDL cholesterol
High blood sugar level
• Other cardiovascular disease:
Stroke
Heart failure
Kidney disease
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WEB OF CAUSATION OF CARDIOVASCULAR DISEASE

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 PREVENTION OF CARDIOVASCULAR DISEASES

• As a part of primordial and primary prevention, the following interventions for the
risk factors need to be implemented through the following approaches:

• The two modalities of interventions in primordial prevention:

Mass education approach

Individual education approach

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PRIMARY PREVENTION

• Population Strategy
• High risk strategy:
Identification of at risk population
Specific advice
Health protection/promotion approach

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MODALITIES OF PRIMARY PREVENTION IN CVD

Health education

Health promotion
Dietary modification

Behavioural and lifestyle

modification

Environmental modifications

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 SECONDARY PREVENTION
• Early diagnosis and treatment:

• Screening for serum cholesterol abnormalities, tracking of blood pressure and

early detection of onset of HTN, abnormalities in blood sugars like general
random blood sugar levels.

• Treatment of conditions that may predispose to an acute cardiovascular event.

• use of low dose aspirin (75mg daily dose) in individual with high risk of acute
cardiovascular event to prevent myocardial infarction and stroke.
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 TERTIARY PREVENTION

• By clinical diagnosis of an acute cardiac event using a health team approach with
prompt referral and follow-up of the patients to prevent long-term complications
due to CVDs.

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 CORONARY HEART DISEASE(SYN: ISCHAEMIC HEART DISEASE)
• “Impairment of Heart function due to inadequate blood flow to the heart compared to its
needs, caused by obstructive changes in the coronary circulation to the heart.”
• As per WHO, CHD is our modern “Epidemic”
• CHD manifest itself in the form of:
Angina pectoris of effort
Myocardial infarction (specific to CHD)
Irregularities of the heart
Cardiac failure
Sudden death
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 MEASURING THE BURDEN OF CHD

Burden of CHD may be estimated in various ways:

• Proportional mortality ratio
• Loss of life expectancy
• CHD incidence rate
• Age-specific death rates
• Prevalence rate
• Case Fatality rate
• Measurement of risk factor level
• Medical care
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RISK FACTORS: AETIOLOGY OF CHD IS MULTIFACTORIAL.

What are risk factors for CHD?

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 PREVENTION OF CHD
Recommended strategies are:
• Primordial prevention in whole population. Aim is to change the Community as a
whole.
• Primary prevention:
a. Population Strategy: (Prevention in whole populations.)
Specific interventions
Dietary changes
Smoking
Blood pressure
Physical activity 23
b. High risk strategy:
• Identifying risk
• Specific advice

• Secondary Prevention(Aim): To prevent the recurrence and progression of CHD.

Cessation of smoking
Control of HTN & Diabetes
Healthy nutrition
Exercise promotion
Beta-blockers 24
REVASCULARIZATION PROCEDURES FOR PATIENTS WITH ANGINA PECTORIS

• Coronary artery bypass grafting (CABG)

• Percutaneous transluminal coronary angioplasty (PTCA)

• Tertiary prevention

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 Risk factors intervention trials

The Framingham study has played a major role in establishing the nature of CHD
risk factors and their relative importance.

Several well planned risk factors intervention trails(Primary prevention) are:

• The multiple risk factors intervention trials(MRFIT)
• The Stanford heart disease prevention programme in California
• The north Kerelia project in Finland.
Several well planned high risk intervention studies are:
Oslo heart study
Lipid research clinics study 26
 SECONDARY PREVENTION TRIALS
• Aim – prevention of subsequent coronary attack or sudden death.

• Trials performed mainly on

• Anti-coagulants
• Lipid-lowering agents (e.g., clofibrate)
• Anti-thrombotic agents (e.g., aspirin)
• Beta-blockers

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THE END

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