Global Burden of Coronary Heart Disease

Global Burden of Coronary
Heart Diseases
Rochmad Romdoni
President of Inaheart
Rochmad Romdoni
President of Inaheart
Department of Cardiology and Vascular Medicine
Airlangga School of Medicine - Dr. Soetomo Hospital
Surabaya

Cardiovascular Diseases
CVDs due to
Atherosclerosis:
• Coronary Artery
Disease (Heart Attack,
AMI)
• Cerebrovascular
Disease (Stroke)
• Aorta & Artery
Diseases :
• Hypertension & PAD
Other CVDs:
• Congenital Heart
Disease
• Rheumatic Heart
Diseases
• Cardiomyopathies
• Cardiac Arrhythmias
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization.
2011

Risk Factors
(Factors that Promote The Process of Atherosclerosis)
Behavioural risk
factors:
• Tobacco use
• Physical inactivity
• Unhealthy diet (rich
in salt, fat, and
calories)
• Harmful use of
alcohol
Metabolic risk
factors:
• Raised blood
pressure
(hypertension)
• Raised blood sugar
(diabetes)
• Raised blood lipids
(cholesterol)
• Overweight and
obesity
Other risk factors:
• Poverty and low
educational status
• Advancing age
• Gender
• Inherited (genetic)
disposition
• Psychological
factors (stress,
depression)
• Other risk factors
(e.g. excess
homocysteine)
2011

Global Map Risk Factors of Cardiovascular
Diseases
2011

Surveillance Map and Monitor
The Epidemic of CVDs

WHO 2011: Cause of Death
Distribution of major causes of death including CVDs
WHO/WHF/WSO : Global Atlas on Cardiovascular Disease Prevention and Control. Geneva : World Health Organization. 2011
Cardiovascular
diseases
31%
Injuries
9%
Communicable, maternal, perinatal and
nutriotional conditions
27%
Other NCOs
33%

WHO 2011: Cause of Death
Distribution of CVD deaths due to heart
attacks, strokes and other types of
cardiovascular diseases (MALES)
Distribution of CVD deaths due to heart
attacks, strokes and other types of
cardiovascular diseases (FEMALES)
2011
Other cardiovascular diseases
11%
Inflamatory heart
diseases
2%
Cerebrovascular
diseases
34%
Rheumatic heart diseases
1%
Hypertensive heart
diseases
6%
Ischemic heart disease
46%
Other cardiovascular diseases
14%
Inflamatory heart
diseases
2%
Cerebrovascular
diseases
37%
Ischemic heart disease
33%
Hypertensive heart
diseases
7%
Rheumatic heart diseases
1%

World Map Showing The Global Distribution of CVD Mortality
Rates in Males (Age Standardized, per 100.000)
2011

World Map Showing The Global Distribution of CVD Mortality
Rates in Females (Age Standardized, per 100.000)
2011

Global Burden Hidden of
2011

WHO (2009):
“CHD is now the leading cause of death worldwide; it is on the rise
and has become a true pandemic that respects no borders
Coronary Artery Disease
Leading cause of mortality
Happened globallyHappened globally
Leading cause of loss of productivity
Increase new cases

CAD is Leading Cause of
Premature Death
CAD is Leading Cause of
Premature Death
Calls for a different approach
on handling CAD
Calls for a different approach
on handling CAD

in Indonesia
Riset Kesehatan dasar (RisKesDas) 2007:
• Prevalence of Heart Diseases 7.2 %
• Prevalence of Coronary Risk Factors :
• Smoking 35.4 % (65.3 % men & 5.6 % women)
• Hipertension 31.7 %
• Diabetes Mellitus 1.1 % (Urban 5.7 %)
DepKes RI: RisKesDas. 2007

in Indonesia
Riset Kesehatan dasar (RisKesDas) 2007:
• Mortality of Various Diseases:
• Ischemic Heart diseases (5.1 %)
• Stroke (15.4 %)
• Hipertension (6.8 %)
• Other Heart Diseases (4.6 %)
• Diabetes Mellitus (5.7 %)
• Accidence (6.5 %)
• Cancer (5.7 %)
• Chronic Lower Respiratory Tract Diseases (5.1 %)
DepKes RI: RisKesDas. 2007

Reducing Cardiovascular Risk
to Prevent Heart Attacks and
Strokes

Cardiovascular Continuum
InterventionIntervention

Focusing on high risk people
To prevent one from having a
CHD or CVD event
People with established disease
To reduce morbidity and mortality
Primary
Prevention
Primary
Prevention
Secondary
Prevention
Secondary
Prevention
To prevent one from having a first
time or repeated CVD event

