Organizing the fight against cardiovascular disease in

Tangshan and in the Netherlands

Tangshan, the 10th of March 2008

Prof. Ernst W. Roscam Abbing, MD, ML

Epidemiological transition

• All over world there has been or there is going on a transition of infectious diseases to chronic degenerative diseases, of which the cardiovascular diseases are the most important for the life expectancy;

• The transition is often slower in rural than in urban areas.

Infectious chronic conditions

Causes of death

• Netherlands 2005: 32% cardiovascular diseases and 30% cancer;

• In the future the same in China and Tangshan ?

                                                                                                                           

                  

The importance of cardiovascular disease (CVD) as cause of death worldwide

Trends in death rates in the Netherlands

deathcases per 100.000

cancer, men cancer, women

cardiovascular dis., men cardiovascular dis., women

Cardiovascular disease:(morbidity)

• Myocardial infarction;• Chronic heart failure;• Aneurysm of the aorta; • Stroke;• Other. We concentrate on myocardial infarction and

stroke as the two most common events.

Raised blood pressure ( > 140 systolic and > 90 diastolic) in China, Beijing 1996

n = 1439

Diabetes in China, Beijing 1999 n = 1474

Body Mass Index > 25 in China 2002 both urban and rural populationn = 220,000 adult men

Physical Inactivity among school children in their leisure time in China, Beijing

n = 2326

Systolic blood pressure in the Netherlands 1999 – 2001n = 5298

Raised cholesterol level in the Netherlands 1999 – 2001n = 4878

men women age

Average yearly prevalence (per 1000) of diabetes mellitus in the registration systems of general practitioners in the Netherlands

Percentage children (4-15 y.) with overweight and with obesity for age and sex in the Netherlands

boys with overweight boys with obesity age (years)girls with overweight girls with obesity

Netherlands: percentage smokers for age and sex in 2006

The importance of monitoring CVD in China:

Monitoring CVD with international standardized methods in China is feasible and urgently needed in view of the rapid socioeconomic development and transition of disease patterns taking place in China.

Conclusion of the Sino-MONICA Project (Circulation. 2001;103:462-468 )

Why is registration important, also in Tangshan?

To know about:

• Which preventable diseases are important in your population?

• Which subpopulations (age, sex, educational level, occupation, etc) are most at risk?

• Which are the ongoing trends for those diseases in those subpopulations?

• Do preventive interventions make a difference in those trends?

Risk factors for CVD

Genetics

and

Behavior

Blood pressure

Cholesterol level

Glucose tolerance

Weight (Obesity)

Myocardial infarction

and

Stroke

Behavioral risk factors:- smoking;

- diet, too much and too fat;

- lack of exercise.

Possible interventions

Treatment of disease

Early detection of a starting, latent disease and of an high risk profile, stimulating awareness of risks.

Health promotion, stimulating behavioral change, sometimes preventive medication

Cardiovascular risk management in the Netherlands, the standard:

Distinction between two groups:

1. Patients who had already an episode of CVD or who have diabetes II;

2. Patients without CVD or diabetes II, but with:

- systolic blood pressure > 140 mmHg

- total cholesterol . 6.5 m mol/l

- smoking, men 50 years and older

women 55 years and older

Making a risk profile of the following factors:

• Age• Sex• Smoking• Systolic blood pressure• Spectrum of lipids (TC, HDL, TC/HDL ratio, LDL, triglycerides)• Blood glucose • Family history• Nutrition• Alcohol• Physical activity• Body mass index (weight in kg / quadrate of length in meters)

Subregion South-East Asia D comprises amongst others: India, Bangladesh, Myanmar, Nepal;Data for West Pacific Region, subregion B with China in it are not sufficiently available.

Why should an hospital be interested in prevention ?

• First of all to keep the people as long as possible healthy;

• But also to build a referral network, which strengthen the position of the hospital in the area.

Different types of prevention, characterized by target group, indication and situation:

- General population;- Groups, like children, elderly, etc;- Groups at risk like smokers; - Visitors of health facilities, like the general practitioner, the health centre, the hospital: = visitors with symptoms not related with vascular disease and risk; = visitors with symptoms related with risk factors, like high blood pressure, smoking etc; = visitors with symptoms of (beginning) cardiovascular disease.

Possible prevention within the hospital:

• At the departments for cardiology, nephrology, pulmonology and neurology recovering patients could be helped (referred to a supporting program) to quit smoking;

• Smoking in the hospital itself could be reduced.

Collaboration between public health service, general practitioner and hospital in the

Netherlands:

- Public health service (municipal health service): epidemiology and offering programs for groups; (facilitating) mass screening;

- General practitioner (GP): detection of patients at risk and referral;

- Hospital: support of the GP with laboratory facilities and in some cases treatment.

Possible translation to the Tangshan preventive and curative heath care of CVD:

• The Tangshan public health bureau: epidemiology and planning of mass health promotion and screening;

• 20 health stations of the Tangshan Workers Hospital can play a role comparable with the Dutch GP-role;

• The hospital can support the 20 health stations in their diagnostic activities and treat some patients. It can be the centre of a collaboration network.