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Prevention strategies Preventive CouncilPeshawar Heart Study
Prof Mohammad HafizullahProf Mohammad HafizullahCardiology DepartmentCardiology Department
Postgraduate Medical InstitutePostgraduate Medical InstituteLady Reading HospitalLady Reading Hospital
PeshawarPeshawar
Country Country YearsYears Groups ContrastedGroups Contrasted AgeAge CHD CHD Mortality Mortality
Ratio Ratio
SingaporeSingapore 1980-861980-86 South Asian vs ChineseSouth Asian vs Chinese 30-69 30-69 yrsyrs 3.83.8
FijiFiji 19801980 South Asian vs South Asian vs Melanesian Melanesian
40-59 40-59 yrsyrs 3.0 3.0
TrinidadTrinidad 1977-861977-86 South Asian vs AfricanSouth Asian vs African 35-69 35-69 yrsyrs 2.42.4
South South AfricaAfrica 19851985 South Asian vs South Asian vs
EuropeanEuropean35-74 35-74
yrsyrs 1.41.4
EnglandEngland 1979-831979-83 South Asian vs South Asian vs EuropeanEuropean
20-69 20-69 yrsyrs 1.41.4
Mortality from CAD in Indians andMortality from CAD in Indians and Pakistanis OverseasPakistanis Overseas
CAD in South Asians in UK
CAD in South Asians in UK
Early onset / malignant course
First MI 5 years earlier in average
Occurrence of first MI before the age of 40, 10
times higher (UK-Hughes 1989)
40% higher death rates across all age groups with
CAD
Two fold excess of deaths in men before the years
45
Prevalence of CAD (before 40 yrs) in the young:
West (less than 2%) South Asians (12%)
Early onset / malignant course
First MI 5 years earlier in average
Occurrence of first MI before the age of 40, 10
times higher (UK-Hughes 1989)
40% higher death rates across all age groups with
CAD
Two fold excess of deaths in men before the years
45
Prevalence of CAD (before 40 yrs) in the young:
West (less than 2%) South Asians (12%) McKeigue PM. Marmot MG. BMJ 1988;297:903.
Q: But can we fight the relentless onslaught of heart diseases?
Answer : NO
We have to PREVENT Heart problems
Ray of hope!
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EuroAction -SMOKING
Over half (58%) of the patients who were smokers prior to their coronary event had stopped by the end of the hospital programme.
One in five partners also stopped smoking cigarettes.
EuroAction- improvements in the dietary habits - pts and families Saturated fat consumption levels of patients
decreased by almost 16% (12% in partners)
Patients increased their consumption of fruit and vegetables by an average of 155 grams each day (113 grams each day for partners)
Patients increased fish consumption 58% ; (71% of partners) eating oily fish three times or more each week.
EuroAction- Physical activity
25% pts regularly active (20% of partners)
Absolute increase of 11% compared to baseline (5% in partners).
86% of pts (83% of partners) highly active; an improvement of around one-fifth against baseline.
Step counter showing an increase of 1362 steps (739 for partners) equates to around an extra three quarters of a mile each day.
Yes we can do it!
Pakistan Cardiac society established council of Preventive Cardiology
-‘preventive cardiology’. most arduous but very important job of looking after the orphan
Plan for every thing from the scratch and hopefully
develop it as a vibrant body so that we can set the program for whole of the country.
Prevention and Research
Prevention through research
Risk factors detection in major cities Risk factors in Karachi AKUH Risk factors in rural areas of Peshawar Risk factors in urban areas of Peshawar INTER HEART Heart File – wealth of data Peshawar Heart Study
PESHAWAR HEART STUDY(PHS)
CARDIOVASCULAR DISEASE RISK ASSESSMENT IN
DIFFERENT POPULATIONS OF PESHAWAR
AIMS OF PHS
To identify the risk factors for coronary artery disease (CAD) in various occupational groups of Peshawar.
Risk stratification (European Task Force risk scores).
AIMS
To determine any correlation between conventional risk factors, educational level social status and CAD risk score.
