treating the turkish patient: is he different?€¦ · 52 24 19 14 5. 0 102030405060 kvh kanser....
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Treating the Turkish Patient: Treating the Turkish Patient: Is he different?Is he different?
Prof. Prof. MehdiMehdi ZoghiZoghi--EEgege University, University, İİzmirzmir
Prevention in Prevention in Coronary ArteryCoronary Artery DiseaseDisease
20112011
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καλωσόρισμαWELCOME
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5224
19
14
5
0 10 20 30 40 50 60
KVH
Kanser
İnfeksiyonlar
Akc hast.
AIDSHIV
Pulmonary disease
Infections
Cancer
CVD
The World Health Report 2004
Cardiovascular disease (CVD) is a major cause of death
throughout the world.
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Percentage of the population citing health as their main
concern before other
issues, such as financial problems,
housing or crime.
Health is among the top personal concerns
!
Primary
health care : Now
more than ever
The world health report 2008
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NHLBI. www.nhlbi.nih.gov
$54
$56
$133
$239
$368$368
$29
0 50 100 150 200 250 300 350 400
Billions of dollars
Congestive heart failure
Stroke
Hypertension
Coronary heart disease
Heart disease
Total CVD†
CVD=Cardiovascular disease
1 of every 3 deaths
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Coronary Artery Disease Coronary Artery Disease (CAD) in Turkey(CAD) in Turkey
•
New CAD: 300.000/year
•
CAD Mortality: 170.000/year
•
STEMI: 80.000/year
Turkish
Adult
Risk factor
StudyA. Onat Atherosclerosis
Risk Factors
2001;156,1-10
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45,2
8,5
0
10
20
30
40
50
1999
Over 60 yOver 80 y
Dea
th p
er 1
00,0
00 p
opul
atio
n
Think about where you're going to be in
20502050
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45,2
8,5
97
30
0102030405060708090
100
1999 2050 (estimate)
Over 60 y
Over 80 y
Dea
th p
er 1
00,0
00 p
opul
atio
n
20502050
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• The underling pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms
occur, generally in middle age.
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The major risk factors for CVD are well established, with the principal three modifiable factors being hypertension, dyslipidemia and smoking.
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Primary prevention can help prevent 80%
of coronary heart disease.
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Two complementary strategies that are usually advocated for primary prevention:
The population strategy
aims to reduce the burden of disease in the whole community while conferring small benefits to each individual.
The high-risk strategy, provides large benefits to the few individuals who are most vulnerable but the benefits to the whole community may be relatively limited because the beneficiaries are few.
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Risk prediction charts enable the estimation of total cardiovascular risk of
people in the first category.
Total cardiovascular risk means the likelihood of a person developing an atherosclerotic cardiovascular event over a
defined period of time.
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Both community-based primary prevention and secondary prevention are needed for
effective CVD prevention and control
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ON
TARGET
55 yrs
Cigarette smoking, Family history (+)
BP: 135/80 mmHg,
TC: 280 mg/dl, LDL-C: 130 mg/dl, HDL-C:35 mg/dl,
Blood glucose: 90 mg/dl, microalbuminuria (-)
ECG: Normal
Echocardiography: Normal
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ON
TARGET
http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof
10-year risk for developing CHD
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ON
TARGET
Individual counseling and provision of care may have to be prioritized according to cardiovascular risk.
Risk <10% Individuals in this category are at low risk. Conservative management focusing on lifestyle interventions is
suggested.
Risk
10% to <20%Individuals in this category are at moderate risk
of fatal or non-fatal vascular events.Monitor risk profile every 6–12 months.
Risk
>20%Individuals in this category are at high risk of
fatal or non-fatal vascular events.Monitor risk profile every 3–6 months.
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PRESENTATION NAMECompany name
Risk factor screening
Adults should know the levels and significance of risk factors as routinely
assessed by their primary care provider.
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Turkish Patient: Is he different?Turkish Patient: Is he different?
Prevention in Prevention in Coronary ArteryCoronary Artery DiseaseDisease
20112011
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The EUROASPIRE III survey was conducted in 2006-2007 in 22
countries in Europe to describe risk factors, lifestyle and
therapeutic management of patients with coronary heart
disease (CHD), compliance with current guidelines, and to
document changes over time.
EUROASPIRE : European
Action
on Secondary and
Primary
Prevention
by
Intervention
to
Reduce
Events
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EUROASPIRE : European
Action
on Secondary and
Primary
Prevention
by
Intervention
to
Reduce
Events
Eur
J Cardiovasc
Prev
Rehabil. 2009 Apr;16(2):121-37
1.
Belgium2.
Bulgaria
3.
Croatia4.
Cyprus
5.
Czech
Republic6.
Finland
7.
