La Malattia Cardiovascolare in EuropaLa Malattia Cardiovascolare in Europa (CVD) 1 E’ l E’ la...

La Malattia Cardiovascolare in Europa (CVD)(CVD)

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E’ l i i l di t t d il % di E’ la principale causa di morte contando per il 41% di tutti i decessi (Eurostat 2003)

1.2 milioni di decessi in Europa / annop /

1/3 degli anni di vita perduti per morte precocesecondaria a CVD

www.cardiovascularprevention.com

Maggiori cause di morte in EU anno 2003 per gruppi di 5 anni di età

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Maggiori cause di morte in EU anno 2003 per gruppi di 5 anni di età


Age-standardised death rates, per 100.000, fromCHD 68 l d i h ld ( )CHD, 1968-2002, selected countries, the world (1)

From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart diseaseCoronary heart disease statistics. British Heart Foundation: London.


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Age-standardised death rates, per 100.000, from CHD 68 l d i h ld ( )CHD, 1968-2002, selected countries, the world (2)



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EUROPE 1995-2006

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Cardiovascular Disease in United Kingdom -2006-Cardiovascular Disease in United Kingdom 2006

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Diseases of the heart and circulatory system (cardiovascular disease or CVD) are the main cause of y y ( )death in the UK and account for almost 198,000 deaths each year. More than one in three deaths (35%) are from CVD each year. The main forms of CVD are coronary heart disease (CHD: Acute myocardial infarction, Angina pectoris, sudden cardiac death) and stroke. About half (48%) of all deaths from CVD are from CHD and more than a quarter (28%) are from stroke.

CHD by itself is the most common cause of death in the UK Around one in five men and one in seven CHD by itself is the most common cause of death in the UK. Around one in five men and one in seven women die from the disease. CHD causes around 94,000 deaths in the UK each year.

Other forms of heart disease cause over 31,000 deaths in the UK each year so in total there were just under 126,000 deaths from heart disease in the UK in 2006.

Premature mortality(death before the age of 75). CVD is one of the main causes of premature death in the UK 30% of premature deaths in men and

22% of premature deaths in women were from CVD in 2006. CVD caused just over 53,000premature deaths in the UK in 2006.

CHD, by itself, is the most common cause of premature death in the UK About one fifth (19%) of premature deaths in men and one in ten (10%) premature deaths in women were from CHD.premature deaths in men and one in ten (10%) premature deaths in women were from CHD.

CHD caused almost 31,000 premature deaths in the UK in 2006. Other forms of heart disease cause more than 7,500 premature deaths in the UK each year. In total

there were over 38,000 premature deaths from heart disease in the UK in 2006 - around one fifth of all premature deaths.

From: Steven Allender, Viv Peto, Peter Scarborough, Asha Kaur and Mike Rayner (2008) Coronary heart disease statistics. British Heart Foundation: London.

6www.cardiovascularprevention.com

DEATHS BY SEX, AGE, UNITED KINGDOM -2006-2006-

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Incidenza in Italia per annop8

Sindromi coronariche acute 280 000 M Sindromi coronariche acute 280.000 M 78.000 F + 50.000 morti improvvise

S l il % d i tti f tt i di i hi Solo il 30% dei soggetti con fattori di rischiotradizionali manifesta segni di CAD

Studio: Pz giovani, 50 aa. senza FRC: nel% M % F IMA M t i 50% M, 25% F , IMA o Morte come prima

manifestazione di CAD, di questiIl 68% h t i i h b iti h < 50%Il 68% ha stenosi coronariche subcritiche, < 50%


Mortalità Per Grandi Gruppi anno 2002 - ISTAT (Italy)

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MalattieCardiovascolari 237.198

Tumori 163.070

Morte improvvisa 54 000Morte improvvisa 54.000


Numero dimessi 2004 - Ricoveri per ti acuti. (ISTAT – Italy)

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Tumori 761.5827 5

Malattie cardiovascolari 1.413.082


CONSUMO DI FARMACIConsumo nazionale di farmaci a carico del Servizio Sanitario Nazionale per categorie terapeutiche (ATC al I° livello) Anno 2005

CONSUMO DI FARMACI Consumo nazionale di farmaci a carico del Servizio Sanitario Nazionale per categorie terapeutiche (ATC al I° livello) - Anno 2005

