ihd
Table of Contents
ischaemic heart disease (IHD)
see also:
Epidemiology:
general points:
- also referred to as coronary artery disease (CAD)
- incidence of coronary events = rate of occurrence of totality of fatal & non-fatal events
- strictly speaking incidence should refer only to 1st event not recurrences but these are often lumped together in which case should be referred to as event rates
- mortality from coronary heart disease is usually measured as annual umber deaths per 100,000 pop.
- case fatality = risk of death after an event (ie. proportion who die within a set period after an event)
USA:
- 1 million deaths per year = 50% of all deaths
- 160,000 deaths occurred in people < 65 yrs old (45% of all AMI's occur in this age group)
- 2/3rds of sudden deaths ffrom IHD occur outside hospital & usually within 2hrs of onset of symptoms
- >50% are women
- 5 million years of potential life is lost per year due to cardiovascular disease & costs > $US100b/year
- there has been a 54% reduction in age-adjusted mortality from IHD from 220/100,000 pop. in 1963 to 101/100,000 pop. in 1990:
- 25% fall in incidence
- 25% fall in case fatality rate:
- 30% mortality pre-CCUs
- 15% mortality post-CCUs
- 12.5% mortality post-CCUs with emphasis on decreasing MVO2
- 5% mortality with introduction of thrombolytic therapy
- cocaine abuse:
- accounts for ~25% of non-fatal AMI's in those aged 18-45yrs with peak age of 32yrs
- relative risk of AMI is 24x during the 1st hour after use
Australia:
- mortality rates per 100,000:
- 1950-1970:
- men aged 20-69:
- all causes: ~700
- all cardiovascular: ~350
- coronary heart disease: ~230
- stroke: ~50
- women aged 20-69:
- all causes: 460 declining to 380
- all cardiovascular: 210 declining to 160
- coronary heart disease: ~75
- stroke: 75 declining to 40
- since 1970 there has been a steady decline in mortality such that by 1994:
- men aged 20-69:
- all causes: 390 (46% fall from 1967)
- all cardiovascular: ~100 (67% fall from 1967)
- coronary heart disease: ~90 (69% fall from 1967)
- stroke: ~15? (73% fall from 1967)
- women aged 20-69:
- all causes: ~230 (46% fall from 1967)
- all cardiovascular: ~40 (71% fall from 1967)
- coronary heart disease: ~25 (71% fall from 1967)
- stroke: ~10 (77% fall from 1967)
- 28 day AMI case fatality rates in Australia:
- 31% in 1960's, 25% in 1970's, 18% in 1980's
- under 65yrs: 10.7% 1984-6; 8.4% 1987-9; 7.5% 1990-2;
Risk factors for coronary artery disease:
- these are essentially those for atherosclerosis and primary prevention
- Emerging risk factors for ACS include:
- C-reactive protein (reduced by statin therapy)
- raised homocysteine
- amyloid A
- interleukin-6
- low activity of interleukin-1 (raises LDL, 15% incr. risk IHD, also risk for AAA)
- genetic
- drugs such as anakinra
- mercury
- sleep-disordered breathing
- coffee (only in slow-caffeine metabolisers!)
- obesity (using waist-to-hip ratio not simply BMI).
- Consumption of alcohol of any type 3-4 times a week is protective. ref
taking a family history:
- consider:
- number of relatives at risk & their sex, age & age at which they developed disease
- whether another explanation for coronary disease (eg. smoking, diabetes) exists
- when is a 'positive' FH really STRONG?
- several of 1st degree relatives have been affected
- disease developed at a young age (< 65yrs)
- cases include females
- affected persons didn't smoke
- when is a 'negative' FH really PROTECTIVE?
- family is large, yet few developed disease
- most members lived to a ripe old age
- no disease develops despite a large number of smokers
ihd.txt · Last modified: 2015/02/28 22:32 by gary1
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