Coronary Heart Disease Prevalence DR. MOHAMMED O. AL-RUKBAN Assistant Professor Department of Family and Community Medicine College of Medicine, King Saud

Coronary Heart Coronary Heart Disease Disease

PrevalencePrevalence

DR. MOHAMMED O. AL-RUKBANDR. MOHAMMED O. AL-RUKBANAssistant ProfessorAssistant Professor

Department of Family and Community MedicineDepartment of Family and Community MedicineCollege of Medicine, King Saud UniversityCollege of Medicine, King Saud University

• What issues do you hope this What issues do you hope this course will address?course will address?

ExpectationsExpectations

The Heart

Heart Attach

Leading Causes of Death for All Males and Leading Causes of Death for All Males and FemalesFemales

United States: 2000United States: 2000

A Total CVD A Total CVD B B Cancer Cancer CC Chronic Lower Chronic Lower Respiratory DiseasesRespiratory Diseases

D Accidents D Accidents EE Diabetes Mellitus Diabetes Mellitus FF Alzheimer’s Disease Alzheimer’s Disease GG Influenza and Pneumonia Influenza and Pneumonia

P 8

Percentage Breakdown of Deaths from Cardiovascular Percentage Breakdown of Deaths from Cardiovascular DiseasesDiseases


Deaths From Diseases of the Heart Deaths From Diseases of the Heart United States: 1979-2000United States: 1979-2000

ISD Scotland http://www.isdscotland.org/chdstroke

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Cru

de

inci

den

ce r

ate/

100,

000

Males

Females

Coronary heart disease incidence by sex, crude rates per 100,000, Coronary heart disease incidence by sex, crude rates per 100,000, Scotland, 1994-2003Scotland, 1994-2003

ISD Scotland (2004)

Coronary heart disease mortality by sex, all ages, Scotland, 1994-2003

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Dea

ths/

100,

000

(ag

e-st

and

ard

ised

)

Men

Women

World Health Organization (2004)

Death rates from CHD, men and women aged 35-74,

FranceItaly

SwitzerlandChile

MexicoNetherlands

AustraliaNorway

SloveniaCanada

SwedenAustriaUSA

IrelandFinland

Czech RepublicCroatia

HungarySlovakia

ArmeniaGeorgia

LatviaMoldova, Rep of

KazakstanRussian Federation

Ukraine

United Kingdom

-1,000 -800 -600 -400 -200 0 200 400 600

Japan

Age-standardised death rates/100,000

Women

Men

Office for National Statistics (2005) www.heartstats.org

Deaths from CHD by sex and month, 2003/04, England and Wales

0 1000 2000 3000 4000 5000 6000

August

September

October

November

December

January

February

March

April

May

June

July

Mon

th

Number of CHD deaths

Men

Women

World Health Organization (2004)

