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Cardiovascular diseases (CVDs)

KEY FACTS

CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause An estimated !" ! million people died from CVDs in #$$%& representing #'(of all global deaths )f these deaths& an estimated " # million *ere due to coronary heart disease and + " million *ere due to stro,e -o*. and middle.income countries are disproportionally affected: /#( of CVD deaths ta,e place in lo*. and middle.income countries and occur almost e0ually in men and *omen 1y #$2$& almost #2 3 million people *ill die from CVDs& mainly from heart disease and stro,e These are pro4ected to remain the single leading causes of death The largest percentage increase

Related links: =<) action plan for the strategy for pre7ention and control of noncommunicable <ealth topic: cardio7ascular diseases

*ill occur in the Eastern 5editerranean 6egion The largest increase in number of deaths *ill occur in the South.East Asia 6egion

What are cardiovascular diseases? Cardio7ascular diseases 8CVDs9 are a group of disorders of the heart and blood 7essels and include:

coronary heart disease : disease of the blood 7essels supplying the heart muscle cerebro7ascular disease . disease of the blood 7essels supplying the brain peripheral arterial disease : disease of blood 7essels supplying the arms and legs rheumatic heart disease : damage to the heart muscle and heart 7al7es from rheumatic fe7er& caused by streptococcal bacteria congenital heart disease . malformations of heart structure e;isting at birth deep 7ein thrombosis and pulmonary embolism : blood clots in the leg 7eins& *hich can dislodge and mo7e to the heart and lungs

<eart attac,s and stro,es are usually acute e7ents and are mainly caused by a bloc,age that pre7ents blood from flo*ing to the heart or brain The most common reason for this is a build.up of fatty deposits on the

inner *alls of the blood 7essels that supply the heart or brain Stro,es can also be caused by bleeding from a blood 7essel in the brain or from blood clots What are the risk factors for cardiovascular disease? The most important beha7ioural ris, factors of heart disease and stro,e are unhealthy diet& physical inacti7ity and tobacco use 1eha7ioural ris, factors are responsible for about /$( of coronary heart disease and cerebro7ascular disease The effects of unhealthy diet and physical inacti7ity may sho* up in indi7iduals as raised blood pressure& raised blood glucose& raised blood lipids& and o7er*eight and obesity> these are called ?intermediate ris, factors? There are also a number of underlying determinants of CVDs& or& if you li,e& @the causes of the causes@ These are a reflection of the ma4or forces dri7ing social& economic and cultural change : globaliAation& urbaniAation& and population ageing )ther determinants of CVDs are po7erty and stress What are common symptoms of cardiovascular diseases? Symptoms of heart attacks and strokes )ften& there are no symptoms of the underlying disease of the blood 7essels A heart attac, or stro,e may be the first *arning of underlying disease Symptoms of a heart attac, include:

pain or discomfort in the centre of the chest> pain or discomfort in the arms& the left shoulder& elbo*s& 4a*& or bac,

Bn addition the person may e;perience difficulty in breathing or shortness of breath> feeling sic, or 7omiting> feeling light.headed or faint> brea,ing into a cold s*eat> and becoming pale =omen are more li,ely to ha7e shortness of breath& nausea& 7omiting& and bac, or 4a* pain The most common symptom of a stro,e is sudden *ea,ness of the face& arm& or leg& most often on one side of the body )ther symptoms include sudden onset of: numbness of the face& arm& or leg& especially on one side of the body> confusion& difficulty spea,ing or understanding speech> difficulty seeing *ith one or both eyes> difficulty *al,ing& diAAiness& loss of balance or coordination> se7ere headache *ith no ,no*n cause> and fainting or unconsciousness Ceople e;periencing these symptoms should see, medical care immediately What is rheumatic heart disease? 6heumatic heart disease is caused by damage to the heart 7al7es and heart muscle from the inflammation and scarring caused by rheumatic fe7er 6heumatic fe7er is caused by streptococcal bacteria& *hich usually begins as a sore throat or tonsillitis in children 6heumatic fe7er mostly affects children in de7eloping countries& especially *here po7erty is *idespread Dlobally& almost #( of deaths from cardio7ascular diseases is related to rheumatic heart disease& *hile %#( of deaths from cardio7ascular diseases is related to ischaemic heart disease& and 2%( to cerebro7ascular disease Symptoms of rheumatic heart disease

Symptoms of rheumatic heart disease include: shortness of breath& fatigue& irregular heart beats& chest pain and fainting Symptoms of rheumatic fe7er include: fe7er& pain and s*elling of the 4oints& nausea& stomach cramps and 7omiting

Treatment

Early treatment of streptococcal sore throat can stop the de7elopment of rheumatic fe7er 6egular long.term penicillin treatment can pre7ent repeat attac,s of rheumatic fe7er *hich gi7e rise to rheumatic heart disease and can stop disease progression in people *hose heart 7al7es are already damaged by the disease

Why are cardiovascular diseases a development issue in low and middle income countries?