Population-Based
Strategy
High Risk
Strategy
Ideal Cardiovascular Health
Targetting on modifiable
risk factors
Introduction of
pharmacotherapy
How To Apply CVD Prevention
No Smoking
Healthy diet
Sufficient physical
activity
Low blood pressure
Low cholesterol

Risk Assessment
Individu
Level of Risk
Low RiskLow Risk
Moderate RiskModerate Risk
High RiskHigh Risk
Very High RiskVery High Risk

How To Apply CVD Prevention
Starts with Behaviour ChangeStarts with Behaviour Change
Key to succesful lifestyle changes
Should involved patients, family dan physician altogether
Communication plays vital role

Cardiovascular Risk Prediction Chart
WHO and International Society of Hypertension (ISH)
Cardiovascular Risk Prediction Chart (shows the 10 year
risk of a fatal or nonfatal cardiovascular event by gender,
age, smoking status, systolic blood pressure, blood
cholesterol and presence or absence of diabetes).
Different charts are available for all WHO subregions.

10 Year Risk Predictor Charts of Fatal CVD

10 Year CVD Risk Predictor Chart in Indonesia

Recommendation for CVD Prevention

General Practitioner Cardiologist
Serve as consultant
Further diagnostic tools :
ECG, echocardiography,
vascular ultrasound
Pivotal Role
Screening
Ability to do risk
assesment
Primary care
Role of General Practitioner and Cardiologist
Motivating, counseling the
patient
Implementation of
evidence-based
Communication to patient
regarding severity of
disease, therapeutic
options and target

SUMMARY
Cardiovascular Disease (CVD), especially Coronary Artery Disease is the
leading cause of morbidity and mortality worldwide.
CVD Prevention is the cornerstone of reducing global burden of
cardiovascular disease.
The implementation of CVD prevention by Population-based strategy
and High Risk strategy should give a more benefit in achieving
prevention target.
General practitioner and Cardiologist has a different yet vital role in CVD
prevention with synergistic effect one to the other.

“The doctor of the future will give“The doctor of the future will give“The doctor of the future will give“The doctor of the future will give
no medicine, but will interest hisno medicine, but will interest hisno medicine, but will interest hisno medicine, but will interest his
patients in the care of humanpatients in the care of humanpatients in the care of humanpatients in the care of human
frame, in diet and in the cause andframe, in diet and in the cause andframe, in diet and in the cause andframe, in diet and in the cause and
prevention of disease”prevention of disease”prevention of disease”prevention of disease”
(Thomas Edison)(Thomas Edison)(Thomas Edison)(Thomas Edison)

CVD Prevention and Control:
Why It should not be Ignored any Longer?
International efforts in poverty reduction will be derailed if the global challenge of CVD
is not addressed.
If no action is taken, increasing numbers of people will slip into highrisk categories or
develop CVD due to continuing exposure to risk factors.
Millions of deaths due to CVD can be prevented by scaling up implementation of high-
impact interventions that already exist.
High-impact interventions include policies that promote governmentwide action:
stronger anti-tobacco controls; promotion of healthier diets and physical activity;
reducing the harmful use of alcohol; improving people's access to essential health care.
2011

CVD Prevention and Control:
Why It should not be Ignored any Longer?
CVD s are eminently preventable.
Investment in prevention is the most sustainable solution for the
CVD epidemic.
Over the last two decades, CVD mortality has declined in developed
countries due to a combination of prevention and control measures.
Prevention of CVD by reducing the total cardiovascular risk is cost
effective.

SUMMARY
• During the last century, Cardiovascular Disease (CVD) has burgeoned from a
relatively minor disease worldwide to a leading cause of morbidity and mortality.
• A substantial portion of the increasing global impact of CVD is attributable to
economic, social, and cultural changes that have led to increases in risk factors
for CVD.
• CVD Prevention is the cornerstone of reducing global mortality and morbidity
worldwide.
• Risk factor screening should be considered in adult men >40 years old and in
women >50 years of age or post menopausal.
• The physician in general practice is the key person to initiate, coordinate, and
provide long term follow-up for CVD prevention.
• The practising cardiologist should be the advisor in cases where there is
uncertainty over the use of preventive medication or when usual preventive
options are difficult to apply.

Global Burden of Coronary Heart Disease

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