Stand und Potentiale der Bekämpfung von Herz-Kreislauf-Krankheiten und Diabetes in der Schweitz Netwektreffen 2013 CardioVascSuisse Bern, 22 August 2013 Index Cardiovascular mortality Prevalence and management of cardiovascular risk factors in Switzerland Cardiovascular prevention in Switzerland: it is worth? Diabetes in Switzerland: prevalence, incidence and prevention potential Pedro Marques-Vidal Institut Universitaire de Médecine Sociale et Préventive Management of AMI in Switzerland: the wild west? Summary and conclusion 2 Coronary heart disease (2000) Men Stroke (2000) Men Müller-Nordhorn et al. Eur Heart J. 2008;29:1316 3 Müller-Nordhorn et al. EurHeart J. 2008;29:1316. 4
Trends in mortality rates Trends in mortality rates, men www.bfs.admin.ch/bfs/portal/fr/.../publikationen.document.110661.pdf 5 www.bfs.admin.ch/bfs/portal/fr/.../publikationen.document.110661.pdf 6 Trends in mortality rates, women Geneva, 1993 2000 Bluthochdruck Übergewicht/obesitas Höhes Cholesterin www.bfs.admin.ch/bfs/portal/fr/.../publikationen.document.110661.pdf 7 Galobardes et al. Ann Epidemiol. 2003;13:537-40 8
Smoking Overweight and obesity, men Marques-Vidal et al. J Epidemiol Community Health. 2011;65:281 9 Marques-Vidal et al. BMC Public Health. 2010;10:87 10 Educational level (Low, Middle, High) Overweight and obesity, women Obesity, men Marques-Vidal et al. BMC Public Health. 2010;10:87 11 Educational level (Low, Middle, High) Faeh et al. Swiss Medical Weekly. 2008;138:204 12
Obesity, women Trends in reported hypertension Faeh et al. Swiss Medical Weekly. 2008;138:204 13 Estoppey et al. BMC Public Health. 2011;11:114 14 Hypertension, men Hypertension, women Prevalence: 4 out of 10 Prevalence: 3 out of 10 Danon-Hersch et al. Eur J Cardiovasc Prev Rehab. 2009;16:66 15 Danon-Hersch et al. Eur J Cardiovasc Prev Rehab. 2009;16:66 16
Trends in reported hypercholesterolemia Dyslipidemia Percentage 100 90 80 70 68 59 60 55 54 56 50 47 43 40 40 32 30 27 21 20 10 8 0 35-44 45-54 55-64 65-75 Age group Prevalence Treated Controlled Estoppey et al. BMC Public Health. 2011;11:114 17 Firmann et al. Eur J Cardiovasc Prev Rehab. 2010;17:682-7 18 Risk estimation Most CVD events occur in subjects with moderately elevated risk factors The presence of several moderately elevated risk factors adds up and might overcome the effect of a single elevated risk factor Current recommendations stress the need to base intervention on the individual's total risk rather than on the level of any particular risk factor. Risk estimation in Switzerland Lack of consensus Framingham (USA) PROCAM (Germany) SCORE (many European countries) Equations taken «as provided» Little if no validation. Results different. Conroy et al. Eur Heart J 2003;24:987 19 20
Framingham: risk of overestimation PROCAM: risk of overestimation Spain, Men 4'500 4'000 3'500 3973 Belfast 3'000 Number 2'500 2'000 1'500 1'000 1178 1457 500 0 370 35-44 45-54 55-64 65-74 France Predicted Observed Marrugat et al. J. Epidemiol. Community Health 2003;57: 634 21 Empana et al. Eur Heart J 2003;24:1903 22 SCORE calibration SCORE calibration Marques-Vidal et al. EurJ CardiovascPrevRehabil. 2008;15:402 23 Marques-Vidal et al. EurJ CardiovascPrevRehabil. 2008;15:402 24
25 CV prevention in Switzerland: it is worth? ESC/SCORE Eligible Deaths Cost for 1 year of life gained subjects adverted Option 1 Option 2 Option 3 Men 243,721 970 306 404 615 Women 96,390 225 552 719 1078 All 340,111 1195 352 464 702 IAS/PROCAM Men 360,347 1062 421 554 838 Women 153,698 270 734 956 1432 All 513,715 1332 485 635 958 ATPIII/Framingham Men 436,270 1112 490 644 972 Women 189,742 298 824 1073 1606 All 626,012 1409 561 735 1107 Ito et al. Am J Cardiovasc Drugs. 2011;11:33 Trends in reported diabetes, 1997-2007 5-year incidence of T2DM: 5.5% (1% per year) Estoppey et al. BMC Public Health. 2011;11:114 Schmid et al. Arch intern Med 2012;172:187 26 Risk of developping diabetes Risk of developping diabetes As for cardiovascular disease, several scores have been proposed to predict the development of T2DM. A first analysis showed that the number of persons at risk varied considerably according to the score used. Based on prospective data, only 2/7 scores were considered as valid. Schmid et al. Diabetes Care. 2011;34:1863 Schmid et al. Arch Intern Med. 2012;172:188 Schmid et al. J Clin Endocrinol Metab. 2012. Marques-Vidal et al. PLoS One, 2012;7 27 The inclusion of inflammatory or genetic data does not improve the prediction Schmid et al. Diabetes Care. 2011;34:1863 28
Management of AMI: the wild west? Management of AMI: the wild west? % Léman Mittelland Northwest Zurich East Central Ticino Emergency 81 85 55 88 80 90 90 ICU 69 21 43 20 32 45 17 Any IC intervention 51 41 35 46 38 31 39 Bare stent 61 36 37 49 26 55 17 DE stent 39 64 63 51 74 45 83 CABG 4.0 3.4 2.3 3.6 0.5 0.7 4.8 Insam et al. EurJ PrevCardiol. 2012 29 Insam et al. BMC Public Health. 2013;13:270 30 Summary and conclusion CVD mortality decreasing overall, but increasing in the elderly. Although some risk factors are decreasing, their management can still be improved. The increase in the prevalence of obesity and diabetes is worrying. Prevention for all might not be cost-effective. Considerable variations in AMI management 31 32