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| ====== Global Burden of Disease: Coronary Artery Disease (CAD) ====== | ====== Global Burden of Disease: Coronary Artery Disease (CAD) ====== | ||
| - | <box 40%| > {{:w09.jpg|}} </box| Figure 1 - Normal vs Narrowed Artery with Plaque Accumulation in CAD > | + | <box 35%| > {{:cad1.jpg|}} </box| Figure 1: Fatty deposit build up in coronary artery disease (CAD) Retrieved from https://www.mountelizabeth.com.sg/facilities-services/centre-excellence/heart/conditions > |
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| - | <box 72% round | > {{:w11.jpg|}} </box| Figure 2 - Pie Chart Representing the Major Contribution of Ischemic Heart Disease as Compared with Other Cardiovascular Diseases. (Wong, 2014)> | + | <box 72% round | > {{:w11.jpg|}} </box| Figure 2 : Pie Chart Representing the Major Contribution of Ischemic Heart Disease as Compared with Other Cardiovascular Diseases. (Wong, 2014)> |
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| - | <box 49% round| > {{:w10.jpg|}} </box| Figure 3 - Bar Graph Indicating Increased Prevalence of Atrial Fibrillation in Men vs Women. (Benjamin et al., 2014)> | + | <box 49% round| > {{:w10.jpg|}} </box| Figure 3 : Bar Graph Indicating Increased Prevalence of Atrial Fibrillation in Men vs Women. (Benjamin et al., 2014)> |
| ==== Prevalence and Mortality Rate ==== | ==== Prevalence and Mortality Rate ==== | ||
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| - | <box 88% round | > {{:w07.jpg|}} </box| Figure 4 - Pie Chart Representing the Major Contribution of Ischemic Heart Disease as Compared with Other Cardiovascular Diseases. (Wong, 2014)> | + | <box 88% round | > {{:w07.jpg|}} </box| Figure 4 : Pie Chart Representing the Major Contribution of Ischemic Heart Disease as Compared with Other Cardiovascular Diseases. (Wong, 2014)> |
| ==== Global and Regional DALY ==== | ==== Global and Regional DALY ==== | ||
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| - | <box 44% round | > {{:w02.jpg|}} </box| Figure 5 - Observed Increase in Global DALY Measurement (WHO, n.d.)> | + | <box 44% round | > {{:w02.jpg|}} </box| Figure 5 : Observed Increase in Global DALY Measurement (WHO, n.d.)> |
| - | <box 44% round | > {{:w01.jpg|}} </box| Figure 6 - Observed Increase in South-East Asian DALY Measurement (WHO, n.d.)> | + | <box 44% round | > {{:w01.jpg|}} </box| Figure 6 : Observed Increase in South-East Asian DALY Measurement (WHO, n.d.)> |
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| - | <box 38% round | > {{:AA.png?371x265|}} </box|Figure 7: Plaque Accumulation in a Coronary Artery, Retrieved from: http://www.montcopa.org/ImageRepository/Document?documentID=12042> | + | <box 45% round | > {{:w14.jpg|}} </box|Figure 7: Plaque Accumulation in a Coronary Artery, Retrieved from: http://www.montcopa.org/ImageRepository/Document?documentID=12042> |
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| Physiologically, high cholesterol, high blood pressure, and high blood sugars (diabetes) have all been reported as key risk factors for CAD (Coronary Artery Disease Risk Factors, 2016). In addition, one’s risk for developing CAD increases greatly as the number of risk factors an individual possess increases (CADRF, 2016). Fortunately because of the advances in medicine, there are numerous pharmacological treatment options available for combating each and every single one of these aforementioned risks. Furthermore, there are also non-modifiable risk factors for which someone can do nothing about. These include age, sex, and ethnicity (CADRF, 2016). | Physiologically, high cholesterol, high blood pressure, and high blood sugars (diabetes) have all been reported as key risk factors for CAD (Coronary Artery Disease Risk Factors, 2016). In addition, one’s risk for developing CAD increases greatly as the number of risk factors an individual possess increases (CADRF, 2016). Fortunately because of the advances in medicine, there are numerous pharmacological treatment options available for combating each and every single one of these aforementioned risks. Furthermore, there are also non-modifiable risk factors for which someone can do nothing about. These include age, sex, and ethnicity (CADRF, 2016). | ||
| + | <box 30% round right| > {{:w12.jpg|}} </box| Figure 10 - Risk factors for CAD. Retrieved from: https://www.emaze.com/@ALCFLOQO/Heart-Disease> | ||
| ====Lifestyle Risk Factors==== | ====Lifestyle Risk Factors==== | ||
