Combating CV Diseases: The Salt Reduction Path

Transcription

1 Combating CV Diseases: The Salt Reduction Path H. Isma eel, MD, FSCCT, FESC Assistant Professor of Medicine Co-Director, Vascular Medicine Program American University of Beirut

2 Outline Why this presentation here? International CVD Data versus local? Why Salt? Time for action: introduce the Lebanese Action on Salt and Health (LASH) Group a member of WASH

3 Millions of Deaths from Cardiovascular Causes Death from CVD Worldwide Over 70% of the global burden of heart attack and stroke is on poor countries Western countries Non-Western (developing) countries ~15m >25m 6 million 19 million 5 million 9 million KS Reddy et al, N Engl J Med 2004 Fuster V et al, Lancet 2005

4 Fuster, V. et al. Circulation 2007;116: CVD mortality in various age groups and countries across the globe South Africa India Brazil USA Portugal

5 Myocardial Infarction or Sudden Cardiac Death as Initial Presentation of CHD Men 62 Women Patients Diagnosed with CHD (%) Murabito et al Circulation 1993

6 Trends in Age-standardized mortality & incidence of Acute MI Infarction (NHANES) Per 100, 000 Person Acute MI Mortality Acute MI incidence Ergin A, An J Med

7 Where do we stand in Lebanon?

8 Hwalla & Sibai et al, 2009 Data on a Nationally representative sample of 2000 adults in Lebanon ages Women Men Overall Cigarette 31.6% 46.8% 38.5% smokers HTN 14.2% 13.2% 13.8% DM2 4.8% 7.2% 5.9% Raised Cholesterol 15.2% 18.0% 16.5% On meds for 45.5% 36.9% Chol. 41.2% Family History of 52.4% 48.3% 50.5% CAD Obese 26.5% 28.7% 27.4% % with 3-4 risk factors 27.1% 42.9% 34.1%

9 Corresponding %in USA 33.7% 11.9% 33% 28.3% CDC Stats and Facts Nasreddine L. et al, 2012 LMJ In press

10 Figure 1: Secular linear trends in the prevalence (%) of obesity, diabetes and hypertension among Lebanese adults* (Nasreddine L. et al, 2012 LMJ In Press) 70% 60% 50% 40% 30% 20% 10% Obesity Diabetes Hypertension Linear trend (Obesity) Linear trend (Diabetes) Linear trend (HTN) 0% And if this continues in a linear manner then we re heading towards a disaster.

11 GBACC: Great Beirut Area CV Cohort

12 What has happened over 5 years?

13 HTN & SES in Lebanon HTN No/Yes No Yes N ColPctN N ColPctN p-value DEMO_GENDER 0.52 Male Female Age ± ± < Socioeconomic_5_education_n Less then elementary Elementary Secondary - technical Higher education Income < < 600$ $ $ >2000$ Crowd_index_c 0.11 Not crowded Crowded Severely crowded

14 HTN No Yes Definite diabetes < No Yes BMI_c < Normal Overweight Obese Obesity < Non obese Obese MetS_WC < SMOKE_CN_NY No Yes SMOKE_CN_NEY Never Ex Current LDL (mg/dl) HDL (mg/dl) Triglyceride (mg/dl) < Glucose(mg/dL) < HbA1C (%) < Waist circumference (cm) <0.0001

15 Hence: POLICY CHANGES Highly Commend the Tobacco Working Group and we look forward to emulating them

16 Lebanese Action on Salt and Health Na Reduction Working Grp 1. Why? 2. Who? 3. What are we doing? 4. When?

17 List of FACTS: 1. Despite some noise, salt is associated with HTN, CVD and others 2. Reducing salt intake is associated with reduced CVD outcomes 3. Reducing salt intake policy is among the most cost-effective interventions as per the WHO 4. Reducing salt intake is beyond an individual s effort it requires a cultural change and MAJOR FORCE 5. Reducing salt needs to be gradual with realistic goals

18 List of Myths 1. most of the salt is added via the shaker 2. Salt is needed as a preservative TODAY 3. People who are used to salt cannot cut it 4. It s an individual s choice

19 From Knowledge to Policy Where are the major sources of salt in our diet? Who are the major stakeholders? How are we moving forward?

