La Malattia Cardiovascolare in Europa

Transcript

La Malattia Cardiovascolare in Europa
(CVD)
1
 E’ la
l principale
i i l causa di morte
t contando
t d per il 41%
% di
tutti i decessi (Eurostat 2003)
 1.2 milioni di decessi in Europa
p / anno
 1/3 degli anni di vita perduti per morte precoce
secondaria a CVD
www.cardiovascularprevention.com
Maggiori cause di morte in EU anno 2003 per gruppi di 5 anni di età
2
Age-standardised death rates, per 100.000, from
CHD 1968-2002,
CHD,
68
selected
l
d countries,
i the
h world
ld ((1))
From: Steven Allender, Viv Peto,
Peter Scarborough, Asha
Kaur and Mike Rayner (2008)
Coronary heart disease
statistics. British Heart
Foundation: London.
3
3
Age-standardised death rates, per 100.000, from
CHD 1968-2002,
CHD,
68
selected
l
d countries,
i the
h world
ld ((2))
Foundation: London.
4
4
EUROPE 1995-2006
5
5
Cardiovascular Disease in United Kingdom -20062006
6








Diseases of the heart and circulatoryy system
y
((cardiovascular disease or CVD)) are the main cause of
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.
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 53,000
premature 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.
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.
6
DEATHS BY SEX, AGE, UNITED KINGDOM 20067
Foundation: London.
7
Incidenza in Italia p
per anno
8
 Sindromi coronariche acute 280.000
280 000 M
 78.000 F + 50.000 morti improvvise
 Solo
S l il 30%
% dei
d i soggetti
tti con fattori
f tt i di rischio
i hi
tradizionali manifesta segni di CAD
 Studio: Pz giovani, 50 aa. senza FRC: nel
50%
%M
M, 25%
% F , IMA o Morte
M t come prima
i
manifestazione di CAD, di questi
Il 68% ha
h stenosi
t
i coronariche
i h subcritiche,
b iti h < 50%
Mortalità Per Grandi Gruppi
anno 2002 9 - ISTAT (Italy)
Malattie
Cardiovascolari
Tumori
237.198
163.070
Morte improvvisa
54 000
54.000
Numero dimessi 2004 - Ricoveri per
acuti.
ti
(ISTAT – Italy)
10
 Tumori
7 5
761.582
 Malattie cardiovascolari
1.413.082
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
CARDIOVASCOLARE
GASTROINTESTINALE E METABOLISMO
ANTIMICROBICI
SISTEMA NERVOSO CENTRALE
RESPIRATORIO
ANTINEOPLASTICI
EMATOLOGICI
GENITO-URINARI E ORMONI SESSUALI
MUSCOLO-SCHELETRICO
ORMONI SISTEMICI
ORGANI DI SENSO
DERMATOLOGICI
VARI
ANTIPARASSITARI
392,2
92,9
24,2
46,3
48 0
48,0
5,7
72,3
40,2
37,9
27,7
15,7
3,0
0,2
06
0,6
806,9
DDD - Daily Defined Dose (dose giornaliera di mantenimento in un adulto)
Fonte: AIFA - Rapporto nazionale OSMED sul consumo di farmaci 2005
ITALY
11
Variazione
percentuale
rispetto al 2004
%
48,6
11,5
3,0
5,7
59
5,9
0,7
9,0
5,0
4,7
3,4
1,9
0,4
0,0
01
0,1
100,0
4,7
5,3
4,8
7,1
54
5,4
-3,0
6,6
-1,8
-7,9
7,9
0,8
-1,5
-2,0
35
3,5
4,0
Particolari condizioni associate ad
elevata
l
t mortalità
t lità cardiovascolare
di
l
12
 Diabete mellito
 Scompenso cardiaco
 Ictus ischemico/emorragico
/
g
U.S.A. Data 1999-2002
999
13
 Of the 71 300 000 American adults with 1 or more types of


