Treating the Turkish Patient: Treating the Turkish Patient: Is he different?Is he different?

Prof. Prof. MehdiMehdi ZoghiZoghi--EEgege University, University, İİzmirzmir

Prevention in Prevention in Coronary ArteryCoronary Artery DiseaseDisease

20112011

καλωσόρισμαWELCOME

5224

19

14

5

0 10 20 30 40 50 60

KVH

Kanser

İnfeksiyonlar

Akc hast.

AIDSHIV

Pulmonary disease

Infections

Cancer

CVD

The World Health Report 2004

Cardiovascular disease (CVD) is a major cause of death

throughout the world.

Percentage of the population citing health as their main

concern before other

issues, such as financial problems,

housing or crime.

Health is among the top personal concerns

!

Primary

health care : Now

more than ever

The world health report 2008

NHLBI. www.nhlbi.nih.gov

$54

$56

$133

$239

$368$368

$29

0 50 100 150 200 250 300 350 400

Billions of dollars

Congestive heart failure

Stroke

Hypertension

Coronary heart disease

Heart disease

Total CVD†

CVD=Cardiovascular disease

1 of every 3 deaths

Coronary Artery Disease Coronary Artery Disease (CAD) in Turkey(CAD) in Turkey

•

New CAD: 300.000/year

•

CAD Mortality: 170.000/year

•

STEMI: 80.000/year

Turkish

Adult

Risk factor

StudyA. Onat Atherosclerosis

Risk Factors

2001;156,1-10

45,2

8,5

0

10

20

30

40

50

1999

Over 60 yOver 80 y

Dea

th p

er 1

00,0

00 p

opul

atio

n

Think about where you're going to be in

20502050

45,2

8,5

97

30

0102030405060708090

100

1999 2050 (estimate)

Over 60 y

Over 80 y

Dea

th p

er 1

00,0

00 p

opul

atio

n

20502050

• The underling pathology is atherosclerosis, which develops over many years and is usually advanced by the time symptoms

occur, generally in middle age.

The major risk factors for CVD are well established, with the principal three modifiable factors being hypertension, dyslipidemia and smoking.

Primary prevention can help prevent 80%

of coronary heart disease.

Two complementary strategies that are usually advocated for primary prevention:

The population strategy

aims to reduce the burden of disease in the whole community while conferring small benefits to each individual.

The high-risk strategy, provides large benefits to the few individuals who are most vulnerable but the benefits to the whole community may be relatively limited because the beneficiaries are few.

Risk prediction charts enable the estimation of total cardiovascular risk of

people in the first category.

Total cardiovascular risk means the likelihood of a person developing an atherosclerotic cardiovascular event over a

defined period of time.

Both community-based primary prevention and secondary prevention are needed for

effective CVD prevention and control

ON

TARGET

55 yrs

Cigarette smoking, Family history (+)

BP: 135/80 mmHg,

TC: 280 mg/dl, LDL-C: 130 mg/dl, HDL-C:35 mg/dl,

Blood glucose: 90 mg/dl, microalbuminuria (-)

ECG: Normal

Echocardiography: Normal

ON

TARGET

http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof

10-year risk for developing CHD

ON

TARGET

Individual counseling and provision of care may have to be prioritized according to cardiovascular risk.

Risk <10% Individuals in this category are at low risk. Conservative management focusing on lifestyle interventions is

suggested.

Risk

10% to <20%Individuals in this category are at moderate risk

of fatal or non-fatal vascular events.Monitor risk profile every 6–12 months.

Risk

>20%Individuals in this category are at high risk of

fatal or non-fatal vascular events.Monitor risk profile every 3–6 months.

PRESENTATION  NAMECompany name

Risk factor screening

Adults should know the levels and  significance of risk factors as routinely 

assessed by their primary care provider.

Turkish Patient: Is he different?Turkish Patient: Is he different?

Prevention in Prevention in Coronary ArteryCoronary Artery DiseaseDisease

20112011

The EUROASPIRE III survey was conducted in 2006-2007 in 22

countries in Europe to describe risk factors, lifestyle and

therapeutic management of patients with coronary heart

disease (CHD), compliance with current guidelines, and to

document changes over time.

EUROASPIRE : European

Action

on Secondary and

Primary

Prevention

by

Intervention

to

Reduce

Events

EUROASPIRE : European

Action

on Secondary and

Primary

Prevention

by

Intervention

to

Reduce

Events

Eur

J Cardiovasc

Prev

Rehabil. 2009 Apr;16(2):121-37

1.

Belgium2.

Bulgaria

3.

Croatia4.

