Cardiovascular Disease Prevention

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Intro & Scope - CVD Crisis India

  • India faces a CVD epidemic; a leading public health challenge.
  • Responsible for ~27% of total deaths, over 3 million annually.
  • Rapidly ↑ prevalence across urban and rural settings; urban areas more affected.
  • Substantial economic drain: premature mortality in working-age adults, high out-of-pocket expenditure.
  • Worrying trend: younger age of onset in Indians vs. Western counterparts.

⭐ CVDs have emerged as the number one killer in India, surpassing all other causes.

Risk Factors - Dodging Danger

Key CVD risk factors:

CategoryRisk Factors
Non-ModifiableAge, Sex (M>F pre-menopause), Family Hx (Premature CVD: M<55y, F<65y), Ethnicity (South Asian).
ModifiableTobacco, Unhealthy Diet (↑salt, sugar, trans/sat fats), Physical Inactivity (<150min/wk), HTN (BP≥140/90 mmHg), DM (HbA1c≥6.5%), Dyslipidemia (↑LDL,↑TG,↓HDL), Obesity (Asian BMI≥23 kg/m²; Central WC M>90cm,F>80cm), Alcohol (excess), Stress.

Indian Context: Key for India: ↑Central obesity, dyslipidemia (↑TG, ↓HDL), T2DM risk.

Summary of Cardiovascular Disease Risk Factors

📌 MetS (IDF, S. Asians): Central Obesity (WC M≥90cm, F≥80cm) + ≥2 of:

  • ↑TG (≥150 mg/dL)
  • ↓HDL (<40M, <50F mg/dL)
  • ↑BP (≥130/85 mmHg or Rx)
  • ↑Fasting Glucose (≥100 mg/dL or T2DM)

Prevention Levels - Shield Up Stages

  • Primordial: Prevent risk factor development. Target: Whole population, esp. children. Interventions: Health education, promoting healthy lifestyles.

    ⭐ Primordial prevention focuses on maintaining healthy lifestyles from childhood.

  • Primary: Prevent disease in at-risk individuals.
    • Strategies: Population (e.g., community salt ↓ to <5g/day) & High-risk (e.g., statins for dyslipidemia).
    • Interventions: Diet (DASH), exercise (150 min/wk moderate or 75 min/wk vigorous), tobacco cessation.
  • Secondary: Halt/slow disease progression in diagnosed patients. Interventions: Aspirin, β-blockers post-MI, risk factor control.
  • Tertiary: Limit disability, improve quality of life. Interventions: Cardiac rehabilitation, managing complications.

CVD Prevention: Primordial, Primary, Secondary, Tertiary

Screening & Action - Early Bird Wins

  • Hypertension: Screen ≥18 yrs. Annually if BP 120-139/80-89 mmHg; else 3-5 yrs. Diagnose ≥140/90 mmHg.
  • Diabetes: Screen ≥30 yrs (earlier if high-risk e.g., BMI >23 kg/m² + risk factors). HbA1c ≥6.5%, FPG ≥126 mg/dL. Use Indian Diabetes Risk Score (IDRS).
  • Dyslipidemia: Screen ≥20 yrs. Lipid profile (TC, LDL-C, HDL-C, TG). Target LDL <100 mg/dL (varies with risk).
  • Opportunistic screening in all healthcare settings is key.
  • Assess overall risk: WHO CVD Risk Charts (SEAR D).

⭐ First BP screening is recommended from age 18 years.

National Efforts - India Fights CVD

  • NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke): Aims to prevent & control major NCDs.
    • Key Components: Health promotion, early diagnosis, screening, timely referral, management at different healthcare levels.
    • Services: Opportunistic screening, diagnosis, treatment, and follow-up.
  • Other Initiatives:
    • National Tobacco Control Programme (NTCP): Reduces tobacco consumption.
    • FSSAI regulations: e.g., limiting trans-fats (target <2% by 2022), promoting ↓salt intake.
    • Ayushman Bharat (HWCs): Strengthens NCD screening & management at primary level.

⭐ NPCDCS targets a 25% relative reduction in premature mortality (30-70 years) from NCDs by 2025.

High‑Yield Points - ⚡ Biggest Takeaways

  • Primordial prevention targets preventing the development of risk factors like obesity.
  • Primary prevention focuses on controlling established risk factors (e.g., hypertension, smoking).
  • Population strategy aims to shift the average risk level in the entire community.
  • High-risk strategy identifies and manages individuals with multiple risk factors.
  • Tobacco cessation offers the most significant and cost-effective impact on CVD reduction.
  • Key WHO "Best Buys" include tobacco control, reduced salt intake, and managing hypertension.
  • India's NPCDCS program is crucial for CVD prevention and control efforts nationwide.

Practice Questions: Cardiovascular Disease Prevention

Test your understanding with these related questions

Among the following, most reliable test for screening of diabetes mellitus?

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Flashcards: Cardiovascular Disease Prevention

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What is the most commonly abused substance in India?_____

TAP TO REVEAL ANSWER

What is the most commonly abused substance in India?_____

Tobacco

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