•


cardiovascular disease (CVD),
27 400 000
g 65
5 or older
are estimated to be age
High blood pressure
65 000 000.
Coronaryy heart disease
13 200 000.
– 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 2003
• Th
The 2003 preliminary
li i
CVD d
death
th rates
t were 364.2
364 2 for
f males
l
and 262.5 for females.
• Cancer death rates were 232.3 for males and 160.2 for
f
females.
l
• Breast cancer claimed the lives of 41 566 females in 2003.
• Lung
g cancer claimed 67 894.
• 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,
cancer while 1 in
2.6 are from CVD.
• Based on preliminary 2003 mortality, CVD caused about a
death a minute among females over
• 480 000 female lives every year.
14
U.S.A. Data 2003 & cost 2006
15
Other causes of death in 2003 in
USA (preliminary data)
•
•
•
•
Cancer
554 643
Accidents 105 695
Alzheimer’s disease 63 343
HIV (AIDS) 13 544
544.
16
CARDIOVASCULAR DISEASE IN CANADA (2)
These statistics are based on 2004 data (from Statistics Canada)
Cardiac arrest
Aboutt 40,000
Ab
40 000 Canadians
C
di
experience
i
cardiac
di arrestt 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
400 000 Canadians living with congestive
heart failure (CHF).
Stroke
More than 50,000 strokes occur in Canada each year. That’s one stroke
everyy 10 minutes.
Stroke is the third leading cause of death in Canada.
Each year, more than 14,000 Canadians die from stroke.
Each yyear, more women than men die from stroke.
17
ACUTE CORONARY SINDROME IN INDIA
18
 India has the largest percentage of heart disease in the world
 Xavier
X i ett al's,
l' examined
i d th
the iincidence
id
off STEMI and
d non-STEMI
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
vast majority
j i were ffrom llower-middle-income
iddl i
or poor ffamilies.
ili
 The Indians were, on average, 57,5 years of age compared with 70.7 years for




the European whites.
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
whites.
whites
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
and
d PCI/CABG were all
ll far
f lower
l
than
th rates
t seen in
i the
th West.
W t
18
India: Mortality rates and
socioeconomic status
19
M t lit
Mortality
Rich
Ri
h
(%)
Unadjusted mortality 5.5
Mortality adjusted for 7.2
risk
i k ffactors,
t
location
l
ti
of infarct, and
treatments
Lower Poor
L
P
(%) p
middle
class
(%)
6.5
6.4
8.2
6.6
From: Xavier D. et al. Lancet 2008; 371:1435-1442.
19
<0.0001
0.97
Ten-year risk of CVD event (%) in 60-yearolds
ld British
i i h minority
i
i Ethnic
h i groups
20
Ethnic group
Male
nonsmoker
Male
smoker
Female
nonsmoker
Female
smoker
Indian
22.4
36.7
8.7
15.1
Pakistani
24.7
40.0
13.4
22.8
Bangladeshi
24.9
40.4
7.4
13.0
All South
Asians
Chinese
23.6
38.5
9.7
16.9
11 1
11.1
19 1
19.1
25
2.5
44
4.4
Caribbean
13.3
22.7
9.7
16.9
Black African
20 1
20.1
33 3
33.3
10 8
10.8
18 7
18.7
Irish
16.0
27.0
9.1
15.8
g
Framingham
score
14.1
22.3
8.7
14.7
From: P Brindle, M May, et Al: Heart 2006;92:1595–1602. doi: 10.1136/hrt.2006.092346
20
Health care costs off CVD,, CHD and stroke
by EU country, 2006, Europe
CVD
Cost per
capita
Country
(€)
Austria
198
Belgium
Bulgaria
Cyprus
CHD
% of total
health
expenditure
Cost per
Stroke
% of total
capita
(€)
health
expenditure
Cost per
% of total
capita
health
(€)
expenditure
1
6
43
1
35
193
6
46
1
27
1
Ì5
14
6
2
7
3
59
5
18
2
7
l
Czech Republic
107
13
25
3
16
2
Denmark
182
5
44
1
37
l
Estonia
77
15
22
4
14
3
Finland
237
10
52
2
65
3
France
207
7
32
!
2;
1
Germany
413
14
96
3
58
1
Greece
173
10
46
3
44
2
75
111
15
2
10
1
Hungary
Ireland
183
6
46
1
26
1
Italy
235
in
45
2
45
2
L t i
Latvia
47
9
13
3
8
2
Lithuania
59
13
14
3
14
3
252
5
60
1
24
0
72
6
IS
1
5
0
Luxembourg
Malta
Netherlands
271
9
73
2
78
3
74
17
18
4
10
2
Portugal
151
LO
33
2
27
2
Romania
14
15
6
3
6
2
Slovakia
74
13
21
4
11
2
Slovenia
91
7
19
1
12
1
Spain
130
7
31
2
Sweden
308
10
62
2
52
UK
313
12
71
3
69
Total EU
223
10
49
2
38
Poland
17
Foundation: London.
1
2
3
2
21
Problemi cardiologici
g attuali e
futuri
• Sproporzione tra la domanda crescente di
prestazioni e le risorse economiche scarse
p
• Ciò richiede
i hi d ffondamentali
d
t li modifiche
difi h nella
ll
strategia diagnostica e terapeutica
22
Circulation January 24, 2006
Alter et al The Proliferation of Cardiac Technology
In Canada
23
Lucas et al Temporal Trends in Cardiac Testing and Treatment- USA- Circulation January 24, 2006
24
www CardioVascularPrevention com
www.CardioVascularPrevention.com
E-mail: [email protected]
25

La Malattia Cardiovascolare in Europa

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