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| To further complicate the problem, individuals in developing nations simply lack the access to affordable and reliable healthcare facilities to adequately treat their chronic conditions. In addition, healthcare systems around the world are reactionary in nature and tend to treat diseases only when the patient manifests symptoms rather than preventing the disease in the first place. This approach to healthcare is especially problematic for chronic diseases such as CAD for which there appears to be no immediate cure but rather the only plausible medical solution is to manage the current conditions to not allow any advancement in the disease. Unfortunately, this approach to disease is extremely expensive, and thus simply impractical for many living in developing nations. Thus without the proper medical management of CAD in addition to rising global life expectancies, especially in predominantly developing parts of the world, the global burden of CAD will undoubtedly increase for the foreseeable future (World Health Organization, n.d.). The most effective long term strategy for combating CAD should focus on preventing any and all risk factors associated with CAD from occurring in the first place. | To further complicate the problem, individuals in developing nations simply lack the access to affordable and reliable healthcare facilities to adequately treat their chronic conditions. In addition, healthcare systems around the world are reactionary in nature and tend to treat diseases only when the patient manifests symptoms rather than preventing the disease in the first place. This approach to healthcare is especially problematic for chronic diseases such as CAD for which there appears to be no immediate cure but rather the only plausible medical solution is to manage the current conditions to not allow any advancement in the disease. Unfortunately, this approach to disease is extremely expensive, and thus simply impractical for many living in developing nations. Thus without the proper medical management of CAD in addition to rising global life expectancies, especially in predominantly developing parts of the world, the global burden of CAD will undoubtedly increase for the foreseeable future (World Health Organization, n.d.). The most effective long term strategy for combating CAD should focus on preventing any and all risk factors associated with CAD from occurring in the first place. | ||
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| - | <box 26% round left| > {{:ang1.jpeg|}} </box| Figure 10: Coronary Artery Bypass Graft Surgery (CABG) performed using the saphenous vein from the leg to bypass blockage in the right coronary artery (University of Maryland Medical Center, 2017)> | + | <box 26% round left| > {{:ang1.jpeg|}} </box| Figure 11: Coronary Artery Bypass Graft Surgery (CABG) performed using the saphenous vein from the leg to bypass blockage in the right coronary artery. Retrieved from: http://umm.edu/health/medical/ency/presentations/heart-bypass-surgery-series> |
| - | CABG the most common type of heart surgery, is performed to improve blood flow into the heart. This surgery is performed by connecting a healthy artery or vein from another part of your body such as from the leg, chest, or arm to the blocked coronary artery. The healthy artery or vein bypasses the blocked or narrowed part of the artery, thus providing a new pathway for oxygen-rich blood to flow to the heart. During CABG, the breastbone is divided and the heart is stopped to send blood through a heart-lung machine. It is important to note that bypass surgery will not cure coronary artery disease, but it will improve heart function and reduce the risk of dying of heart disease (National Heart, Lung, and Blood Institute, 2016). After the surgery, it is important that the patient takes time to recover. During the recovery period, a patient may participate in a cardiac rehabilitation program under the direct supervision of medical professionals. | + | CABG the most common type of heart surgery, is performed to improve blood flow into the heart. As seen in figure 11, this surgery is performed by connecting a healthy artery or vein from another part of your body such as from the leg, chest, or arm to the blocked coronary artery. The healthy artery or vein bypasses the blocked or narrowed part of the artery, thus providing a new pathway for oxygen-rich blood to flow to the heart. During CABG, the breastbone is divided and the heart is stopped to send blood through a heart-lung machine. It is important to note that bypass surgery will not cure coronary artery disease, but it will improve heart function and reduce the risk of dying of heart disease (National Heart, Lung, and Blood Institute, 2016). After the surgery, it is important that the patient takes time to recover. During the recovery period, a patient may participate in a cardiac rehabilitation program under the direct supervision of medical professionals. |