)7er /$( of the *orld?s deaths from CVDs occur in lo*. and middle.income countries Ceople in lo*. and middle.income countries are more e;posed to ris, factors leading to CVDs and other noncommunicable diseases and are less e;posed to pre7ention efforts than people in high. income countries Ceople in lo*. and middle.income countries *ho suffer from CVDs and other noncommunicable diseases ha7e less access to effecti7e and e0uitable health care ser7ices *hich respond to their needs 8including early detection ser7ices9 As a result& many people in lo*. and middle.income countries die younger from CVDs and other noncommunicable diseases& often in their most producti7e years The poorest people in lo*. and middle.income countries are affected most At household le7el& sufficient e7idence is emerging to pro7e that CVDs and other noncommunicable diseases contribute to po7erty For e;ample& catastrophic health care e;penditures for households *ith a family member *ith CVD can be 2$ per cent or more of annual household spending At macro.economic le7el& CVDs place a hea7y burden on the economies of lo*. and middle.income countries <eart disease& stro,e and diabetes are estimated to reduce DDC bet*een ! and +( in lo*. and middle.income countries e;periencing rapid economic gro*th& as many people die prematurely For e;ample& it is estimated that o7er the ne;t !$ years 8#$$3.#$!+9& China *ill lose E++/ billion in foregone national income due to the combination of heart disease& stro,e and diabetes

!ow can the "urden of cardiovascular diseases "e reduced? <eart disease and stro,e can be pre7ented through healthy diet& regular physical acti7ity and a7oiding tobacco smo,e Bndi7iduals can reduce their ris, of CVDs by engaging in regular physical acti7ity& a7oiding tobacco use and second.hand tobacco smo,e& choosing a diet rich in fruit and 7egetables and a7oiding foods that are high in fat& sugar and salt& and maintaining a healthy body *eight Comprehensi7e and integrated action is the means to pre7ent and control CVDs

Comprehensi7e action re0uires combining approaches that see, to reduce the ris,s throughout the entire population *ith strategies that target indi7iduals at high ris, or *ith established disease E;amples of population.*ide inter7entions that can be implemented to reduce CVDs include: comprehensi7e tobacco control policies& ta;ation to reduce the inta,e of foods that are high in fat& sugar and salt& building *al,ing and cycle *ays to increase physical acti7ity& pro7iding healthy school meals to children Bntegrated approaches focus on the main common ris, factors for a range of chronic diseases such as CVD& diabetes and cancer: unhealthy diet& physically inacti7ity and tobacco use

There are se7eral treatment options a7ailable

Effecti7e and ine;pensi7e medication is a7ailable to treat nearly all CVDs

Sur7i7ors of a heart attac, or stro,e are at high ris, of recurrences and at high ris, of dying from them The ris, of a recurrence or death can be substantially lo*ered *ith a combination of drugs : statins to lo*er cholesterol& drugs to lo*er blood pressure& and aspirin )perations used to treat CVDs include coronary artery bypass& balloon angioplasty 8*here a small balloon.li,e de7ice is threaded through an artery to open the bloc,age9& 7al7e repair and replacement& heart transplantation& and artificial heart operations 5edical de7ices are re0uired to treat some CVDs Such de7ices include pacema,ers& prosthetic 7al7es& and patches for closing holes in the heart

There is a need for increased go7ernment in7estment through national programmes aimed at pre7ention and control of CVDs and other noncommunicable diseases
#or more information contact:

http://www.americanheart.org/downloadable/heart/1236978541670OU !O"! #O$%.pd& $tati'tical("act($heet()(*i'cellaneo+' 2009(Update

2009, American Heart Association, americanheart.org. For more information, call 1-800-AHA-USA1