CATEGORIA TERAPEUTICA DDD ogni 1.000 abitanti al giorno %Variazione percentuale

rispetto al 2004

CARDIOVASCOLARE 392,2 48,6 4,7GASTROINTESTINALE E METABOLISMO 92,9 11,5 5,3ANTIMICROBICI 24,2 3,0 4,8SISTEMA NERVOSO CENTRALE 46,3 5,7 7,1RESPIRATORIO 48 0 5 9 5 4RESPIRATORIO 48,0 5,9 5,4ANTINEOPLASTICI 5,7 0,7 -3,0EMATOLOGICI 72,3 9,0 6,6GENITO-URINARI E ORMONI SESSUALI 40,2 5,0 -1,8MUSCOLO-SCHELETRICO 37,9 4,7 -7,9ORMONI SISTEMICI 27,7 3,4 7,9ORGANI DI SENSO 15,7 1,9 0,8DERMATOLOGICI 3,0 0,4 -1,5VARI 0,2 0,0 -2,0ANTIPARASSITARI 0 6 0 1 3 5ANTIPARASSITARI 0,6 0,1 3,5

806,9 100,0 4,0

Fonte: AIFA - Rapporto nazionale OSMED sul consumo di farmaci 2005DDD - Daily Defined Dose (dose giornaliera di mantenimento in un adulto)

ITALY

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Fonte: AIFA Rapporto nazionale OSMED sul consumo di farmaci 2005


Particolari condizioni associate ad l t t lità di lelevata mortalità cardiovascolare

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Diabete mellito

Scompenso cardiaco

Ictus ischemico/emorragico/ g


U.S.A. Data 1999-200299913

Of the 71 300 000 American adults with 1 or more types of Of the 71 300 000 American adults with 1 or more types of cardiovascular disease (CVD), 27 400 000are estimated to be age 65 or olderg 5

High blood pressure 65 000 000. Coronary heart disease 13 200 000.y

– Myocardial infarction (MI, or heart attack)7 200 000.

– Angina pectoris (AP, or chest pain) 6 500 000.• Heart failure 5 000 000. Stroke 5 500 000. Congenital cardiovascular defects 1 000 000.


USA Death rate in 2003USA Death rate in 2003Th 2003 li i CVD d th t 364 2 f l• The 2003 preliminary CVD death rates were 364.2 for males and 262.5 for females.

• Cancer death rates were 232.3 for males and 160.2 for f lfemales.

• Breast cancer claimed the lives of 41 566 females in 2003.• Lung cancer claimed 67 894.g• Death rates for females were 25.2 for breast cancer and 41.1

for lung cancer. • One in 30 female deaths are from breast cancer while 1 in• One in 30 female deaths are from breast cancer, while 1 in

2.6 are from CVD. • Based on preliminary 2003 mortality, CVD caused about a

death a minute among females overdeath a minute among females over • 480 000 female lives every year.


U.S.A. Data 2003 & cost 2006


Other causes of death in 2003 in USA (preliminary data)

Cancer 554 643• Cancer 554 643• Accidents 105 695• Alzheimer’s disease 63 343

HIV (AIDS) 13 544• HIV (AIDS) 13 544.


CARDIOVASCULAR DISEASE IN CANADA (2)These statistics are based on 2004 data (from Statistics Canada)These statistics are based on 2004 data (from Statistics Canada)

Cardiac arrest

Ab t 40 000 C di i di tAbout 40,000 Canadians experience cardiac arrest every year.Less than 5% of those who have a cardiac arrest outside of a hospital

survive.

Congestive heart failure

It is estimated that there are 400 000 Canadians living with congestiveIt is estimated that there are 400,000 Canadians living with congestive heart failure (CHF).

StrokeStroke

More than 50,000 strokes occur in Canada each year. That’s one stroke every 10 minutes.y

Stroke is the third leading cause of death in Canada. Each year, more than 14,000 Canadians die from stroke.

Each year, more women than men die from stroke.

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y


ACUTE CORONARY SINDROME IN INDIA

18 India has the largest percentage of heart disease in the world

X i t l' i d th i id f STEMI d STEMI Xavier et al's, examined the incidence of STEMI and non-STEMI among almost 21 000 patients from 89 centers in 50 Indian cities. They found that more than 60% of these patients were diagnosed with STEMI, mean age was 57.5 years (although STEMI patients tended to be even younger), and the

j i f l iddl i f ili vast majority were from lower-middle-income or poor families.

The Indians were, on average, 57,5 years of age compared with 70.7 years for the European whitesthe European whites.

