NON COMMUNICABLE DISEASE

Dr Nadira Sultana Kakoly

Assistant Professor, Department of Public
Health
North south university
CARDIOVASCULAR DISEASES (CVD)
WHAT IS CVD
• Cardiovascular diseases (CVD) are a group of diseases of heart and blood vessels in our body

• CVD is the leading cause of death globally and it kills 17.5 million people every year, which is
one third of all global deaths and half of all deaths from NCD

• Globally 1 in every 10 people aged 30 – 70 years die from CVD every year (premature death)
TYPES OF CVD
• Coronary artery disease and Stroke are the two major types of CVD that contribute to 85% of
all CVD deaths

• Coronary artery diseases is when arteries supplying the heart are blocked partially or
completely making it difficult for heart to continue pumping blood in absence of blood supply.
The resultant condition is called Myocardial infarction (heart attack)

• Stroke or Cerebrovascular disease/accident is the condition when blood vessels supplying the
brain are blocked (ischemic stroke) or ruptured (hemorrhagic stroke) interrupting the blood
supply to brain
TYPES OF CVD
Other types of CVD include Peripheral arterial disease
(Disease of the arteries supplying the arms and legs),
Rheumatic Heart disease (damage to the heart muscle and
heart valves from rheumatic fever, caused by a bacteria),
Heart Block (block in conduction of the electric impulse
resulting in irregular beats), Congenital Heart Diseases
(Malformations of heart structures existing at birth) etc.
SIGN/SYMPTOMS OF MAJOR CVDS
Heart attack/Myocardial infarction Stroke/Cerebrovascular accident

• Chest pain • Sudden weakness of the face, arm, or leg, most

• Discomfort/tingling in arms, back, jaw, neck, often on one side of the body.
shoulder • Numbness of face/arm/leg, especially on one
• Shortness of breath side of the body
• Sudden dizziness, unusual tiredness • Confusion, difficulty speaking or understanding
• Nausea or vomiting speech;
• Heart burn like feeling • Difficulty seeing with one or both eyes;
• Cold sweat • Difficulty walking, dizziness, loss of balance or
coordination;
• Severe headache with no known cause
• Fainting or unconsciousness.
RISK FACTORS FOR CVD – NON-MODIFIABLE
RISK FACTORS FOR CVD - MODIFIABLE
Tobacco
Tobacco consumption causes atherosclerosis thereby increasing the chance of heart attack and stroke
Diet
A high intake of salt leads to hypertension. Besides, saturated fat and trans-fat increase the risk of coronary heart
disease.
Inactivity
Physical Inactivity can increase the risk of abnormal blood lipids and overweight or obesity and thereby cause
hypertension.
Alcohol
There is a direct relationship between higher levels of alcohol consumption and rising risk of cardiovascular diseases.
Mental health
Harmful stress is associated with cardiovascular diseases as it can result in increased blood pressure (hypertension)
RISK FACTORS FOR CVD - MODIFIABLE
Hypertension
Hypertension can result in atherosclerosis which can increase risk of heart disease like stroke and heart attack.
Also, it can weaken our heart muscle and cause Heart failure.
Overweight and obesity
Obese adults are especially likely to develop cardiovascular diseases and other health problems. Obesity is
associated with some of the major risk factors for cardiovascular diseases, such as hypertension and low
concentrations of HDL cholesterol
Diabetes or Increased blood sugar
Diabetes is a major risk factor and trigger for cardiovascular disease.
Cholesterol Level
Abnormal cholesterol can cause atherosclerosis. Also increase in bad cholesterol (LDL – Low density Lipoprotein)
and/or decrease in good cholesterol (HDL – High denisity Lipoprotein) can trigger heart attack.
EXERCISE – CVD Risk factors Age

Alcohol Tobacco

Obesity

Sex HTN DM Family History

Dyslipidemia

Inactivity Diet

Ethnicity
DIABETES MELLITUS (DM)
DIABETES MELLITUS
• Diabetes mellitus is a chronic disease caused by deficiency of insulin produced by the pancreas

• Insulin is a hormone that regulates blood sugar

• Results in increased concentrations of glucose in the blood, damaging many of the body's
systems, blood vessels and nerves

• The deficiency can be absolute/relative

• One of the major NCDs and a global health problem

DIABETES MELLITUS GLOBAL SCENARIO
• Around 426 million people had Diabetes in 2017

• The prevalence of DM among adult population is increasing day by day, which nearly
doubled from 1980 to 2014 (4.7% to 8.5%)

• In 2016, an estimated 1.6 million deaths were directly caused by diabetes

• WHO estimates in 2016, DM was the seventh leading cause of death

Beta cells release
Insulin
Cell Muscl Adipose Liv
s e tissue er

Glycogen
Glucose conversion
Glucose uptake synthesis
(Protein and Fat)
Glycogenesis

