Coronary Heart Disease

CORONARY HEART DISEASE
AB RAJAR
ASSOCIATE PROFESSOR
COMMUNITY MEDICINE.
Muhammad Medical College
Email:drabrajar@gmail.com

Overview
• Introduction
• Definition & Types
• Problem statement.
• Risk factors for CVD
• Prevention and control

INTRODUCTION
• Cardiovascular diseases (CVD) comprise of a group of diseases of
the heart and the vascular system.
• The major conditions are;
• Ischemic heart disease (stroke).
• Congenital heart disease.
• Rheumatic heart disease (RHD).

Definition
• It is defined as an impairment of heart function due to inadequate
blood flow to the heart compared to its needs, caused by obstructive
changes in the coronary circulation to the heart.

Types
• Angina pectoris
• Myocardial infarction
• Irregularities of the heart
• Cardiac failure
• Sudden death.

Problem statement (World)
• Non-communicable diseases accounts about 36m.
• Just half of these 17.9 million people died from CVDs in 2016.
• It is 31% of all global deaths.
• Of these deaths, 85% are due to heart attack and stroke.
• Over ¾ of CVD deaths take place in low- and middle-income countries.
• Out of the 17 million premature deaths (under the age of 70) due to NCD in
2015,
• 82% are in low- and middle-income countries, and 37% are caused by CVDs.

Risk of premature death due to NCDs(%)

Cardiovascular Proportional mortality

Adult Risk Trends

Risk factors for CVD
NON-MODIFIABLE
• Age
• Gender
• Family History
• Genetics Factors
• Type of Personality
•
MODIFIABLE
• Smoking
• Obesity
• Sedentary life style
• Diabetes
• Serum cholesterol
• Stress

PREVENTION AND CONTROL

Prevention of CHD.
I. Population Strategy
II. High risk Strategy
III. Secondary prevention.

Ⅰ-Population Strategy
• PRINCIPLE
• Small change in risk factors in total population can result in biggest
reduction in mortality.
– A.Primordial Prevention.
– B.Prevention in whole population.
I. Dietary changes
II. Smoking
III. Blood Pressure
IV. Physical Activity

A.Primordial Prevention.
• It consists of actions and measures that inhibit the
emergence and spread of risk factors CHD in the form of:
– Environmental,
– Economic,
– Social,
– Behavioral conditions
– and cultural patterns of living.

B.Prevention in whole population.
• Ⅰ-DIETARY CHANGES:
• ↓↓ fate intake to 20-30% of total energy intake.
• ↓↓ saturated fat less than 10% total energy intake.
• ↑↑ HDL more than 30mg/dl
• ↓↓ dietary cholesterol to below 100mg/100 kcal/day.
• ↑↑ complex carbohydrate use.
• ↓↓ salt intake to 5g/day or less
• Avoidance of alcohol

B.Prevention in whole population.
• Ⅱ-Smoking:
– The goal to achieve a smoke free society
• Ⅲ-Blood pressure:
– The goal is to reduce mean population blood pressure levels by
healthy life style.
• Ⅳ-Physical activity:
– Regular physical activity should be a part of normal daily life

Ⅱ-High risk Strategy
• A. IDENTIFYING AT RISK INDIVIDUALS:
– By measuring Blood Pressure, Blood sugar levels and serum cholesterol are
those who have strong family history.
• B. SPECIFIC ADVICE:
– Motivate at high risk individuals to take positive action like
– Control Blood Pressure.
– Cessation of smoking (use of nicotine gum can be tried to wean smoking,
– Serum cholesterol concentration should be reduced.

Ⅲ-Secondary prevention.
• It is the continuation of primary prevention.
• AIM:
– To prevent the reoccurrence and progression of CHD.
• Principles of secondary prevention:
– Cessation of smoking
– Control of Hypertension and Diabetes mellitus,
– Healthy nutrition
– Exercise promotion
– Use of Beta-Blockers

Summary
• In summary, the major CVD risk factors of tobacco use,
inappropriate diet and physical inactivity explain at least 75-85 % of
new cases of coronary heart disease.
• In the absence of elevation of these risk factors,CHD is a rare cause
of death.
• Unfortunatly,the vast majority of the populations in almost all
countries are at risk of developing CVD because of higher than
optimal levels of main risk factors.

Coronary Heart Disease

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