Department of Cardiology
King Georges Medical University.
Lucknow.India.
Inspired by:-
Global Burden of
Cardiovascular Disease
Economic Burden of
Cardiovascular Diseases
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).
Smoking
Hypertension
Dyslipidemia
Metabolic Syndrome
Mental Stress
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
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.
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.
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..
Evidence
Asian Indian living in USA *
54% men had HDL <40mg%.
JAPI 2004;52:137-142
L
D
H
JAPI 2004;52:137-142
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
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