Changes in death rates from CHD, men and women aged 35-74,

Mexico

Georgia

Armenia

Slovenia

Chile

France

Finland

United Kingdom

Australia

New Zealand

Ireland

LuxembourgItaly

USA

Spain

Japan

Romania

Russian Federation

BelarusKazakstan

Ukraine

Hungary

Portugal

Germany

-80 -60 -40 -20 0 20 40 60 80

Ukraine

% decrease % increase

Women

Men

Norw ay

Death rates from CHD, for people aged 65-74, 1970-2003, England

0

200

400

600

800

1000

1200

70717273747576777879808182838485868788899091929394959697989900010203

Year

Death rates from CHD for people aged under 65,

0

10

20

30

40

50

60

70

80

90

100

70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03

Year

0

100

200

300

400

1980 19901985 20001995

Coronary Heart Disease

Coronary Heart Disease Death Rates, 1980-2000

Age-adjusted rate per 100,000

0

100

200

300

400

1980 19901985 20001995

Coronary Heart Disease

CHD 2010 target

Coronary Heart Disease and Stroke Death Rates, 1980-2000


Coronary Heart Disease Death Rates, 2000

0

50

100

150

200

250

TotalBla

ck, N

ot

Hispan

ic

Hispan

ic

Asian

or

Pac

ific Is

lande

r

Amer

ican

India

n

or Ala

ska

Nativ

e

White

, Not

Hispan

ic Mal

eM

ale

Femal

e

2010target


0.4

0.6

0.8

1.0

1.2

1.4

Coronary Heart Disease Death Rates, 2000

Relative Risk

Black, NotBlack, NotHispanicHispanic

HispanicHispanic

Asian orAsian or Pacific IslanderPacific Islander

American IndianAmerican Indianor Alaska Nativeor Alaska Native

White, NotHispanic

MaleMale

FemaleFemale

Relative risk compared to the total population

GreaterRisk

LessRisk

CVD Risk Factors

2010 targetBaseline Most recent

Age-adjusted percent

Obesity Currentsmoker

Moderateactivity

Adults

Overweight Currentsmoker

Moderateactivity

Adolescents

0

10

40

20

30

50Percent

Serum Cholesterol Levels > 240 mg/dL,

Adults 20 and Older

Total MexicanAmerican

Black, NotHispanic

White, NotHispanic

2010 target

0

5

10

15

20

25


Female Male Female Male Female Male Female Male

1988-94 1999-2000

Hypertension Prevalence in Adults,1999-2000

0

5

10

15

20

25

30

35

40

45

Total Black, NotHispanic

MexicanAmerican

White, NotHispanic


High schoolgraduate

Less thanhigh school

At leastsome college

2010 target

20 years and older 25 years and older

0

200

400

600

800

1000

1999 2025

21%

29%724

883

Proportiondue to

diabetes

Heart Disease Deaths (thousands)

Projected Increase in Total Heart Disease Deaths Related to Increased Diabetes

Prevalence

0

5

10

15

20

25

30

35

40

45

Total Black, Not Hispanic White, Not Hispanic Mexican American

Obesity in Adults 20 and Older

1988-94 1999-2000

2010 target


Cardiovascular Disease Mortality Trends Cardiovascular Disease Mortality Trends United States: 1979-2000 United States: 1979-2000

Age-Adjusted Death Rates for Coronary Heart Disease, Age-Adjusted Death Rates for Coronary Heart Disease, Stroke, Lung and Breast CancerStroke, Lung and Breast Cancer


P 13

Prevalence of Coronary Heart Disease by Age and SexPrevalence of Coronary Heart Disease by Age and Sex

United States: 1988-94United States: 1988-94

P 8

Prevalence of Cardiovascular Diseases in Americans Age 20 Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sexand Older by Age and Sex


P 13

Annual Rate of First Heart Attacks by Age, Sex and Race Annual Rate of First Heart Attacks by Age, Sex and Race


P 39

Trends in Cardiovascular Operations and Trends in Cardiovascular Operations and ProceduresProcedures


Estimated Direct and Indirect Costs (in Billions of Dollars) Estimated Direct and Indirect Costs (in Billions of Dollars) of Cardiovascular Diseases and Stroke of Cardiovascular Diseases and Stroke


What about Saudi Arabia?What about Saudi Arabia?

Coronary Heart disease in Coronary Heart disease in SASA

• (944), out of 17232 were diagnosed to have CAD (5.5%). (944), out of 17232 were diagnosed to have CAD (5.5%). • 4.9% of the subjects has reported anginal chest pain and 4.9% of the subjects has reported anginal chest pain and

0.4% gave history consistent with previous MI. 0.4% gave history consistent with previous MI. • Male subjects have reported significantly more cases of Male subjects have reported significantly more cases of

