Global Impact of Cardiovascular Diseases Flashcards
Describe Atherosclerotic plaque formation
A – Endothelial dysfunction
Low-density lipoproteins (LDL) uptake into vessel wall and are oxidised to oxLDL.
Which Upregulate integrin receptors.
These bind to immune cells.
Uptake of immune cells into vessel wall
B – Immune cells (macrophages) take up oxLDL and form foam cells.
This causes Vascular remodelling - Fibrous cap formation over the necrotic core filled with immune cells and Oxydated LDL
C – Expanding neurotic core occurs which causes Thinning of fibrous cap – Unstable – Rupture Platelet aggregation – Thrombus formation (clotting) – Blocked artery
What are the central risk factors for atherosclerotic plaque formation?
Non-modifiable risk factors:
Age
Gender
Ethnicity
Genetics
Family history (too much cholesterol)
Modifiable risk factors:
Smoking
Hypertension
Diabetes
Dyslipidaemia
Physical inactivity
Dietary habits
What is the function of a healthy endothelium?
Essential for control of vascular functioning, e.g. helps maintain normal blood pressure and good blood flow to our end organs and tissues (controls vascular function).
How can these risk factors link to endothelial dysfunction (which illustrates atherosclerotic plaque formation)?
Risk factors:
Diabetes: Increased blood glucose –> greater oxLDLs (changes to how the endothelium functions)
Hypertension: Damage endothelium
Aging: Cellular senescence (cell stops dividing/growth arrest)– VSMCs cell growth arrested
Raised cholesterol: Linked to raised LDL levels
Obesity: Relates to ‘metabolic syndrome’ of
insulin resistance, dyslipidaemia, high blood pressure
Smoking: Damage endothelium-> they cause oxidative stress, produces free radicals
What are the result of endothelial dysfunction?
Lower vasodilators factors (NO) and higher contractile factors
e.g. greater risk of high blood pressure, vessels become more immunogenic
What are principles of treatment in high-income countries (the west)?
Prevention:
Governmental /societal measures:
- policies,
law,
education,
taxation,
public health initiatives (smoking ban, stop smoking clinics, protection of green spaces)
guidelines based on evidence-based medicine and science,
prediction of CVD (QRISK3 and JBS3 calculators) etc etc….
Treatment of risk factors:
e.g. Pharmacology - Anti-hypertensives,
statins,
prevent thrombosis (anti-platelet agents: aspirin, clopidogrel and anti-thrombotics: warfarin, heparin,
new anti-coagulants – NOACs);
Surgery – bariatric surgery
Treatment of event= opening the blocked artery.
Pharmacologically – thrombolytic agents (e.g. streptokinase)
Surgery – PCI (Stent) or By-pass graft
These involve primary and secondary care
What is the issue with CVD in high income countries?
Many patients present late:
e.g. sudden cardiac death, heart failure
Hence too late to do anything, will increase with aging population
Changes in location
Treatment does not equal cure:
- Long-term medication, treatments,
- hospitalisations,
- complications,
- co-morbidities,
- long-term problems – e.g. heart failure
Not all treatments are 100% effective
-Residual disease
- Recurrence
-non-compliance
This increases with the aging population
Treatments are costly:
Angiotensin receptor blockers (ARBs) are $80-300 per 30 day supply
Who can afford it? Insurance, NHS
You must maintain the treatment as well!
GLOBAL BURDEN of CVD?
- 18 million deaths caused by CVD in 2019
- 30% of all global deaths
- Nearly 400 million DALYS (10% of global DALYS)
- Massive economic burden
Financial impacts of CVD?
- Direct Costs:
- hospitalisation, treatments/procedures, outpatients,
- nursing homes etc.
Indirect Costs
-
Microeconomic effects
- Impact of CVD on the household
- Loss of economic power of the individual
- Lack of income
- Savings
- Cost of insurance (people live alone)
- Macroeconomic issues:
- Loss of economic productivity and economic growth of nations
How does the US combat the issue of CVDs?
To offset the health issues of the population and combat economic issues US spends 3% of its $17 trillion GDP on CVD = > $300 billion ($10K per capita)
What is the global issue of CVD?
Differences between HICs and LMICs
- Once thought that CVD was a rich nation issue
- Epidemiological transition worldwide
- CVD ON HICs and LMICs
HICs
- world bank states that approx. $13 000 per capita
- aVERAGE-> $50 000 PER CAPITA
- 80% Urbanisation
- Spend 10% on healthcare
- Life expectancy approx. 80 years old in Europe
LMICs:
- World bank states -< $1K per capita for LICs,
- >$4K-<$13K per capita for MICs
- Most populations in LMICs are becoming urbanised
- Changing landscape – e.g. 70% of elderly will be in LMICs!
What is happening to global CVD (rising)
- Global burden of disease study 1990-2019
- Cases: 270 to 523 million per year
- Deaths: 12 to 18 million per year
- DALYS, YLLs and YLDs all increased
- Where is this happening?
- HICs. Developing countries are on the rise though!!
- Years of life lost (YLLs) per 100,000 persons due to CVD in 2019
Describe (as a summary) the epidemiological transition
Stage 1: Age of pestilence and famine (life expectancy 35 yrs)
Stage 2: Age of receding pandemics (life expectancy 50 yrs)
Stage 3: Age of degenerative and man-made diseases (life expectancy >60 yrs)
Stage 4: Age of delayed degenerative diseases (life expectancy >70 yrs)
Describe stage 1 of the epidemiological transition
Stage 1: Age of pestilence and famine (life expectancy 35 yrs)
- Mainly deaths through infectious diseases and malnutrition
- <10% deaths caused by CVD (rheumatic/cardiac disease, sudden cardiac death)
- USA/Europe – mainly during 1500-1800s
- Continues in LMICs today (SSA where approx 60% of the world’s LICs lay)
Describe stage 2 of the epidemiological transition
Stage 2: Age of receding pandemics (life expectancy 50 yrs)
public health, agriculture (malnutrition is aliviated), healthcare
Emergence of risk factors for CVD, e.g. Hypertension, 10-30% deaths caused by CVD
Areas of China and India today
What are some strategies and solutions for CVD?