Cyprus

5.

Czech

Republic6.

Finland

7.

France8.

Germany

9.

Greece10.Hungary11.Ireland12.Italy13.Latvia14.Lithuania15.The

Netherlands

16.Poland17.Romania18.Russian

Federation

19.Slovenia20.Spain21.21.TurkeyTurkey22.United

Kingdom

Compared to the EUROASPIRE III data, classical

risk factors did not exhibit

remarkable differences.

Records

from Turkish

centers:1.

Belgium

2.

Bulgaria3.

Croatia

4.

Cyprus5.

Czech

Republic

6.

Finland7.

France

8.

Germany9.

Greece

10.Hungary11.Ireland12.Italy13.Latvia14.Lithuania15.The

Netherlands

16.Poland17.Romania18.Russian

Federation

19.Slovenia20.Spain21.21.TurkeyTurkey22.United

Kingdom Tokgözoğlu

L et al. Turk

Kardiyol

Dern

Ars.

2010;38(3):164-72

The most important differences were observed in the higher rates of the following:

•

Young patients with myocardial infarction (<50 years, 20% vs. 12.7%),

•

Persistence in smoking (23.1% vs. 17.2%), •

İmmobility,

•

Low HDL-cholesterol •

Insufficient follow-up by physicians after the index event (12% vs. 2.2%),

and •

Insufficient patient education.

EUROASPIRE III survey-Turkish

Data

Tokgözoğlu

L et al. Turk

Kardiyol

Dern

Ars.

2010;38(3):164-72

Risk FactorEurope

(n=8966)Turkey(n=338)

Obesity 35,3 35,5

High BP 56.0 55.2

High Cholesterol 51.1 48.3

Low HDL 36.7 50.2

Diabetes 34.8 33.6

HDL was low in half of pts

Tokgözoğlu

L et al. Turk

Kardiyol

Dern

Ars.

2010;38(3):164-72

1.

Romania2.

South Cyprus

3.

Turkey....

HDLFemale:46.0 vs

49.5 mgr/dl

Male: 39.4 vs

43.3 mgr/dl

Tokgözoğlu

L et al. Turk

Kardiyol

Dern

Ars.

2010;38(3):164-72

HDL in Turkish

Population2

Reasons

for Low

International Physical Activity Questionnaire

Physical ActivityEurope

(n=8966)Turkey(n=338)

Low 54.4 23.1High 39.4 10.5

PREvention and CONtrol Program for Cardiovascular

Diseases in TuRkish POpuLation (PRE-CONTROL)

1) The level and distribution of cardiovascular risk factors in our population,

2) The knowledge and awareness of participants about CVD

3) The evaluation of the effectiveness of prevention education program on awareness of CVD in urban population of Turkey

EUROPREVENT 2011

A 24-item questionnaire form

was used for detecting cardiovascular risk factors and the awareness of participants about CVD which was concerning personal and family history of disease, education levels, lifestyle factors and heart attack or stroke medications.

The Joint British

Societies’

cardiovascular disease risk prediction chart

was used

for

investigating cardiovascular risk levels (low risk < 10%; intermediate risk 10-20%; high risk > 20%) of participants.

Education programs feed-back data

were collected by questionnaires and individual interviews of participants after 2 weeks of education seminars by telephone surveys.

Total cardiovascular risk

76,4

23,60

1020304050607080

Risk Score %

Moderate-High Low

ÖMER Kozan, MEHDİ

Zoghi, GÜLAY Güven

Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü, OKTAY Ergene

on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011

PRE-CONTROL

PRE-CONTROL

Although the cardiovascular risk is high (moderate or high risk rate was 74.6%) the knowledge and

awareness of the risk factors for cardiovascular disease are low in our community.

•

Only 21% of participants with cardiovascular risk score more than 10%

have visited any physician within last year.

PRE-CONTROL

PRE-CONTROL

Community-based educational programs are helpful to increase public

awareness, health promotion and management of

cardiovascular

diseases.

The awareness of cardiovascular diseases and risk factors was significantly increased following our

education programs.

ÖMER Kozan, MEHDİ

Zoghi, GÜLAY Güven

Sain, M Arıcı, ÜLVER Derici, GÖKSEL Bakaç, SEVİM Güllü, OKTAY Ergene

on behalf of PRE-CONTROL study investigators, Presented in EUROPREVENT 2011

Risk Factor

Sex: Male Male

Age (yrs): 36 50Smoker: - -Diabetes: - -Blood Pressure: 130/80 130/80 Total Cholestrol 200 200

HDL Cholesterol: 36 36

5%

10%

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