| - | PCI, which is also known as coronary angioplasty, is a nonsurgical procedure often used to open blocked or narrow coronary arteries. The procedure requires cardiac catheterization which involves the insertion of a hollow tube (catheter) with a small inflatable balloon at its tip covered with a stent. The inserted balloon catheter then compresses the plaque and opens up the blocked artery. The inserted stent then remains in the artery holding it open (National Heart, Lung, and Blood Institute, 2016). | + | As seen in figure 12, PCI, which is also known as coronary angioplasty, is a nonsurgical procedure often used to open blocked or narrow coronary arteries. The procedure requires cardiac catheterization which involves the insertion of a hollow tube (catheter) with a small inflatable balloon at its tip covered with a stent. The inserted balloon catheter then compresses the plaque and opens up the blocked artery. The inserted stent then remains in the artery holding it open (National Heart, Lung, and Blood Institute, 2016). |
| - | <box 36% round right| > {{:ang2.jpg|}} </box| Figure 11: Percutaneous coronary intervention (PCI). Retrieved from: http://www.premierheartcarett.com/coronary-angioplasty-pci> | + | <box 36% round right| > {{:ang2.jpg|}} </box| Figure 12: Percutaneous coronary intervention (PCI). Retrieved from: http://www.premierheartcarett.com/coronary-angioplasty-pci> |
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| - | **Life Style Modifications** | + | ====Life Style Modifications==== |
| Lifestyle modifications are important for both preventing, and treating CAD. They include: proper nutrition, and regular physical activity. | Lifestyle modifications are important for both preventing, and treating CAD. They include: proper nutrition, and regular physical activity. | ||
| - | ===Nutrition=== | + | **Nutrition** |
| In general, avoiding a lot of red meat, sugary foods and beverages, and trying to lower your consumption of saturated and trans fat are crucial for reducing your risk of CAD. Saturated fat and trans fat, are known to raise blood cholesterol levels and thus it's important to consume more sources of monounsaturated and polyunsaturated fats which are known to help lower blood cholesterol levels. For example, avocados, salmon & trout, nuts and seeds, olive, canola, peanut , tofu are all great sources of monounsaturated and polyunsaturated fats. In addition, limiting the amount of alcohol you consume and quitting smoking, are also essential in reducing your risks of CAD (National Heart, Lung, and Blood Institute, 2016). | In general, avoiding a lot of red meat, sugary foods and beverages, and trying to lower your consumption of saturated and trans fat are crucial for reducing your risk of CAD. Saturated fat and trans fat, are known to raise blood cholesterol levels and thus it's important to consume more sources of monounsaturated and polyunsaturated fats which are known to help lower blood cholesterol levels. For example, avocados, salmon & trout, nuts and seeds, olive, canola, peanut , tofu are all great sources of monounsaturated and polyunsaturated fats. In addition, limiting the amount of alcohol you consume and quitting smoking, are also essential in reducing your risks of CAD (National Heart, Lung, and Blood Institute, 2016). | ||
| - | ====Physical Activity==== | + | **Physical Activity** |
| Regular physical activity has been shown to improve symptoms and reduce mortality in patients with CAD. According to a study conducted in 2001, patients in the training group experienced fewer cardiac events and had a lower number of hospital readmissions. The total mortality of patients with CAD was found to be reduced by about 27% and 31%, as a result of the exercise training (Erbs, Linke & Hambrecht, 2006), (Jolliffe, Rees, Taylor, Thompson, Oldridge,& Ebrahim, 2001). | Regular physical activity has been shown to improve symptoms and reduce mortality in patients with CAD. According to a study conducted in 2001, patients in the training group experienced fewer cardiac events and had a lower number of hospital readmissions. The total mortality of patients with CAD was found to be reduced by about 27% and 31%, as a result of the exercise training (Erbs, Linke & Hambrecht, 2006), (Jolliffe, Rees, Taylor, Thompson, Oldridge,& Ebrahim, 2001). | ||