France8.
Germany
9.
Greece10.Hungary11.Ireland12.Italy13.Latvia14.Lithuania15.The
Netherlands
16.Poland17.Romania18.Russian
Federation
19.Slovenia20.Spain21.21.TurkeyTurkey22.United
Kingdom
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Compared to the EUROASPIRE III data, classical
risk factors did not exhibit
remarkable differences.
Records
from Turkish
centers:1.
Belgium
2.
Bulgaria3.
Croatia
4.
Cyprus5.
Czech
Republic
6.
Finland7.
France
8.
Germany9.
Greece
10.Hungary11.Ireland12.Italy13.Latvia14.Lithuania15.The
Netherlands
16.Poland17.Romania18.Russian
Federation
19.Slovenia20.Spain21.21.TurkeyTurkey22.United
Kingdom Tokgözoğlu
L et al. Turk
Kardiyol
Dern
Ars.
2010;38(3):164-72
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The most important differences were observed in the higher rates of the following:
•
Young patients with myocardial infarction (<50 years, 20% vs. 12.7%),
•
Persistence in smoking (23.1% vs. 17.2%), •
İmmobility,
•
Low HDL-cholesterol •
Insufficient follow-up by physicians after the index event (12% vs. 2.2%),
and •
Insufficient patient education.
EUROASPIRE III survey-Turkish
Data
Tokgözoğlu
L et al. Turk
Kardiyol
Dern
Ars.
2010;38(3):164-72
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Risk FactorEurope
(n=8966)Turkey(n=338)
Obesity 35,3 35,5
High BP 56.0 55.2
High Cholesterol 51.1 48.3
Low HDL 36.7 50.2
Diabetes 34.8 33.6
HDL was low in half of pts
Tokgözoğlu
L et al. Turk
Kardiyol
Dern
Ars.
2010;38(3):164-72
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1.
Romania2.
South Cyprus
3.
Turkey....
HDLFemale:46.0 vs
49.5 mgr/dl
Male: 39.4 vs
43.3 mgr/dl
Tokgözoğlu
L et al. Turk
Kardiyol
Dern
Ars.
2010;38(3):164-72
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HDL in Turkish
Population2
Reasons
for Low
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International Physical Activity Questionnaire
Physical ActivityEurope
(n=8966)Turkey(n=338)
Low 54.4 23.1High 39.4 10.5
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PREvention and CONtrol Program for Cardiovascular
Diseases in TuRkish POpuLation (PRE-CONTROL)
1) The level and distribution of cardiovascular risk factors in our population,
2) The knowledge and awareness of participants about CVD
3) The evaluation of the effectiveness of prevention education program on awareness of CVD in urban population of Turkey
EUROPREVENT 2011
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A 24-item questionnaire form
was used for detecting cardiovascular risk factors and the awareness of participants about CVD which was concerning personal and family history of disease, education levels, lifestyle factors and heart attack or stroke medications.
The Joint British
Societies’
cardiovascular disease risk prediction chart
was used
for
investigating cardiovascular risk levels (low risk < 10%; intermediate risk 10-20%; high risk > 20%) of participants.
Education programs feed-back data
were collected by questionnaires and individual interviews of participants after 2 weeks of education seminars by telephone surveys.
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Total cardiovascular risk
76,4
23,60
1020304050607080
Risk Score %
Moderate-High Low
ÖMER Kozan, MEHDİ
Zoghi, GÜLAY Güven
Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü, OKTAY Ergene
on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011
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PRE-CONTROL
PRE-CONTROL
Although the cardiovascular risk is high (moderate or high risk rate was 74.6%) the knowledge and
awareness of the risk factors for cardiovascular disease are low in our community.
•
Only 21% of participants with cardiovascular risk score more than 10%
have visited any physician within last year.
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PRE-CONTROL
PRE-CONTROL
Community-based educational programs are helpful to increase public
awareness, health promotion and management of
cardiovascular
diseases.
The awareness of cardiovascular diseases and risk factors was significantly increased following our
education programs.
ÖMER Kozan, MEHDİ
Zoghi, GÜLAY Güven
Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü, OKTAY Ergene
on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011
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Risk Factor
Sex: Male Male
Age (yrs): 36 50Smoker: - -Diabetes: - -Blood Pressure: 130/80 130/80 Total Cholestrol 200 200
HDL Cholesterol: 36 36
5%
10%
You can’t change everything
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Brigitte Bardot
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Marlon BrandoMarlon Brando
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Gregory PeckGregory Peck
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MadonnaMadonna
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AjdaAjda PekkanPekkan (Famous Turkish Pop Singer(Famous Turkish Pop Singer))
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DemisDemis RoussosRoussos
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Σας
ευχαριστώ
για
την προσοχή
σας