CORONARY
HEART
DISEASE
B LOCHANA
- 29
INTRODUCTION
Definition :
Coronary heart disease also known as Ischemic heart disease has
been defined as impairment of heart function due to inadequate blood
flow to the heart compared to its needs, caused by obstructive changes in
the coronary circulation to the heart.
INTRODUCTION
It is the cause of 25-30% of deaths in the most industrialized countries.
CHD may manifest itself in many presentations:
a. Angina pectoris of effort
b. Myocardial infarction
c. Irregularities of the heart
d. Cardiac failure
e. Sudden death
Myocardial infarction is specific to CHD.
The natural history of CHD is very variable. Death may occur in the first episode or
after a long history of disease.
Measuring the burden of
disease
The burden of CHD may be estimated in various ways,
a. Proportional mortality ratio: This is the simplest measure. The proportion of all
deaths currently attributed to it.
b. Loss of life expectancy: CHD cuts short the life expectancy.
c. CHD incidence rate: This is the sum of fatal and non fatal attack rates. Accurate
incidence of CHD rates are difficult to compute due to its different
manifestations. Mortality rates can be used as crude indicator of incidence.
d. Age specific death rates: This suggest a true increase in incidence.
Measuring the burden of
disease
Cont......
e. Prevalence rate: This can be estimated from using ECG for evidence of infarction and
history of prolonged chest pain.
f. Case fatality rate: This is defined as the proportion of attacks that are fatal within 28
days of onset. The International Society and Federation of Cardiology has suggested that
“sudden deaths” to include deaths “occurring instantly or within an estimated 24 hours of
the onset of acute symptoms or signs”.
g. Measurement of risk factor levels: These include measurement of levels of cigarette
smoking, BP, alcohol consumption and serum cholesterol in the community.
h. Medical care: Measurement of levels of medical care in the community are also
pertinent.
EPIDEMIOLOGY
Epidemics of CHD began at different times in different countries. In US, early 1920s, in
Britain in the 1930s and in several European countries, still later.
Countries where the epidemic began earlier are now showing decline due to
changes in the life styles and related risk factors (diet and diet dependent serum
cholesterol, cigarette use and exercise habits) and better control of hypertension.
The WHO has completed a project known as MONICA (“multinational monitoring of
trends and determinants in cardiovascular diseases”).
The primary goal of this project is to provide a measurement tool to cardiovascular
and non communicable disease prevention and control programs.
EPIDEMIOLOGY
International variations:
CHD is a world wide disease.
At present, Highest coronary mortality
rate is seen in the Western Pacific
Region followed by European Region.
EPIDEMIOLOGY
CHD in India:
CHD is assuming serious dimension in developing countries.
There is a considerable increase in prevalence of CHD in urban areas during the
last decade.
The estimations from studies carried out in 1990s – 2002 shows the prevalent rate
of CHD in urban areas as 6.4% (Males 6.1% and Females 6.7%) and in rural areas
as 2.5% ( Males 2.1% and Females 2.7%).
EPIDEMIOLOGY
Cont....
According to medical certification of cause of death data, 25.1% of total
deaths in urban areas are due to diseases of cardiovascular system.
Mortality rate due to CHD in rural areas is expected to be half of as that of
urban areas.
It is estimated that 16,08,700 people died of CHD during 2016. The crude
death rate was 121.5/100,000 population.
Reference
Park’s Textbook of PREVENTIVE AND SOCIAL MEDICINE
