WHO publishes definitive atlas on global heart disease and stroke epidemic

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WHO publishes definitive atlas on global heart disease and stroke epidemic
23 SEPTEMBER 2004 | GENEVA -- The atlas of heart disease and stroke, graphically detailing a global epidemic that is the leading single cause of death worldwide, was launched here today, to coincide with World Heart Day, Sunday 26 September 2004. The atlas is expected to provide a powerful advocacy tool to stimulate vital action and help promote constructive decision-making by governments, policymakers, national and international organisations, health professionals, individuals and families everywhere.

The atlas is published by the World Health Organization (WHO), in conjunction with the USA's Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services, and is strongly supported by NGOs such as the World Heart Federation (WHF).



Heart disease and stroke chart [gif 116kb]
Heart disease and stroke kill some 17 million people a year, which is almost one-third of all deaths globally. By 2020, heart disease and stroke will become the leading cause of both death and disability worldwide, with the number of fatalities projected to increase to over 20 million a year and by 2030 to over 24 million a year.

"The old stereotype of cardiovascular diseases affecting only stressed, overweight middle-aged men in developed countries no longer applies," said Dr Robert Beaglehole, WHO Director of Chronic Diseases and Health Promotion. "Today, men, women and children are at risk and 80% of the burden is in low- and middle-income countries. Heart disease and stroke not only take lives, but also cause an enormous economic burden. The atlas should be a significant new resource for global advocacy and education activity."

Dr Judith Mackay, co-author of the atlas with CDC's Dr George Mensah, said: “No matter what advances there are in high-technology medicine, the fundamental message is that any major reduction in deaths and disability from heart disease and stroke will come primarily from prevention, not just cure. This must involve robust reduction of risk factors, through encouraging our children to adopt healthy lifestyle habits and by introducing appropriate policies and intervention programmes.”

For the first time in one publication, the atlas captures updated data for each country, which is depicted through colourful maps, photographs and images and provides risk factor statistics for the occurrence of high blood pressure, tobacco, physical inactivity, obesity, lipids and diabetes. The diverse elements of this global epidemic including risk factors, similarities and differences between countries, the economic burden, prevention, policies and legislation, treatment and predictions are chronicled. A world data table is also published for the first time and gives statistics for each country, including the number of healthy life years lost to heart disease and stroke, the prevalence of smoking and the status of policies and legislation.

“While heart disease and stroke are eminently preventable, decision-makers and government funding agencies are, overall, neglecting this public health issue,” said Janet Voûte, CEO, WHF, an NGO dedicated to the global prevention of heart disease and stroke. “The WHF strongly endorses the atlas as a valuable resource for global advocacy and educational activity to fight the heart disease and stroke epidemic. We know how to reduce the burden of heart disease and stroke, but what is needed now is the combination of necessary resources and political will by each country to take effective action."

The atlas is being launched to coincide with World Heart Day, which is a major driving force for encouraging global heart disease and stroke prevention. The focus this year is Children, Adolescents and Heart Disease, because children are increasingly adopting unhealthy lifestyles. Obesity, poor diets, smoking and physical inactivity, the leading causes of heart disease and stroke, are now being seen at an alarmingly early age. Around 100 countries will take part in this, the fifth annual, World Heart Day, with member societies organising educational activities for everyone to get involved. Thousands of people around the world will join one of the walks, runs, jump rope or fitness sessions, have a health check or learn about heart-healthy lifestyles from the public talks, scientific forums and exhibitions.

heart diseases

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heart diseases
Heart diseases are number one killer in the world. There are many different forms of heart diseases. Mostly heart diseases are caused due to narrowing or blockage of the coronary arteries, the blood vessels that supply blood to the heart. This heart disease is called coronary artery disease and happens slowly over time. This blockage causes major heart attacks.

The problem that happens with heart is valve problem. In this problem, heart may not pump well and cause heart failure. Some people are born with this kind of heart disease.

ischemic heart disease

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ischemic heart disease
Apart from chest pain, other symptoms that accompany Ischemic Heart Disease include back pain, pressure in the chest area, shortness of breath, and extreme fatigue. Pain from angina is usually known to radiate down a person’s left arm, jaw and back. This type of pain is worsened by any form of exercise, but relieved by periods of rest. Usually the pain may be accompanied by excessive sweating.

Other signs that accompany ischemia include obesity, thyroid and vascular disease, anemia, and tendon xanthomas, a thickening in the Achilles tendon.

