Khawar Kazmi

The Evil

WHO report 2003

DEATHS FROM CORONARY HEART DISEASE

WHO Atlas of Heart Disease & Stroke 2004

• Lower consumption of energy rich foods and fats, higher consumption of complex carbohydrates

• Increased expenditure of energy (high levels of physical activity during daily usual activities

• Greater social integration due to maintenance of traditional lifestyles

Proximal Determination of Behavior

• Level of economic development

• Education• Income

distribution• Social

organization • Global

Influences (e.g trade promotion and cultural diffusion

Interactions of environmental factors and tobacco use with genetic

predisposition

• Higher consumption of energy rich foods, refined carbohydrates, processed foods, salt and fats

• Lower energy expenditure due to low levels of physical activity

• Greater social isolation, psychosocial stress

• Crowded housing

Programming Factors:

e.g. Intrauterine environment

Predisposing risk factors:

e.g. Obesity in childhood &

early adulthood

Classical riskfactors:

e.g. Cholesterol

Blood Pressure Glucose

• Psychosocial factors

• Susceptibility of plaques to rupture

• Knowledge of prevention

• Access to care

• Coronary Heart Disease

• Ischemic strokes

• Peripheral arterial Disease

• Hypertensive Heart Disease

• Hemorrhagic strokes

• Chronic renal failure

• Vascular dementia(?)

Development of Risk Factors

Modifying Influences

Clinical Events

(+)

(-)

Rural Lifestyle

Urban Lifestyle

Epidemiological Transition

CIRCULATION 2001;104:2855-64

Cardiovascular Diseases Axis

(Axis of Evil)

CVD

EXPRESSION

BEHAVIOURS

Diet, Physical Activity & Tobacco Use

Obesity and Tobacco

Risk Factors start in Childhood and Youth

• Worldwide 22 million children under five years

are obese and many more are overweight.

• 14% of 13 to 15 year old students around the

world currently smoke cigarettes.

• In USA physical activity decreases

precipitously esp. in girls beginning around 10

years. WHO Atlas of Heart Disease & Stroke 2004

Children, Adolescents and Obesity

• Obese Children are at approximately a 3 – fold higher risk for HTN than non – obese children.

• The risk of developing type 2 DM is clearly linked to the increasing prevalence of obesity, with increasing cases of type 2 DM in children.

• Cohort studies show that obesity can be tracked from childhood to adulthood, where morbidity is very evident.

• Obesity in adolescents is directly associated with increased morbidity and mortality in adult life independent of adult body weight.

• Unhealthy diet is one of the leading causes of CVD. This unhealthy life style is more and more adopted at early age.

WHF fact sheet 2003, BMJ 2001;322:1094-5

Aga Khan UniversityCARDIOLOGY PROGRAM

SMART HEART PROGRAM First institution based CVD prevention

program Evolving into a comprehensive

multifaceted program including secondary, primary and primordial prevention

www.akunet.org/smartheart

ACME

HEALTH

HABITS

Research capacity building

Aga Khan University

SMART HEART PROGRAM

Primary & Primordial Prevention

- A Continued Medical Education Program

- Healthy Eating, physical Activity and Living with no Tobacco: A family Health initiative

- Health Awareness By Imparting lifestyle Training to School Children

Aga Khan UniversitySMART HEART PROGRAM

HABITS(Health Awareness By Imparting lifestyle Training to School children )

Objective Stimulate thinking process

Healthy Behaviors

Empowerment Through Knowledge

Plan Data Collection

Intervention through a Teaching module

HABITS - PilotSeptember to December 2005

HABITS - PilotSeptember to December 2005

HABITS - PilotSeptember to December 2005

• Total # of grade VI Children: 105 (CAS:78 , AMI:

27)

• # consented for the study: 101

• Mean Age: 11.4 yrs.• Boys to Girls ratio: 1.2 (57/48)

HABITS – PilotSeptember – November 2005

Preliminary Results

HABITS - Pilot

72.5

5.1 6.1

16.3

Underweight NormalOverweight At Risk

BMI(98)

74.3

25.7

Normal Abnormal

Waist(98)

(< 71 cm)

There was significant association between

days of physical activity and BMI(P=0.003) as well as

between duration of sedentary activity and waist circumference (p=0.001)

HABITS - Pilot

• 98.9% had normal blood pressure of < 120/80

• 59% indulged in daily physical activities, 33.3% were active less than 6 days a week and 2.9% did not participate in any physical activity

• 22.9% spent more than 2 hrs and 30.5% 1-2 hrs in sedentary activities apart from studying

Blood Pressure & Physical Activity

HABITS - Pilot

• 21.9% had tried cigarettes and 30.5% were exposed to passive smoking

• 40% responded positively on the use of Shisha. Most were unaware of it being a form of tobacco

• 2.9% were using “Chalia” on daily basis with 4.8% consuming it on weekly basis

Tobacco and Diet

• 60% reported eating out on weekly basis • 16.2% were snacking more than twice daily

• 31% had soft drinks every day

• 12.4% used vegetables every day

HABITS - PilotSpot Blood Test Results

93.5

5.41.1

79.3

18.4

2.30

102030405060708090

100

CHOL FBS

NormalBorderlineHigh

(92) (87)

Aga Khan UniversitySMART HEART PROGRAM

HABITS(Health Awareness By Imparting lifestyle Training to School children )

CVD poses a huge challenge with Obesity being the largest emerging global epidemic.

Yes, it is possible to nip the evil in the bud but to achieve that

All health care providers including public and private institutions, NGOs and professional bodies need to join hands and work together.

There is an imminent need for leadership to create a common platform and to provide direction.