20 Lebanese Action on Salt and Health Vascular Medicine Program at American University of Beirut from all faculties Adel Berbari Kamal Badr Hussain Isma eel VMP assigned Group Facilitator Lara Nasreddine Haya Hamadeh Imad El Haj Samir Arnaout Abir Barhoumi Mariam Olaik Mohamad Medawar Nathalie Khoueiry Sami Sanjad George Saade Hani Tamim Abla Sibai

21 Goals VMP- Na Intake optimization working Group Health Communication Plan Research Clinical Internal Education and Training External Education and Training Health Policy

22 Na in Leb. Food 54.7% of the adult Lebanese population was found to exceed the maximum intake level of 2300 mg/day. 4% 2% 4% 3% Major food group contributors to sodium intake 2% 1% 1% 1% 2% 2% 2% 25% Bread, other bread-like products and breakfast cereals Processed meats Cheese and labneh 47% of Na 5% Salads 8% 12% Vegetable based dishes and moughrabieh 8% 9% 10% Potato chips and salty snacks Isma eel H. et al, CDT 2015

23 How do we compare to the USA? 40% of sodium consumed in the U.S. comes from 10 food categories, with bread and poultry among the top 5 (47% among Leb.) 88% are above the 2300 mg/d recommendation (55%) CDC Morbidity and Mortality Weekly Report

24 StakeHolders: All healthcare providers Governmental Bodies Food industry and Catering Services

25

26

27 Salt Shopping Guide:

28 Food Labels

29 Radio Messages & Social Media

30 Time Line: Only KEY ongoing projects will be mentioned 2-year Plan is pending approval in 2 weeks World Action on Salt and Health _ Lebanon (all working grp) First Doctors to Coach Change workshop (Coaching & Career Counseling Ltd. to train health care workers (HCW) adopt a coaching style to change lifestyle habits and Improve Compliance with Meds) Validate Na Food Frequency Questionnaire Launch Survey on Consumer Awareness of Health Hazards of Salt and Major sources of Salt in diet Launch Survey on HCW Awareness of Health Hazards of Salt and major sources of salt in diet Na Calculator Webpage

31 Time Line: Only KEY ongoing projects will be mentioned Research project Establishment of Salt Intake and Range of PWV within Leb. Initiate Health Comm. Plan Steps (Awareness, Interventions and impact measuring Research) Expect our invitation soon to the first HCW Salt Monitoring Workshop Replicate all the above in Pediatrics Feb 2013 (Credit Hx): Ready to launch National LASH Working Group

32 What CCU patients know about salt intake and their health?

33 Does raising awareness improve knowledge?

34 Does patient awareness raising lead to behavioral changes?

35 Limitations Is the reported change in behavior true? Should we have used urinary sodium collection? Does this change lead to reduction in salt intake? Does this change lead to reduction in HTN? Does this change lead to reduction in CV outcomes?

36 Take home messages CVD are increasing in developing world countries HTN (similar to all CVD risk factors) is on the rise Higher prevalence of HTN are present in lower SES groups Lebanese consume high amounts of salt Bread and processed food are No. 1 source of salt Awareness raising about need/how to reduce salt intake is associated with reported behavioral changes Health Policy Changes are more effective/efficient

37 GBACC Working Group; special thanks to participants, students and volunteers

38 Lebanese Action on Salt and Health Vascular Medicine Program at American University of Beirut from all faculties Adel Berbari Kamal Badr Hussain Isma eel VMP assigned Group Facilitator Lara Nasreddine Haya Hamadeh Imad El Haj Samir Arnaout Abir Barhoumi Mariam Olaik Mohamad Medawar Nathalie Khoueiry Sami Sanjad George Saade Hani Tamim Abla Sibai Thank you