Ischemia Heart Disease may also result in sudden death, also known as a massive heart attack. Nearly 250,000 people succumb to sudden cardiac death each year. This fatal condition is caused by ventricular fibrillation, an abnormal heart rhythm that renders the heart unable to contract, resulting in a cessation of blood flow to the brain as well as other vital organs of the body. Unless immediate CPR is performed or electric shock delivered via a defibrillator, a person suffering from this condition is likely to die.

The doctor will subject the patient to an exercise stress test while the patient is wearing a Holter monitory. This battery-operated tape recorder is a portable electrocardiogram that reads a person’s heart movements for a period of 24 to 48 hours in order to detect ischemia.

The doctor may also order an echocardiogram to check for any abnormalities in the heart’s chambers and to assess the efficiency of the heart’s pumping action. Myocardial perfusion scanning is also useful in diagnosing ischemia, as is having a coronary angiogram taken to accurately pinpoint the extent and location within the coronary arteries that experience hardening and narrowing.

One other diagnostic tool that makes use of imaging technology is nuclear myocardial imaging, which utilizes radioactive tracers to monitor the journey of the blood towards the heart muscle.

There are various therapies geared at treating Ischemic Heart Disease. Doctors may describe nitrates that work to dilate coronary arteries that have narrowed. When placed under the tongue, they can relieve chest pain in minutes. Other medications, such as Isosorbide Mononitrate and Isosorbide Dinitrate are prophylactics that prevent the occurrence of pain.

Pain relief may also be achieved my reducing the demand for oxygen and decreasing a person’s heart rate through the use of Beta-blockers. Calcium channel antagonists are able to dilate constricted blood vessels, as well as lower a person’s excitability, blood pressure, and cholesterol levels. Daily aspirin intake is known to thin the blood and prevent platelets from forming into blood clots.

Surgery is a last resort option if medical therapy has failed to relieve a person’s ischemia symptoms. This is particularly true if an angiogram result reveals significant levels of blockage in the blood vessels. These surgical procedures include Coronary Angioplasty, a process of dilating a congested blood vessel by inflating a balloon within the blood vessel itself. Coronary Artery Bypass Grafting, meanwhile, involves replacing part of a deceased artery with soft tissue grafted from the patient’s body.

A patient who has been diagnosed with Ischemic Heart Disease will need to make certain lifestyle changes in order to ward off symptoms of ischemia. These lifestyle changes will include avoiding stress, smoking, a high fat diet, and a sedentary lifestyle.

Risk Factors for Heart Disease

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Risk Factors for Heart Disease
The reason why some people and not others develop coronary heart disease is not fully understood. It is known that certain factors, called "risk factors" can increase the risk of a person developing the disease.

Risk factors can be divided into two groups 'modifiable' and 'non-modifiable' risk factors;

Modifiable risk factors - these are risk factors that can be changed including:

High Blood Lipids (Fats)

High Blood Pressure

Diabetes

Being Overweight

Smoking

Lack of Physical Activity

Poor Eating Habits

Depression
Non-modifiable risk factors - these are risk factors that can't be changed including:

Age & Sex

Family History

Ethnicity

Stable Angina

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Stable Angina

You will usually get your angina by doing something energetic or by getting excited or upset. You might find it worse in cold weather. We call this kind of angina "stable" angina.

Angina is caused by the heart muscle not getting enough blood; it occurs when there is an insufficient supply of blood due to the narrowing of the coronary arteries (blood vessels) that bring blood to the heart muscle. Normally there is a sufficient flow of blood to the heart muscle at rest or during light activity. With more energetic activity (or when you get excited or angry) the heart has to pump harder and faster and the muscle need more blood (just like a car uses more petrol when it goes faster or climbs a hill). If the coronary arteries are narrowed the blood flow passing through them cannot increase and the heart muscle complains about the blood supply not matching what it needs. You feel this as angina. In many ways angina is like a muscle cramp in the arm or leg; which occurs when the working muscle does not get enough blood to match what it needs. Angina warns you to stop and rest for a few minutes or calm down a bit. Unstable Angina

If your angina suddenly comes on more often and/or the attacks are more uncomfortable or last longer, we call it "unstable" angina. It is much less common than "stable" angina. The attacks may come on with less exercise than usual or even at rest. Sometimes this is how a patient first experiences angina but very often unstable angina happens in a patient who has previously had ordinary (or "stable") angina for months or years.

Unstable angina occurs when an artery becomes very narrow indeed, so that even the blood supply to the heart muscle when you are at rest may not be enough. Unstable angina is an emergency and requires urgent admission to hospital.

'Silent' Heart Attacks Often Unnoticed

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'Silent' Heart Attacks Often Unnoticed

Nearly 200,000 people are affected by an undiagnosed, or “silent,” heart attack in the United States each year, according to a new study by Duke University Medical Center Researchers.