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| ======Future Global Burden====== | ======Future Global Burden====== | ||
| The global burden of coronary artery disease (CAD) is expected to increase in the future. This is especially true in developing countries due to a large population size, low education level, poor lifestyle choices and poor healthcare facilities. According to the Global Burden of Disease Study, developing countries contributed 3.5 million of the 6.2 million global deaths from CAD in 1990 (Murray and Lopez, 1996). This study estimates that the developing countries will account for 7.8 million of the 11.1 million deaths due to CAD by 2020 (Murray and Lopez, 1996). This study provides evidence for an increased economic burden of CAD from only developing countries and all the countries of the world. | The global burden of coronary artery disease (CAD) is expected to increase in the future. This is especially true in developing countries due to a large population size, low education level, poor lifestyle choices and poor healthcare facilities. According to the Global Burden of Disease Study, developing countries contributed 3.5 million of the 6.2 million global deaths from CAD in 1990 (Murray and Lopez, 1996). This study estimates that the developing countries will account for 7.8 million of the 11.1 million deaths due to CAD by 2020 (Murray and Lopez, 1996). This study provides evidence for an increased economic burden of CAD from only developing countries and all the countries of the world. | ||
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| + | <box 80% round| > {{:w13.jpg|}} </box| Figure 13: Global Shift in Burden of CAD (Wang, 2014).> | ||
| ======References====== | ======References====== | ||
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| Mayo Clinic Staff (2015). Coronary artery disease: Symptoms. Retrieved January 15, 2016 from http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/dxc-20165314 | Mayo Clinic Staff (2015). Coronary artery disease: Symptoms. Retrieved January 15, 2016 from http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/dxc-20165314 | ||
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| Murray CJL, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Disease, Injuries and Risk Factors in 1990 and Projected to 2020. Boston, Ma: Harvard University Press; 1996. | Murray CJL, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Disease, Injuries and Risk Factors in 1990 and Projected to 2020. Boston, Ma: Harvard University Press; 1996. | ||
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| Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., & Lucia, A. (2016). Epidemiology of coronary heart disease and acute coronary syndrome. Annals of Translational Medicine, 4(13). | Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., & Lucia, A. (2016). Epidemiology of coronary heart disease and acute coronary syndrome. Annals of Translational Medicine, 4(13). | ||
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| - | University of Maryland Medical Center. (2017). Heart Bypass surgery-series. Retrieved January 18 2017 from http://umm.edu/health/medical/ency/presentations/heart-bypass-surgery-series | ||
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| Wong, N. D. (2014). Epidemiological studies of CHD and the evolution of preventive cardiology. Nature reviews. Cardiology, 11(5), 276. | Wong, N. D. (2014). Epidemiological studies of CHD and the evolution of preventive cardiology. Nature reviews. Cardiology, 11(5), 276. | ||
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| Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance. The American Journal of Clinical Nutrition. http://doi.org/82/1/222S [pii] | Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance. The American Journal of Clinical Nutrition. http://doi.org/82/1/222S [pii] | ||
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| World Health Organization. (n.d.). Estimates for 2000-2012: Disease Burden. Retrieved from: http://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html | World Health Organization. (n.d.). Estimates for 2000-2012: Disease Burden. Retrieved from: http://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html | ||
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| World Health Organization (n.d.). 50 Facts: Global health situation and trends 1955-2025. Retrieved from: http://www.who.int/whr/1998/media_centre/50facts/en/ | World Health Organization (n.d.). 50 Facts: Global health situation and trends 1955-2025. Retrieved from: http://www.who.int/whr/1998/media_centre/50facts/en/ | ||