MI than female subjects (p=0.027). MI than female subjects (p=0.027). • The prevalence of MI diagnosed by ECG was 1.1%.The prevalence of MI diagnosed by ECG was 1.1%.• The prevalence of CAD in males and females were 6.6% The prevalence of CAD in males and females were 6.6%

and 4.4%. and 4.4%. • The prevalence was 6.2% in urban areas, and 4% in rural The prevalence was 6.2% in urban areas, and 4% in rural

areas. areas. • The prevalence was in increasing order from youngest to The prevalence was in increasing order from youngest to

eldest groups.eldest groups.• The body mass index (BMI) of patient with CAD had The body mass index (BMI) of patient with CAD had

higher values than patients without CAD. higher values than patients without CAD. • Patients with CAD showed wider waist circumference Patients with CAD showed wider waist circumference

than patients without CAD.than patients without CAD.

Coronary Heart disease in Coronary Heart disease in SASA

• Systolic and diastolic blood pressures (BP) were Systolic and diastolic blood pressures (BP) were significantly higher in patients with CAD than without significantly higher in patients with CAD than without those of CAD. those of CAD.

• The percentage of smokers and ex-smokers were The percentage of smokers and ex-smokers were significantly higher in subjects with CAD category than significantly higher in subjects with CAD category than the subjects without CAD. the subjects without CAD.

• Mean fasting blood sugar and serum TG level were Mean fasting blood sugar and serum TG level were significantly higher in subjects with CAD than without significantly higher in subjects with CAD than without CAD. CAD.

• Mean TC level was also significantly higher in subjects Mean TC level was also significantly higher in subjects with CAD. with CAD.

• Mean high density lipoprotein-cholesterol (HDL-C) values Mean high density lipoprotein-cholesterol (HDL-C) values were statistically lower in subjects with CAD as were statistically lower in subjects with CAD as compared to subject without CAD. compared to subject without CAD.

• Mean low-density lipoprotein (LDL-C) values were almost Mean low-density lipoprotein (LDL-C) values were almost the same in both with CAD and without CAD groups. the same in both with CAD and without CAD groups.

MI in Young populationMI in Young population

• Approximately 4% of patients with myocardial Approximately 4% of patients with myocardial infarction are <40 years old. infarction are <40 years old.

• The incidence of CAD increases with age. The incidence of CAD increases with age. • There was a total number of 130 patients, with There was a total number of 130 patients, with

male to female ratio of 4:1. male to female ratio of 4:1. • Mean age for males was 37.2 years and for Mean age for males was 37.2 years and for

females was 35.6 years. females was 35.6 years. • Cigarette smoking was present in 94% of Cigarette smoking was present in 94% of

males and 69% of females. males and 69% of females. • A positive family history was present in 77% of A positive family history was present in 77% of

males and 73% of females. males and 73% of females. • Hypertension was found in 11.5% of males, but Hypertension was found in 11.5% of males, but

none of the females. none of the females.

MI in Young populationMI in Young population

• Diabetes mellitus was found in 4.8% of males Diabetes mellitus was found in 4.8% of males and 7.7% of females. and 7.7% of females.

• Mean cholesterol level was 6.9 mmol in males Mean cholesterol level was 6.9 mmol in males and 6.7 mmol in females. and 6.7 mmol in females.

• Mean triglyceride level was 2.7 mmol in males Mean triglyceride level was 2.7 mmol in males and 2.8 mmol in females. and 2.8 mmol in females.

• Coronary angiograms revealed left anterior Coronary angiograms revealed left anterior descending coronary artery (LAD) involvement descending coronary artery (LAD) involvement in 60 male patients and in 14 female. in 60 male patients and in 14 female.

• The right coronary artery (RCA) was involved The right coronary artery (RCA) was involved in 30 males and 4 females. in 30 males and 4 females.

• Combined LAD and RCA involvement was Combined LAD and RCA involvement was found in 10 males and 2 females. found in 10 males and 2 females.

Documents

Coronary Heart Disease Prevalence DR. MOHAMMED O. AL-RUKBAN Assistant Professor Department of Family and Community Medicine College of Medicine, King Saud