A silent heart attack is both silent and potentially deadly, because no typical signs such as shortness of breath and severe chest pain are present.

Researchers estimate about 40 to 60 percent of all heart attacks may be of this “silent” type.

Silent heart attacks, also called non-Q-wave unrecognized myocardial infarctions (UMIs) often go undetected because the person doesn’t experience any pain and telltale irregularities are often undetectable on electrocardiograms (EKGs).

"No one has fully understood how often silent heart attacks occur and what they mean, in terms of prognosis," says Han Kim, MD, a cardiologist at Duke and the lead author of the study.

A heart attack is typically caused by a clot interfering with the flow of blood from a coronary artery to the heart. Well-known symptoms include severe chest pain, fainting, nausea and shortness of breath.

Risk factors are one in the same for both silent heart attacks and regular heart attacks, say experts, and include diabetes, stress, smoking and family history.

For the study, researchers used a new technique called DE-CMR (delayed enhancement cardiac magnetic resonance) on 185 patients who had never had a diagnosed heart attack but were suspected of having coronary artery disease.

A heart attack that occurred in the past may still leave a specific alteration on an ECG called a Q-wave, which signals the presence of damaged tissue. While silent heart attacks do not have associated Q-waves.

They followed up with patients after two years and found that 35 percent of patients had evidence of a heart attack and that silent heart attacks without Q-waves were three times more common than those that had Q-waves.

Those patients with non-Q-wave silent heart attacks also had 11 times greater risk of death from any cause and a 17-fold risk of death from heart problems compared with patients without heart damage.

Currently, there are no definitive treatment guidelines about how patients with UMIs should be treated, says Kim.

“If patients with UMIs are identified, they are typically treated similarly to those patients where heart disease has been previously documented. In future studies, researchers will likely examine how common unrecognized non-Q-wave heart attacks are in other patient groups and how UMIs should be treated

Ischemic Heart Disease

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Ischemic Heart Disease
Ischemic Heart Disease, also known as Coronary Artery Disease, is a condition that involves the accumulation of fatty deposits within the cells that line the walls of the arteries. There are two main coronary arteries that lead to the heart and provide its main source of blood. When these arteries are gradually suffused with a slow build-up of fatty deposits, it narrows these blood supply passages in a process known as atherosclerosis.

Atherosclerosis not only impedes the supply of blood to the heart, it also hardens the coronary arteries. Atherosclerosis eventually leads to ischemia, a condition wherein the heart muscle becomes deprived of oxygen-rich blood, which results in damage to the heart muscle and a possible occlusion of the blood vessels. When this occurs, a person may suffer from a myocardial infarction, more infamously known as a heart attack.

There are as many as 4 million Americans who have Ischemic Heart Disease or experience episodes of ischemia without being aware of it. Some cases of ischemia are asymptomatic, and there is a complete absence of pain. These cases are known as silent ischemia, and may give rise to a heart attack without any warning signs at all. Silent ischemia is prevalent among people suffering from angina, those who have had a history of heart attack, or people suffering from diabetes.

Ischemic Heart Disease is one of the most common causes of cardiovascular disease and a leading cause of death in the United States, responsible for nearly 500,000 deaths annually. It affects more men than women and occurs between the ages of 35 and 55 years for both sexes. There are about 14 million people who suffer from Ischemic Heart Disease in the country, and are at a higher risk for contracting angina, myocardial infarction, and sudden death.

Ischemic Heart Disease has been known to develop due to several risk factors such as having high cholesterol levels, diabetes mellitus and smoking. People who suffer from high blood cholesterol or hypercholesterolemia have a higher degree of risk for developing ischemia.

Other risk factors that may cause Ischemic Heart Disease are hypertension, genetic and hereditary factors, menopause, and stress.

Some of the complications arising from this condition include angina pectoris, or angina. This disorder is characterized by chest pain just underneath the breastbone. The pain is a result of a lack of oxygen to the heart caused by the plaque deposits irregularly lining the coronary arteries. Angina pectoris may be mild or intense, lasting up to several minutes at a time. There are approximately 350,000 cases of angina in the United States each year.

A person with Ischemic Heart Disease may also experience acute myocardial infarction, or heart attack. This occurs when the fatty deposits lining the coronary arteries develop a blood clot. This blood clot presents prevents the flow of oxygen-rich blood to the heart, and when this happens, a portion of the heart muscle may die, causing a heart attack. A person who has had a heart attack will bear a scar or fibrosis on the heart muscle, impairing the heart’s blood-pumping ability to some degree.