Out-of-Hospital Cardiac Arrest Statistics

There is a wi e !ariation in the re"orte inci ence of an o#tcome for o#t-of-hos"ital

car iac arrest. These ifferences are #e in "art to ifferences in efinition an ascertainment of car iac arrest ata, as well as ifferences in treatment after the onset of car iac arrest. $ar iac arrest is efine as cessation of car iac mechanical acti!it% an is confirme &% the a&sence of signs of circ#lation. A!aila&le e"i emiological ata&ases o not a e'#atel% characteri(e car iac arrest or the s#&set of cases that occ#r with s# en onset. The following information s#mmari(es re"resentati!e ata from se!eral so#rces in an attem"t to characteri(e the inci ence an o#tcome of o#t-of-hos"ital car iac arrest. (Circulation. 2004; 110: 33853397) )*tra"olation of the mortalit% rate o&ser!e in +es#scitation ,#tcomes $onsorti#m to the total "o"#lation of the Unite States s#ggests that each %ear there are 2-.,100 )/S-treate o#t of hos"ital car iac arrests ann#all% in the Unite States. (Unpublish !
!ata" # $ichol" %a& 25" 2008)

)*tra"olation of ata from A+0$, $HS, an Framingham Heart St# % s#ggests that there

are 118,000 coronar% heart isease eaths within one ho#r of s%m"tom onset. (' rsonal
co((unication )ith $*+,-" %a& 20" 2008)

,nl% 11 "ercent of those with )/S-treate o#t-of-hos"ital car iac arrest ha!e s%m"toms

within one ho#r of eath. (Circulation. 200.;114:114./1150) Pediatric/Children The re"orte inci ence of o#t-of-hos"ital "e iatric car iac arrest !ar% wi el% 2from 2.- to 19.3 ann#al cases "er 100,0004. (0nn 1( r2 % !. 2005; 4.: 512522) In-Hospital Cardiac Arrests For a #lts, the re"orte inci ence of car iac arrest in hos"ital was 0.13 250.094 "er &e "er %ear. (3 0( Coll Car!iol. 1998;32:18811884) The rates of s#r!i!al to ischarge after in-hos"ital car iac arrest are 23 "ercent among chil ren an 18 "ercent among a #lts. (Circulation. 2007;11.: 13411343) A total of 101 facilities re"orte 21,368 e!ents to the 7ational +egistr% for

$ar io"#lmonar% +es#scitation in 2003. ,f these, 91 "ercent were monitore or witnesse , an 13.9 "ercent ha !entric#lar fi&rillation or "#lseless !entric#lar tach%car ia as the first recor e rh%thm. ,f these, 39 "ercent recei!e a efi&rillation attem"t within three min#tes. (Circulation. 2007;11.:1374/1379) Community Cardiac Arrests 39 "ercent of the la% "#&lic are confi ent that the% 8now what actions to ta8e in a me ical emergenc%9 98 "ercent recogni(e an a#tomate electrical efi&rillator as something that a ministers an electrical shoc8 to restore a normal heart &eat among !ictims of s# en car iac arrest9 an -0 "ercent are familiar with $:+. (1CC *arris
-nt racti4 'oll)

$+dden(,eath'("rom(-ardiac(.rre't()($tati'tic'(2
For additional information see the Heart Disease and Stroke Statistics $pdate% pu&lished in Circulation and a'aila&le on our (e& site)
A&&re'iations $sed* CP+ cardiopulmonary resuscitation

!""#

Sudden Cardiac Death

AHA Scientific Position S# en eath from car iac arrest is a ma;or health "ro&lem that<s recei!e m#ch less "#&licit% than heart attac8. The American Heart Association s#""orts im"lementing the =chain of s#r!i!al= to resc#e "eo"le who s#ffer a car iac arrest in the comm#nit%. The a #lt chain consists of

)arl% +ecognition of the )mergenc% an Acti!ation of )mergenc% +es"onse S%stem 2"hone 9-1-1 imme iatel%4 )arl% $:+ )arl% >efi&rillation )arl% A !ance $are

(hat is sudden cardiac death, S# en car iac eath 2also calle s# en arrest4 is eath res#lting from an a&r#"t loss of heart f#nction 2car iac arrest4. The !ictim ma% or ma% not ha!e iagnose heart isease. The time an mo e of eath are un 5p ct !. 0t occ#rs within min#tes after s%m"toms a""ear. The most common #n erl%ing reason for "atients to ie s# enl% from car iac arrest is coronar% heart isease 2fatt% &#il #"s in the arteries that s#""l% &loo to the heart m#scle4. An estimate 296,8.1 emergenc% me ical ser!ices-treate o#t-of-hos"ital car iac arrests occ#r in the Unite States each %ear. (hat causes sudden cardiac death, All 8nown heart iseases can lea to car iac arrest an s# en car iac eath. /ost of the car iac arrests that lea to s# en eath occ#r when the electrical im"#lses in the isease heart &ecome ra"i 2!entric#lar tach%car ia4 or chaotic 2!entric#lar fi&rillation4 or &oth. This irreg#lar heart rh%thm 2arrh%thmia4 ca#ses the heart to s# enl% sto" &eating. Some car iac arrests are #e to e*treme slowing of the heart. This is calle &ra %car ia.

