Lecture Coronary artery disease - Donn Colby, MD, MPH

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At the end of the lecture, participants will know: the epidemiology of coronary artery disease, the risk factors associated with coronary artery disease, how to use online tools to estimate a patient's risk for myocardial infarction, how to screen for and couns a patient to reduce their risk for coronary artery disease.

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Nội dung Text: Lecture Coronary artery disease - Donn Colby, MD, MPH

Coronary Artery Disease Donn Colby, MD, MPH Medical Director, Harvard Medical School AIDS Initiative in Vietnam Clinical Instructor, Harvard Medical School
Learning Objectives At the end of the lecture, participants will know: 1. The epidemiology of Coronary Artery Disease 2. The risk factors associated with Coronary Artery Disease 3. How to use online tools to estimate a patient's risk for myocardial infarction. 4. How to screen for and counsel a patient to reduce their risk for coronary artery disease.
Outline of Presentation  Definitions  Epidemiology  Risk factors  Estimating Risk for Coronary Heart Disease  Risk reduction
Definitions Coronary artery disease (CAD) is the pathologic process affecting the coronary arteries (atherosclerosis). Coronary heart disease (CHD) results from coronary artery disease and includes angina pectoris, myocardial infarction, silent myocardial ischemia. Cardiovascular disease (CVD) is the pathologic process (atherosclerosis) affecting the entire arterial system, not just the coronary arteries: Stroke, transient ischemic attacks, angina, myocardial infarction, and peripheral artery disease.
Leading causes of death, world, 2004 % of total deaths Mathers, British Medical Bulletin, 2009
Epidemiology (2) Worldwide causes of death, 2004 Mathers, British Medical Bulletin, 2009
Epidemiology (3) Mathers, British Medical Bulletin, 2009
Epidemiology (4) Deaths from Cardiovascular Diseases, USA 1990 - 1997 Cooper, Circulation, 2000
Epidemiology (5) Cardiovascular Disease Risk in Urban and Rural China Yusuf, Circulation, 2001
Risk factors  Tobacco  Cholesterol ( LDL, HDL) Modifiable  Hypertension Risk  Diabetes Factors  Obesity  Inactivity  Family History of premature heart disease  Male  Increased Age
Risk Factor: Cholesterol Association between total cholesterol and CHD risk Stamler, JAMA, 1986
Risk Factor: hypertension Association between blood pressure and CHD mortality Prospective Studies Collaboration, Lancet, 2002
Risk Factor: diabetes Association between diabetes and CHD mortality Haffner, NEJM, 1998
Risk Factors Maximum exercise capacity and risk for CHD Myers, NEJM, 2002
Risk Factors: Increasing in China CHD Mortality, Beijing, 1984-1999 Critchley, Circulation, 2004
Screening Primary care doctors can screen for and treat the modifiable risk factors for CAD.  Screening for risk factors can be done at routine primary care visits or yearly physical exams  Screening is an important part of preventive medicine.  If positive for a risk factor, counseling and treatment can decrease the future risk for cardiovascular diseases.
Screening  Modifiable risk factors  Inactivity  Obesity  Tobacco  Cholesterol ( LDL, HDL)  Hypertension  Diabetes
Screening Guidelines Screening Low Risk High Risk Obesity, Physical Regular Screening and counseling Activity Smoking Regular Screening and counseling Regular screening for age > 18 (at least every 2 Blood Pressure years) Age > 35 every 1-5 Age > 20 every 1-2 Fasting Lipids years years Fasting Blood Sugar Sources: American Association of Family Physicians (AAFP), year States Every 1-3 years Every 1 United Preventive Services Task Force (USPSTF), Canadian Task Force for Preventive Health Services (CTFPHS)
Risk Estimation  Online risk calculator: http://hp2010.nhlbihin.net/atpiii/calculator.asp  Based on the Framingham Heart Study  Longitudinal observational cohort study of risk factors for cardiovascular disease  Over 16,000 people followed in several cohorts since 1948  Generated from an American population: results may not be accurate for other ethnic groups.