khawar kazmi. the evil who report 2003 deaths from coronary heart disease who atlas of heart disease...
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Khawar Kazmi
The Evil
WHO report 2003
DEATHS FROM CORONARY HEART DISEASE
WHO Atlas of Heart Disease & Stroke 2004
• Lower consumption of energy rich foods and fats, higher consumption of complex carbohydrates
• Increased expenditure of energy (high levels of physical activity during daily usual activities
• Greater social integration due to maintenance of traditional lifestyles
Proximal Determination of Behavior
• Level of economic development
• Education• Income
distribution• Social
organization • Global
Influences (e.g trade promotion and cultural diffusion
Interactions of environmental factors and tobacco use with genetic
predisposition
• Higher consumption of energy rich foods, refined carbohydrates, processed foods, salt and fats
• Lower energy expenditure due to low levels of physical activity
• Greater social isolation, psychosocial stress
• Crowded housing
Programming Factors:
e.g. Intrauterine environment
Predisposing risk factors:
e.g. Obesity in childhood &
early adulthood
Classical riskfactors:
e.g. Cholesterol
Blood Pressure Glucose
• Psychosocial factors
• Susceptibility of plaques to rupture
• Knowledge of prevention
• Access to care
• Coronary Heart Disease
• Ischemic strokes
• Peripheral arterial Disease
• Hypertensive Heart Disease
• Hemorrhagic strokes
• Chronic renal failure
• Vascular dementia(?)
Development of Risk Factors
Modifying Influences
Clinical Events
(+)
(-)
Rural Lifestyle
Urban Lifestyle
Epidemiological Transition
CIRCULATION 2001;104:2855-64
Cardiovascular Diseases Axis
(Axis of Evil)
CVD
EXPRESSION
BEHAVIOURS
Diet, Physical Activity & Tobacco Use
Obesity and Tobacco
Risk Factors start in Childhood and Youth
• Worldwide 22 million children under five years
are obese and many more are overweight.
• 14% of 13 to 15 year old students around the
world currently smoke cigarettes.
• In USA physical activity decreases
precipitously esp. in girls beginning around 10
years. WHO Atlas of Heart Disease & Stroke 2004
Children, Adolescents and Obesity
• Obese Children are at approximately a 3 – fold higher risk for HTN than non – obese children.
• The risk of developing type 2 DM is clearly linked to the increasing prevalence of obesity, with increasing cases of type 2 DM in children.
• Cohort studies show that obesity can be tracked from childhood to adulthood, where morbidity is very evident.
• Obesity in adolescents is directly associated with increased morbidity and mortality in adult life independent of adult body weight.
• Unhealthy diet is one of the leading causes of CVD. This unhealthy life style is more and more adopted at early age.
WHF fact sheet 2003, BMJ 2001;322:1094-5
Aga Khan UniversityCARDIOLOGY PROGRAM
SMART HEART PROGRAM First institution based CVD prevention
program Evolving into a comprehensive
multifaceted program including secondary, primary and primordial prevention
www.akunet.org/smartheart
ACME
HEALTH
HABITS
Research capacity building
Aga Khan University
SMART HEART PROGRAM
Primary & Primordial Prevention
- A Continued Medical Education Program
- Healthy Eating, physical Activity and Living with no Tobacco: A family Health initiative
- Health Awareness By Imparting lifestyle Training to School Children
Aga Khan UniversitySMART HEART PROGRAM
HABITS(Health Awareness By Imparting lifestyle Training to School children )
Objective Stimulate thinking process
Healthy Behaviors
Empowerment Through Knowledge
Plan Data Collection
Intervention through a Teaching module
HABITS - PilotSeptember to December 2005
HABITS - PilotSeptember to December 2005
HABITS - PilotSeptember to December 2005
• Total # of grade VI Children: 105 (CAS:78 , AMI:
27)
• # consented for the study: 101
• Mean Age: 11.4 yrs.• Boys to Girls ratio: 1.2 (57/48)
HABITS – PilotSeptember – November 2005
Preliminary Results
HABITS - Pilot
72.5
5.1 6.1
16.3
Underweight NormalOverweight At Risk
BMI(98)
74.3
25.7
Normal Abnormal
Waist(98)
(< 71 cm)
There was significant association between
days of physical activity and BMI(P=0.003) as well as
between duration of sedentary activity and waist circumference (p=0.001)
HABITS - Pilot
• 98.9% had normal blood pressure of < 120/80
• 59% indulged in daily physical activities, 33.3% were active less than 6 days a week and 2.9% did not participate in any physical activity
• 22.9% spent more than 2 hrs and 30.5% 1-2 hrs in sedentary activities apart from studying
Blood Pressure & Physical Activity
HABITS - Pilot
• 21.9% had tried cigarettes and 30.5% were exposed to passive smoking
• 40% responded positively on the use of Shisha. Most were unaware of it being a form of tobacco
• 2.9% were using “Chalia” on daily basis with 4.8% consuming it on weekly basis
Tobacco and Diet
• 60% reported eating out on weekly basis • 16.2% were snacking more than twice daily
• 31% had soft drinks every day
• 12.4% used vegetables every day
HABITS - PilotSpot Blood Test Results
93.5
5.41.1
79.3
18.4
2.30
102030405060708090
100
CHOL FBS
NormalBorderlineHigh
(92) (87)
Aga Khan UniversitySMART HEART PROGRAM
HABITS(Health Awareness By Imparting lifestyle Training to School children )
CVD poses a huge challenge with Obesity being the largest emerging global epidemic.
Yes, it is possible to nip the evil in the bud but to achieve that
All health care providers including public and private institutions, NGOs and professional bodies need to join hands and work together.
There is an imminent need for leadership to create a common platform and to provide direction.