0n 90 "ercent of a #lt !ictims of s# en car iac eath, two or more ma;or coronar% arteries are narrowe &% fatt% &#il #"s. Scarring from a "rior heart attac8 is fo#n in two-thir s of !ictims. ?hen s# en eath occ#rs in %o#ng a #lts, other heart a&normalities are more li8el% ca#ses. A renaline release #ring intense "h%sical or athletic acti!it% often acts as a trigger for s# en eath when these a&normalities are "resent. Un er certain con itions, !ario#s heart me ications an other r#gs @ as well as illegal r#g a&#se @ can lea to a&normal heart rh%thms that ca#se s# en eath. The term =massi!e heart attac8= is often wrongl% #se in the me ia to escri&e s# en eath. The term =heart attac8= refers to eath of heart m#scle tiss#e #e to the loss of &loo s#""l%, not necessaril% res#lting in a car iac arrest or the eath of the heart attac8 !ictim. A heart attac8 ma% ca#se car iac arrest an s# en car iac eath, &#t the terms aren<t s%non%mo#s. Can the cardiac arrest that causes sudden death &e re'ersed, Arain eath an "ermanent eath start to occ#r in ;#st fo#r to si* min#tes after someone e*"eriences car iac arrest. $ar iac arrest is re!ersi&le in most !ictims if it<s treate within a few min#tes with an electric shoc8 to the heart to restore a normal heart&eat. This "rocess is calle efi&rillation. A !ictim<s chances of s#r!i!al are re #ce &% 3 to 10 "ercent with e!er% min#te that "asses witho#t $:+ an efi&rillation. $:+ can o#&le or tri"le a car iac arrest !ictim<s chances of s#r!i!al. Few attem"ts at res#scitation s#ccee after 10 min#tes. 0f someone &ecomes #nconscio#s, call 9-1-1 imme iatel%. The% ma% &e s#ffering from s# en car iac arrest. (hat are treatments for sur'i'ors, 0f a car iac arrest was #e to !entric#lar tach%car ia or !entric#lar fi&rillation, s#r!i!ors are at ris8 for another arrest, es"eciall% if the% ha!e #n erl%ing heart isease. S#r!i!ors of car iac arrest m#st ha!e all ca#ses correcte to "re!ent f#t#re e"iso es. :ossi&le ca#ses incl# e m%ocar ial ischemia 2ina e'#ate &loo flow to the heart m#scle4, arrh%thmia 2a&normal heart rh%thm4, etc. :ossi&le tests an treatments incl# e

car iac catheteri(ation electro"h%siologic tests coronar% arter% &%"ass s#rger% &alloon angio"last% or :$0 2:T$A4 antiarrh%thmic me icine im"lanta&le car io!erter B efi&rillator im"lanta&le "acema8er heart trans"lant

http://www.americanheart.org/presenter.jhtml?identifier=4741
A&out Sudden Death and Cardiac Arrest

S# en eath from car iac arrest is a ma;or health "ro&lem that has recei!e m#ch less "#&licit% than heart attac8. The American Heart Association offers these statistics as "art of o#r "#&lic awareness cam"aign to increase car iac arrest s#r!i!al across the Unite States.

