Atherosclerotic Cardiovascular Diseases: ischaemic heart disease and stroke

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1 «L Europe de la santé au service des patients» October Institut Pasteur Paris Atherosclerotic Cardiovascular Diseases: ischaemic heart disease and stroke Simona Giampaoli National Centre of Epidemiology Surveillance and Health Promotion Istituto Superiore di Sanità Rome, Italy

2 EUROSTAT: 2007 all cause mortality in men and women, all ages Proportional mortality of cardiovascular diseases, cancer and violence (injury and poisoning) ) in EU; 3 year average ( ), by gender MEN WOMEN Source: EUROSTAT-2007 (

3 Time trends of IHD mortality in men and women aged years MEN WOMEN Baltic Countries: Estonia, Latvia, Lithuania Northern Europe: Denmark, Ireland, Malta, Finland, Sweden, United Kingdom Central Europe: Belgium, Germany, Luxembourg, Netherlands, Austria, Slovenia Southern Europe: Greece, Spain, France, Italy, Portugal Eastern Europe (Central): Czech Republic, Poland, Slovakia Eastern Europe (Balkan): Bulgaria, Hungary, Romania

4 Time trends of stroke mortality in men and women aged years MEN WOMEN Baltic Countries: Estonia, Latvia, Lithuania Northern Europe: Denmark, Ireland, Malta, Finland, Sweden, United Kingdom Central Europe: Belgium, Germany, Luxembourg, Netherlands, Austria, Slovenia Southern Europe: Greece, Spain, France, Italy, Portugal Eastern Europe (Central): Czech Republic, Poland, Slovakia Eastern Europe (Balkan): Bulgaria, Hungary, Romania

5 Crude hospital discharge rates (per 100,000 inhabitants) from all cardiovascular diseases (all CVD), ischaemic heart disease (IHD) and stroke. Last year available, all ages All CVD IHD stroke Austria Belgium Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta the Netherlands Norway Poland Portugal Romania Slovakia Slovenia Spain Sweden Switzerland United Kingdom Source: WHO-Heatlh for All Database 2007 ( H ospital discharge rates p er 100,000

6 PERCENT DISTRIBUTION OF CHD CASE FATALITY WHO Project, men years USA-STA UNK-BEL SPA-CAT RUS-MOC NEZ-AUC ITA-FRI ITA-BRI ICE-ICE GER-BRE GER-AUR FRA-LIL FIN-NKA DEN-GLO CAN-HAL AUS-NEW 0% 20% 40% 60% 80% 100% PRE-HOSPITAL WITHIN 24h >24h-28 days

7 The EUROCISS Project Regional AMI/ACS Population-based Registers in Europe: population characteristics and case definition Country Years Age range Population x 1000 ICD version Mortality ICD-9 codes HDR ICD-9 codes Linkage Mortality / HDR Validation Belgium (Ghent( Ghent) VIII, IX,, X , 414, 428, , 414, 428 PTCA, CABG Name, date of birth, PIN ECG, enzymes, symptoms, Denmark All 494 X 410, 411, 428,798, , 411 PTCA, CABG PIN, ESC/ACC Finland IX, X , 414, 428, 798, 799, others , 414, 428 Name, date of birth France ,519 X , 414, 798, , 411 PTCA, CABG Name, date of birth, ESC/ACC Germany IX , 414, 798,799, others Name, date of birth Italy ,600 X PTCA, CABG PIN No validation Norway All 1,000 IX , 414, 428, 798, 799, others Name, date of birth Spain X 410, , 411 PIN Sweden X 410, , 411 PIN Source: European J of Public Health 2003; 13 (Suppl 3): (updated 2006)

8 Explaining the fall in coronary heart disease deaths in England & Wales and in Italy ,230 fewer deaths Risk Factors worse +13% Obesity (increase) +3.5% Diabetes (increase) +4.8% Physical activity (less) +4.4% Risk Factors better - 71% Smoking -41% Cholesterol -9% Population BP fall -9% Deprivation -3% Other factors -8% Treatments - 42% AMI treatments -8% Secondary prevention -11% Heart failure -12% Angina:CABG & PTCA -4% Angina: Aspirin etc -5% Hypertension therapies -3% ,927 fewer deaths 2000 Risk Factors worse +4 % Obesity (increase) + 1.8% Diabetes (increase) + 2.5% Risk Factors better 44 % Smoking % Cholesterol % Population BP fall % Physical activity (incr.) % Treatments - 52 % AMI treatments % Secondary prevention % Heart failure % Angina % CABG & PTCA % Angina: Aspirin etc % Hypertension therapies % Statins 1 prevention % Unal, Critchley & Capewell Circulation (9) L. Palmieri, Am J Public Health, in press

9 INTERHEART Study nine potentially modifiable risk factors account for over 90% of the risk of an initial acute myocardial infarction myocardial infarction Population attributable risk fractions DIET explains DIET explains 50%+ CHD deaths Smoking Hypertension Lipids (ApoB/A1 ratio) Abdom obesity Diabetes Fruit & Veg Alcohol Exercise Psychosocial Other Salim Yusuf et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet Sept 2004

10 The CUORE Project Italian population, years old, 10 years follow-up CHD and stroke incidence rates Low Risk: Chol <200 mg/dl, PA <120/80 mmhg, BMI <25, No-Smoking, No-Diabetes, No-treatment Unfavorable: Chol mg/dl, PA /80-90 mmhg, BMI 25-30, No-Smoking, No-Diabetes, No-treatment High Risk: Chol >240 mg/dl, PA >140/90mmHg, BMI <30, Yes-Smoking, Yes-Diabetes, Yes-treatment Giampaoli S. et al. Am J Epidemiol 2006; 163:

11 Every child born in the new millennium has the right to live until the age of at least 65 without suffering from avoidable cardiovascular disease.

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