Reinfarction, and stroke rates and 30-day death, were higher for STEMI patients than non-STEMI, and mortality, notably, was significantly higher in poor patients than in rich patients.

They also had significantly increased prevalence of diabetes, hypertension, history of CAD compared with European whites.

And triple-vessel disease was more common in the Indian Asians than in the whiteswhites.

Almost all STEMI and non-STEMI patients were treated with antiplatelet drugs (primarily aspirin), but use of thrombolytics, ACE inhibitors or Angiotensin-Receptor Blockers, beta blockers, statins, omega 3 fatty-acids

d PCI/CABG ll f l th t i th W t

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and PCI/CABG were all far lower than rates seen in the West.


India: Mortality rates and socioeconomic statussocioeconomic status

M t lit Ri h L P (%)

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Mortality Rich (%)

Lower middle class

Poor (%) p

class (%)

Unadjusted mortality 5.5 6.5 8.2 <0.0001Mortality adjusted for i k f t l ti

7.2 6.4 6.6 0.97risk factors, location of infarct, and treatmentstreatmentsFrom: Xavier D. et al. Lancet 2008; 371:1435-1442.


Ten-year risk of CVD event (%) in 60-year-ld i i h i i h iolds British minority Ethnic groups

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Ethnic group Male nonsmoker

Male smoker

Female nonsmoker

Female smoker

Indian 22.4 36.7 8.7 15.122.4 36.7 8.7 15.1Pakistani 24.7 40.0 13.4 22.8Bangladeshi 24.9 40.4 7.4 13.0All South Asians

23.6 38.5 9.7 16.9

Chinese 11 1 19 1 2 5 4 4Chinese 11.1 19.1 2.5 4.4Caribbean 13.3 22.7 9.7 16.9Black African 20 1 33 3 10 8 18 7Black African 20.1 33.3 10.8 18.7Irish 16.0 27.0 9.1 15.8Framingham 14.1 22.3 8.7 14.7

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gscore

From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. doi: 10.1136/hrt.2006.092346www.cardiovascularprevention.com

Health care costs of CVD, CHD and stroke f ,by EU country, 2006, Europe

CVD CHD Stroke

Cost per % of total Cost per % of total Cost per % of total

From: Steven Allender, Viv Peto, Peter Scarborough, AshaKaur and Mike Rayner (2008)

capita health capita health capita health

Country (€) expenditure (€) expenditure (€) expenditure

Austria 198 6 43 1 35 1Belgium 193 6 46 1 27 1Bulgaria Ì5 14 6 2 7 3 Kaur and Mike Rayner (2008)

Coronary heart disease statistics. British Heart Foundation: London.

Cyprus 59 5 18 2 7 lCzech Republic 107 13 25 3 16 2

Denmark 182 5 44 1 37 lEstonia 77 15 22 4 14 3Finland 237 10 52 2 65 3France 207 7 32 ! 2; 1Germany 413 14 96 3 58 1Greece 173 10 46 3 44 2Hungary 75 111 15 2 10 1Ireland 183 6 46 1 26 1Italy 235 in 45 2 45 2L t i 47 9 13 3 8 2Latvia 47 9 13 3 8 2Lithuania 59 13 14 3 14 3Luxembourg 252 5 60 1 24 0Malta 72 6 IS 1 5 0Netherlands 271 9 73 2 78 3Poland 74 17 18 4 10 2Portugal 151 LO 33 2 27 2Portugal 151 LO 33 2 27 2Romania 14 15 6 3 6 2Slovakia 74 13 21 4 11 2Slovenia 91 7 19 1 12 1Spain 130 7 31 2 17 1

Sweden 308 10 62 2 52 2

2121 www.cardiovascularprevention.com

UK 313 12 71 3 69 3

Total EU 223 10 49 2 38 2

Problemi cardiologici attuali e gfuturi

• Sproporzione tra la domanda crescente di prestazioni e le risorse economiche scarsep

Ciò i hi d f d t li difi h ll• Ciò richiede fondamentali modifiche nella strategia diagnostica e terapeutica

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Circulation January 24, 2006Alter et al The Proliferation of Cardiac TechnologyIn Canada www.cardiovascularprevention.com

Lucas et al Temporal Trends in Cardiac Testing and Treatment- USA- Circulation January 24, 2006


www CardioVascularPrevention comwww.CardioVascularPrevention.com

25E-mail: [email protected]

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