Altho#gh the irect me ical costs are m#ch less than for lingering illnesses, the economic an social im"acts of s# en eath from car iac arrest are h#ge. S# en eath occ#rs on a!erage at a&o#t -0 %ears of age, claims man% "eo"le #ring their most "ro #cti!e %ears, an e!astates #n"re"are families. Sudden death 2also calle sudden cardiac death4 occ#rs when the heart sto"s a&r#"tl% 2car iac arrest4. The !ictim ma% or ma% not ha!e iagnose heart isease. >eath can occ#r within min#tes after s%m"toms a""ear, or there ma% &e no s%m"toms &efore colla"se. The most common #n erl%ing reason that "atients ie s# enl% from car iac arrest is coronar% heart isease. 0n 90 "ercent of a #lt !ictims of s# en eath, two or more ma;or coronar% arteries are narrowe &% atherosclerosis. Scarring from a "rior heart attac8 is fo#n in two-thir s of !ictims. ?hen s# en eath occ#rs in %o#ng a #lts, other heart a&normalities are more li8el% ca#ses. A renaline release #ring intense athletic or "h%sical acti!it% often triggers s# en eath when these a&normalities are "resent. Un er certain con itions, !ario#s heart me ications an other r#gs -- as well as illegal r#g a&#se -- can lea to a&normal heart rh%thms that ca#se s# en eath. Cardiac arrest occ#rs s# enl% an ramaticall%. 0t<s also sometimes calle sudden cardiac arrest or une-pected cardiac arrest. /ost 8nown heart iseases can lea to car iac arrest an s# en eath. /ost of the car iac arrests that lea to s# en eath occ#r when the electrical im"#lses in the heart &ecome ra"i 2!entric#lar tach%car ia4 or chaotic 2!entric#lar fi&rillation4 or &oth. This irreg#lar heart rh%thm ca#ses the heart to s# enl% sto" &eating. A small n#m&er of car iac arrests are ca#se &% e*treme slowing of the heart 2&ra %car ia4. 7o statistics are a!aila&le for the e*act n#m&er of car iac arrests that occ#r each %ear. Howe!er, a&o#t 110,000 "eo"le a %ear ie of coronar% heart isease witho#t &eing hos"itali(e . That<s a&o#t half of all eaths from $H> -a&o#t 8.0 Americans each a%. /ost of these are s# en eaths ca#se &% car iac arrest. ,ther factors &esi es heart isease an heart attac8 can ca#se car iac arrest. The% incl# e res"irator% arrest, electroc#tion, rowning, cho8ing or tra#ma. $ar iac arrest also can occ#r witho#t an% 8nown ca#se. Arain eath an "ermanent eath start to occ#r in ;#st 6 to - min#tes after someone e*"eriences car iac arrest. $ar iac arrest can &e re!erse in most !ictims if it<s treate with imme iate $:+ an an electric shoc8 to the heart within 3 to 10 min#tes. $:+ consists of mo#th-to-mo#th &reathing an chest com"ressions. The shoc8 eliminates the a&normal rh%thm an allows the heart<s normal rh%thm to res#me. This "rocess is calle efi&rillation. A !ictim<s chances of s#r!i!al are re #ce &% 3-10 "ercent with e!er% min#te that "asses witho#t treatment. Few res#scitation attem"ts s#ccee after 10 min#tes ha!e ela"se . 0t<s estimate that more than 9. "ercent of car iac arrest !ictims ie &efore reaching the hos"ital. 0n cities where efi&rillation is "ro!i e within . to 3 min#tes, the s#r!i!al rate from car iac arrest is as high as 69 "ercent. )arl% $:+ an ra"i efi&rillation com&ine with earl% a !ance care can "ro #ce high long-term s#r!i!al rates for witnesse car iac arrest. 0n one case, a#tomate e*ternal efi&rillators 2A)>s4 were mo#nte a istance of one min#te a"art in "lain !iew at $hicago<s ,<Hare an /i wa% Air"orts in C#ne 1999. 0n the first 10 months, 16 car iac arrests occ#rre with 12 of the 16 !ictims in !entric#lar fi&rillation. 7ine of the 16 !ictims 2-6 "ercent4 were re!i!e with an A)> an ha no &rain amage. 0f &%stan er $:+ was more consistentl% starte , A)>s were more wi el% a!aila&le, an the s#r!i!al rate from car iac arrest was increase to 20 "ercent, at least 60,000 li!es co#l &e sa!e each %ear. The American Heart Association #rges the "#&lic to &e prepared for cardiac emer.encies*

/no0 the 0arnin. si.ns of heart attack and cardiac arrest) >#ring car iac arrest, a !ictim &ecomes #nres"onsi!e, sto"s normal &reathing, an loses "#lse or other signs of circ#lation. 2See heart attac8 warning signs.4 Call #-1-1 imme iatel% to access the emergenc% me ical ser!ices 2)/S4 if %o# see an% warning signs of heart attac8 or if someone colla"ses s# enl% an is #nres"onsi!e.

2e.in cardiopulmonary resuscitation 3CP+4 immediately) This will hel" 8ee" the car iac arrest !ictim ali!e #ntil emergenc% hel" arri!es. $:+ 8ee"s &loo flowing to the heart an &rain #ntil efi&rillation can &e "ro!i e .

>eath from car iac arrest isn<t ine!ita&le. 0f more "eo"le react '#ic8l% &% calling 9-1-1 an "erforming $:+, more li!es can &e sa!e . 0n the remain er of this &oo8let, statistics relating to s# en eath an car iac arrest are highlighte in "in8.

http://www.americanheart.org/presenter.jhtml?identifier=6 4