HEART HEALTH

Melanie Zammit Burg MD MRCP (UK)

Resident Specialist in Cardiology

Heart Health Seminar

27th April 2018

CARDIOVASCULAR DISEASE

• Remains the no. 1 cause of death

• 9% of total EU healthcare cost

• Prevention of risk factors reduces 80% of CVD and is cost-effective

www.heartScore.org

LIPID CONTROL

• Every 1mmol/L reduction in LDL-C

leads to 20-25% reduction in CVD

mortality and non-fatal MI.

Lancet. 2012 Aug 11; 380(9841): 581–590.

LIPID CONTROL

LIPID CONTROL

• Statins

• Selective cholesterol absorption inhibitors (ezetemibe)

• Fibrates

• Bile sequestrants

• Niacin

• Omega-3

• Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors

HYPERTENSION

A risk factor for CAD, heart failure, stroke/TIA, PAD, CKD, atrial fibrillation

DIABETES

Targets:

• A lower BP target <130mmHg to reduce macro-

and microvascular complications

• Lipid control. Statins recommended in all diabetics

>40

• Aspirin only in known CVD.

• Weight control through dietary change and PA is

key in management.

• Strict hyperglycaemia management. More lenient

in elderly, frail, and severe CVD.

Lancet 375:2215-2222, 2010

DIABETES

BODY WEIGHT

In the USA, it has been projected that if obesity trends from 2005 to 2020 continue, obesity will increasingly offset the positive effects of declining smoking rates

N Engl J Med 2009;361:2252 – 2260

BODY WEIGHT

Aim 20-25 kg/m2

PHYSICAL ACTIVITY

• Reduces all cause and CVD mortality by 20-30%.

• Positive effect on:

• HTN

• LDL-C and non-HDL-C

• DM2

• Body weight

• Mental health

Int J Sports Med. 2009 Mar;30(3):213-24

PHYSICAL ACTIVITY

SMOKING

• Smoking cessation is the most cost effective way to

prevent CVD.

• A lifetime smoker has 50% chance of dying from an

avoidable smoking-related death, and loses 10 years

of life (vs 3 years in uncontrolled HTN).

• 10 yr CVD risk is double in smokers.

• Passive smoking increases CVD risk by 30%.

Circulation 2010;121:750 – 758.

SMOKING

SMOKING

• NRT (single or combination)

• Bupropion

• Varenicline

• E-cigarettes

CPR

• Only 1 in 10 survive out-of-hospital cardiac arrest

• Immediate bystander CPR increases survival by 50-60%!

• In countries where CPR is taught in schools survival increases x3

ROLE OF IMAGING

CONCLUSIONS

Who are the priorities? What are the targets?

A LIFELONG PROCESS!

Thank you