The Systemic Approach in

Teaching and Learning

Cardiovascular Diseases

Diaa Marzouk
Assis. Prof Community
Medicine
AIn Shams University
 Cardiovascular
Disease

Renal Diabetes
Diseases Non Communicable Mellitus
Dis

Cancer
may end Cerebrovascular
with Diseases
Accidents
may end with
 By the dawn of the third
millennium
Non communicable diseases are
sweeping the entire globe, with an
increasing trend in developing countries

• Double burden of infective and non-

infective diseases
•By 2020,
•it is predicted that these diseases will
be causing 7 out of every 10 deaths in
developing countries.

•Many of the non communicable

can be prevented by tackling associated
risk factors.
 The Rationale of Teaching and
Learning Cardiovascular Diseases
•If the present trend is maintained, the
health systems in low-and middle-
income countries will be unable to
support the burden of disease
• Prominent causes for cardiovascular
diseases can be prevented
•Urgent and efficient preventive
strategies should deal seriously with
risk factors as smoking……
 Cardiovascular Diseases (CVD) in
Developing Countries

•The economic transition, urbanization,

•Industrialization and globalization
bring about lifestyle changes that are
considered as risk factors that promote heart
disease.
•Life expectancy in developing countries is
rising sharply and people are exposed to the
risk factors for longer periods.
 Cardiovascular Diseases

CVD made up 16.7 million, or one

third (29.2%) of total global
deaths according to World Health
Report 2003.
Around 80% of CVD deaths took
place in low and middle-income
countries.
 Cardiovascular Diseases
(CVD) Deaths

Low Income
80% of
CVD
Deaths

Middle Income High Income

 Rheumatic
Heart Disease

Cardiovascular
Hypertension Coronary
Diseases
Hrt Dis

Cerebrovascular
Heart
Diseases Failure
Congenital Heart
Diseases
 Rheumatic
Heart Disease

Coronary
Hypertension Heart Heart
Disease
Failure

Congenital Heart
Diseases
 Linear Approach for
Teaching Risk Factors of
CVD
Unmodifiable Modifiable

•Age Smoking
Hypertension
•Gender High cholesterol Obesity
High LDL Physical
•Family Inactivity
History Low HDL
High Salt Intake Diabetes Mellitus
•Vascular Alcohol Hyperinsulinemia
Changes Hyperuricemia
Type A behaviour
 Clinical Importance of Global
Estimates for Coronary Heart
Disease Risk

•Any major risk factor, if left

untreated for many years, has the
potential to produce cardiovascular
disease (CVD).

•Preventive efforts should target

each major risk factor.
 Smoking Hypertension Obesity

Age Diet
Risk Factors of
Gender Cardiovascular Salt Intake
Diseases
Family Cholesterol
History LDL
Vascular
HDL
Changes Diabetes
Mellitus
 Unmodifiable Risk Factors

Coronary Heart
Dis
Hypertension
Age
Cerebrovascular
Disease

Vascular Changes
since Childhood 6 yrs

Diabetes Mellitus
Type II
 Unmodifiable Risk Factors

Hypertension
Before Menopause 2 : 1
After Menopause 2 :
1.8
Coronary Heart Dis
Before Menopause 2 : 1 After
Gender Menopause 2 : 1.8
Male: Female
Cerebrovascular
Disease

Vascular Changes

Influence of Estrogen
 Unmodifiable Risk Factors
Genetic •Environ
•Diet Coronary Heart
Dis
Hypertension

Family Cerebrovascular
History Disease

Vascular Changes
since Childhood 6 yrs

Diabetes Mellitus
 Unmodifiable Risk Factors

Lipid Profile
High Cholesterol > 200mg/dl
HighLDL > 160 mg/dl
Low HDL < 40 mg/dl
Triglycerides > 200mg/dl

Vascular Diabetes Mellitus

Changes Smoking
Hypertension
Before Menopause 2 : 1
After Menopause 2 :
1.8
Coronary Heart Dis
Before Menopause 2 : 1 After
Menopause 2 : 1.8
Cerebrovascular
Disease
 Modifiable Risk Factors

Age Obesity
Diabetes Mellitus

Smoking
Hypertension Vascular Changes
•Primary since Childhood 6 yrs
•Secondary
Lipid Profile
High Cholesterol > 200mg/dl
HighLDL > 160 mg/dl
Low HDL < 40 mg/dl
Triglycerides > 200mg/dl

Renal Coronary Heart Dis

Dis Cerebrovascular
Disease
 New Classification of Hypertension
JNC, 2003
Category Systolic Diastolic
BP BP
Normal <120 <80
Prehypertensive 120-139 80-89

Stage (1) 140-159 90-99

Stage (2) ≥ 160 ≥ 100
 Modifiable Risk Factors

Peers Stress
Type A behaviour
Vascular Changes
Smoking
Lipid Profile
HighLDL > 160 mg/dl
Low HDL < 40 mg/dl

Platelet Aggregation
High fibrinogen

Cerebrovascular Coronary Heart

Disease Dis Myocardial infarction
Sudden Death
 Modifiable Risk Factors

Stress

Physical Inactivity

Vascular Changes
Obesity
Lipid Profile
High Cholesterol > 200mg/dl
HighLDL > 160 mg/dl
Low HDL < 40 mg/dl
Triglycerides > 200mg/dl

Hypertension
Cerebrovascular Coronary Heart Dis
Myocardial infarction/ Sudden
Disease Death
Prevention
Unmodifiable
Risk Factors Prevention
of CVD

Age
Unpreventable
Male Sex

Vascular Modification of
changes Life style
Since Childhood
Modifiable Risk
Factors of CVD Prevention

High
Cholest

Modification of
LDL Life style
Since Childhood
HDL

Diabetes
Control Physical
Hypertension
Diet Exercise

Modification of Life style

Since Childhood

Control
Quitting Diabetes
Smoking High
Lipids
Low sodium
intake
Diet

Modification of Life style

Since Childhood
Assessment of Cardiovascular Risk
by Use of Multiple-Risk-Factor
Assessment Equations
The total risk of a person can be
estimated by a summing of the
risk imparted by each of the
major risk factors.

Risk Points= Age + Gender +

Total Cholest + Smoking +
Diabetes + SBP
e.g., *Framingham Risk Scores
* Score Study Risk Factors.
 Advancing
Age +
+

Risk Points
+ +

Diabetes
+ +
 Development of Risk Scores

•The Framingham study in USA & Other

studies made summations of the different
CHD risk factors& developed estimate risk
scores for persons without clinical
manifestations of CHD.

•The individuals could be classified into

low, average & high risk.

•Therefore, the scores apply only to

primary prevention, i.e, to prevention in
persons without established CHD.
 Assessment of
Cardiovascular
Risk
High
Risk
Average
Risk
Low
Risk
 Flow Chart for risk
Assessment & Action
Motivation of
Identification patients to
of high-risk adhere to
patients risk-reduction

Intensive
modification of
≥1 risk factors
patients at high
risk