Transcript Cardiovascular disease in Tangshan and in the Netherlands

Organizing the fight against
cardiovascular disease in
Tangshan and in the Netherlands
Tangshan, the 10th of March 2008
Prof. Ernst W. Roscam Abbing, MD, ML
Epidemiological transition
Infectious
chronic conditions
• All over world there has been or there is
going on a transition of infectious diseases
to chronic degenerative diseases, of which
the cardiovascular diseases are the most
important for the life expectancy;
• The transition is often slower in rural than
in urban areas.
Causes of death
• Netherlands 2005: 32% cardiovascular
diseases and 30% cancer;
• In the future the same in China and
Tangshan ?
The importance of cardiovascular disease (CVD) as cause of death worldwide
Trends in death rates in the
Netherlands
deathcases per 100.000
cancer, men
cancer, women
cardiovascular dis., men
cardiovascular dis., women
Cardiovascular disease:
(morbidity)
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Myocardial infarction;
Chronic heart failure;
Aneurysm of the aorta;
Stroke;
Other.
We concentrate on myocardial infarction and
stroke as the two most common events.
Raised blood pressure ( > 140 systolic and > 90 diastolic)
in China, Beijing 1996
n = 1439
Diabetes in China, Beijing 1999
n = 1474
Body Mass Index > 25 in China 2002 both urban and rural population
n = 220,000 adult men
Physical Inactivity among school children in their leisure time in China,
Beijing
n = 2326
Systolic blood pressure in the Netherlands 1999 – 2001
n = 5298
Raised cholesterol level in the Netherlands 1999 – 2001
n = 4878
Average yearly prevalence (per 1000) of
diabetes mellitus in the registration systems
of general practitioners in the Netherlands
men
women
age
Percentage children (4-15 y.) with overweight and
with obesity for age and sex in the Netherlands
boys with overweight
girls with overweight
boys with obesity
girls with obesity
age (years)
Netherlands: percentage smokers for age and sex in 2006
The importance of monitoring CVD in China:
Monitoring CVD with international standardized methods in
China is feasible and urgently needed in view of the rapid
socioeconomic development and transition of disease
patterns taking place in China.
Conclusion of the Sino-MONICA Project
(Circulation. 2001;103:462-468 )
Why is registration important, also in
Tangshan?
To know about:
• Which preventable diseases are important in
your population?
• Which subpopulations (age, sex, educational
level, occupation, etc) are most at risk?
• Which are the ongoing trends for those
diseases in those subpopulations?
• Do preventive interventions make a
difference in those trends?
Risk factors for CVD
Genetics
Blood pressure
Myocardial infarction
and
Cholesterol level
and
Behavior
Glucose tolerance
Stroke
Weight (Obesity)
Behavioral risk factors:
- smoking;
- diet, too much and too fat;
- lack of exercise.
Possible interventions
Treatment of disease
Early detection of a starting, latent
disease and of an high risk profile,
stimulating awareness of risks.
Health promotion,
stimulating behavioral
change, sometimes
preventive medication
Cardiovascular risk management in
the Netherlands, the standard:
Distinction between two groups:
1. Patients who had already an episode of CVD or
who have diabetes II;
2. Patients without CVD or diabetes II, but with:
- systolic blood pressure > 140 mmHg
- total cholesterol . 6.5 m mol/l
- smoking, men 50 years and older
women 55 years and older
Making a risk profile of the
following factors:
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Age
Sex
Smoking
Systolic blood pressure
Spectrum of lipids (TC, HDL, TC/HDL ratio, LDL, triglycerides)
Blood glucose
Family history
Nutrition
Alcohol
Physical activity
Body mass index (weight in kg / quadrate of length in meters)
Subregion South-East Asia D
comprises amongst others:
India, Bangladesh, Myanmar,
Nepal;
Data for West Pacific Region,
subregion B with China in it
are not sufficiently available.
Why should an hospital be
interested in prevention ?
• First of all to keep the people as long as
possible healthy;
• But also to build a referral network, which
strengthen the position of the hospital in
the area.
Different types of prevention, characterized by
target group, indication and situation:
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General population;
Groups, like children, elderly, etc;
Groups at risk like smokers;
Visitors of health facilities, like the general
practitioner, the health centre, the hospital:
= visitors with symptoms not related with
vascular disease and risk;
= visitors with symptoms related with risk
factors, like high blood pressure, smoking etc;
= visitors with symptoms of (beginning)
cardiovascular disease.
Possible prevention within the
hospital:
• At the departments for cardiology,
nephrology, pulmonology and neurology
recovering patients could be helped
(referred to a supporting program) to quit
smoking;
• Smoking in the hospital itself could be
reduced.
Collaboration between public health service,
general practitioner and hospital in the
Netherlands:
- Public health service (municipal health
service): epidemiology and offering programs
for groups; (facilitating) mass screening;
- General practitioner (GP): detection of
patients at risk and referral;
- Hospital: support of the GP with laboratory
facilities and in some cases treatment.
Possible translation to the Tangshan
preventive and curative heath care of CVD:
• The Tangshan public health bureau:
epidemiology and planning of mass health
promotion and screening;
• 20 health stations of the Tangshan
Workers Hospital can play a role
comparable with the Dutch GP-role;
• The hospital can support the 20 health
stations in their diagnostic activities and
treat some patients. It can be the centre of
a collaboration network.