To determine risk score in “High-risk” occupations
Occupational groupsSecretariat 217Lawyers 159Journalists 150Meat related professions 156Class IV workers 157Teachers 429Nurses Total 1268
Peshawar Heart Study -Civil Secretariat
age
Total no 217 All males Age mean 42 + 9.032 Range 18- 59
0
5
10
15
20
25
30
35
40
30 40 50 59
Age
Peshawar Heart Study Civil Secretariat - BMI
Total no 217
BMI mean 25.88 (5.1) > 23 overweight > 25 obese > 30 OBESE
0
10
20
30
40
50
60
70
>23 >25 >30
BMI
Peshawar Heart Study - Weight
Civil Secretariat
Total no 217
Weight (Kg) Mean 72.57 (SD 11.1) Range 48- 105 > 70 = 52 > 80 = 22 >90 = 9 >100 = 1
0
10
20
30
40
50
60
>70 >80 >90 >100
WeightKg
Peshawar Heart Study - waist
Civil Secretariat
Total no 217 Waist > 86 cm (34 inch) South Asians > 102 cm (40.8 inch) Western standard
0
10
20
30
40
50
60
70
80
>86 >102
waist
Peshawar Heart Study –Blood Pressure
Civil Secretariat
Total no 217
Systolic Blood pressure > 120 mmHg =53.9% >140 mmHg =14.3% >160 mmHg = 3%
0
10
20
30
40
50
60
>120 >140 >160
Sys BP
Peshawar Heart Study –Blood Pressure
Civil Secretariat
Total no 217
Diastolic Blood pressure > 80 mmHg =47.5% >85 mmHg =41.6% >90 mmHg = 17.1%
0
5
10
15
20
25
30
35
40
45
50
>80 >85 >90
Dias BP
Peshawar Heart Study –Cholesterol
Civil Secretariat
Total no 217
Cholesterol > 150 mg/dl= 63 % > 180 mg/dl= 36.9% > 200 mg/dl= 22.6%
0
10
20
30
40
50
60
70
>150 >180 >200
Cholesterol
Peshawar Heart Study – Glucose
Civil Secretariat
Total no 217
Random Glucose Mean 112.6 (SD 40.36) Range 63-375 > 150 mg/dl= 11% 50% new cases 0
2
4
6
8
10
12
>150
Glucose
CURRENT MEDICALSTATUS
Lawyers
n=159
Teachers n=429
MRP*n=156
Sweepersn=157
Journalistn=150
Sectt**n=217
DIAB 10% 5% 4% 3% 0.6% 3%HTN 17% 4% 3.2% 6% 10% 5%
CAD 1.9% 3.4% 1.2% 0.6% 0.6% 1.3%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
*MRP: Meat Related Professions **Sectt: secretariat*MRP: Meat Related Professions **Sectt: secretariat
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
FAMILY HISTORY OF CAD
Lawyers
N= 159
Teachers
n=429
MRP
n=156
Sweepers
n=157
Journalists
n=150
Sectt
n=217
30 7.3 10 30 223737
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
CURRENT SMOKERS
Lawyers
n=159
Teachers
n=429
MRP
n=156
Sweepers
n=157
Journalist
n=150
Sectt.
n=217
13% 4% 25% 26% 36% 21%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
BODY MASS INDEX
Lawyers
N=159
Teachers
n=429
MRP
n=156
Sweepers
n=157
Journalist
n=150
Sectt:
n=217
Mean BMI 28 4 274 255 255 255 254
BMI > 25 77% 66% 36% 58% 44% 59%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
SYSTOLIC BP
Lawyers
N=159
Teachersn=429
MRP n=156
Sweepersn=157
Journalistsn=150
Sectt:n=217
Mean 132 18
13120
11919
12215
11418
12716
> 140 mmHg
59% 58% 28% 42% 20% 46%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
DIASTOLIC BP
Lawyers
N=159
Teachers
n=429
MRP
n=156
Sweepers
n=157
Journalists
n=150
Sectt:
n=217
Mean 85 11
8612
7711
8110
7612
8312
>90mmHg
49% 50% 17% 37% 14% 40%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
CHOLESTEROL
Lawyers
n=159
Teachersn=429
MRP n=156
Sweepersn=157
Journalistsn=150
Sectt:n=217
Mean 183 26
17120
16017
16720
15820
15850
>200mg/dl
28% 11% 5% 5% 12.8% 24%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
RANDOM BLOOD SUGAR
Lawyers Teachers MRP Sweepers Journalists Sectt:
Mean 113 52
10344
10546
10856
9832
11240
>180mg/dl
8% 5% 4.4% 6.3% 3% 5%
PESHAWAR HEART STUDYPESHAWAR HEART STUDY
EXERCISEDAILY FOR ≥ 20 MINS
Lawyers
n=159
Teachers
n=429
MRP
n=156
Sweepers
n=157
Journalist
n=150
Sectt.
n=217
31% 36% 33% 37% 26% 78%
Lessons to be learnt!
Redefine our enemiesStudy correlationsSet new goalsDevelop new strategiesAdherence to guidelines
Guidelines GPs/House staff/
doctors working in the periphery
Primordial Primary Secondary
prevention
Topics Diabetes Dyslipidaemia Hypertension Obesity Smoking Lack of exercise Metabolic syndrome
Guidelines
To disseminate the guidelines more effectively Symposia Workshops Media Print material
General population
Posters Translation in
local languages Pictorial Bill boards
0 Tolerance for Smoking 30 minutes of exercise
every day 120 systolic blood pressure
less than that 34 inch waist & no more 150 cholesterol less than
that 5 times fruits & vegetables
Preventive CouncilPakistan Cardiac society
Prevent a Heart attack Heart Mobile 0-30-120-34-150-5
Healthy Healthy HeartHeart
1. Awareness 2. Knowledge data base3. Capacity building
Undergraduate Medical training Projects for Community Medicine Curriculum/ Final year examination
Part of FCPS training program and examination
Preventive cardiology departments at Institutes/ departments
Recommendations
Foster healthy lifestyles and behaviors in schools.
● Improve education in prevention and nutrition in schools.
● Increase opportunities for physical activity in community, school, and work settings
Recommendations - food policy
● Change food policy to foster the reduction of sodium in the food
supply leading to a 5% per year decline the labeling of the nutritional
content
awareness about caloric value and cholesterol content of diet
Recommendations
● Increase the visibility of preventive cardiology at national meetings attended by cardiologists and/or primary care providers.
● Encourage coordination between professional organizations
Message-Ways to healthy life
1.Search your house for enemies
2.Refuse to inhale nicotine3.Watch what you eat4.Take a walk!
Prevention of CVD
the challenge is huge, the path is arduous, resources are meager persistence is in demand,
BUT fruits are sweet
PCS –Preventive Council