REGULATION OF BLOOD
Pancre
Hig
as
h
Homeostasis
Blood glucose level

GLUCOSE Glycogen
breakdown
Lo
w
Pancre
Glycogenolysis
Glucose formation as
from protein and
Liv
fat
er
Gluconeogenesis Alpha cells release
Glucagon
Fat breakdown to
form glucose
Adipose
Insulin and Diabetes
Glucose uptake
Beta cells

Decrease Blood Glucose

release Cel
ls
Insulin Glucose conversion
to Protein
Musc
le

Type I Type II

level
Glucose conversion
to Fat
DM DM Adipose
tissue

Pancr Glycogen synthesis

eas Glycogenesis
Liv
Hig er

h
Homeostasis
Blood glucose
level
 Different types of DM
Criteria Type I Type II
i. Insulin dependent DM i. Non-Insulin dependent
Other names ii. Juvenile DM DM
iii. Childhood-onset ii. Adult-onset

Deficiency type Absolute Relative

Prevalence Less common (10%) More common (90%)

Mostly children and

Affected group Mostly adults
adolescents
Insulin or other medication
Treatment Insulin is mandatory
to lower blood glucose
RISK FACTORS FOR T2DM – NON MODIFIABLE

Age
Risk for T2DM increases with increased age.
Family history
Chances of Diabetes increases if someone has parent/ sibling with T2DM or child with T1DM
Ethnicity
South Asian descendent and African-Caribbean or Black African descendent in UK. African
American, American Indian, Asian American, Hispanic/Latino In the USA.
Gestational DM (GDM)
GDM increases the chance of both mother and child to have T2DM later
 RISK FACTORS FOR T2DM – MODIFIABLE
Behavioral
Smoking
Smokers have an 30-40% increased risk of developing T2DM. Smoking can cause insulin resistance, high blood pressure
and overweight or obesity that results in T2DM in later life
Sedentary lifestyle and Physical inactivity
Having sedentary lifestyle is associated with T2DM. Physical inactivity results in high level of glucose in blood for
prolonged time
Alcohol
Drinking too much alcohol is associated with an increased risk of T2DM
Sleep
Having disturbed sleep, inadequate sleep or sleeping for too long, all are associated with T2DM
Poor diet
A diet rich in processed foods and refined carbohydrates is linked with T2DM. Fiber, fruit, and vegetables are protective
against the disease
RISK FACTORS FOR T2DM – MODIFIABLE
Mental Illness
Certain mental illness (depression, schizophrenia) are strongly associated with development
of T2DM. Medications used for these condition can cause weight gain, increasing the risk
even more

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary syndrome is a hormonal condition that can increase the chance of T2DM by
reducing the efficiency of insulin in our body
RISK FACTORS FOR T2DM – MODIFIABLE

Metabolic
High blood pressure
People with high blood pressure are at two-fold increased risk of developing T2DM
Overweight/Obesity
Overweight and obesity, especially abdominal obesity increases the chance of developing T2DM
Abnormal blood lipid
High lipid biomarkers such as triglycerides and cholesterol are strongly associated with T2DM
 Signs/Symptoms of DM

Polydips
ia

Polyphag
ia

Polyur
ia
Diagnosis of DM
Diagnosed by measuring blood sugar concentration
Having a blood glucose level of 7.0 millimole/L or more at a fasting state and/or having
the blood glucose level of 11.1 millimole/L or more exactly 2 hours after taking a meal
is indicative of T2DM

Oral Glucose Tolerance Test (OGTT)

For diabetes diagnosis, a person has to measure blood sugar at fasting stage (FBS).
Then he is provided glucose solution/regular breakfast, and his blood sugar is
measured exactly 2 hours after this (2hrAfterMeal).
FBS of ≥ 7.0 millimole/L or 2hrAfterMeal glucose level of ≥ 11.1 millimole/L is
considered Diabetic
FBS of 5.5 – 6.9 mmol/L is considered Impaired Fasting Glucose (Pre-diabetic) and
2hrAfterMeal glucose level of ≥ 7.8 mmol/L, but < 11.1 mmol/L is considered Impaired
Glucose Tolerance (Pre-diabetic).
Consequences
Macrovascular
Chronic

Microvascular

Acute
Consequences - macrovascular

Heart: Increases the risk of coronary artery disease

leading to Heart attack

Brain: Increased chance of Stroke

Extremities: Peripheral vessels gets damaged, reducing

the blood flow. This leads to gangrene and might result
in amputation of the limbs
Consequences - microvascular
Eye: High blood glucose can damage eye blood vessels
causing blurred vision or even blindness

Nerve fiber: High blood glucose can damage our nerve

fibers, causing pain or numbness in the feet or arms

Kidneys: High blood glucose overworks the kidneys,

associated high blood pressure might cause vessel injury,
resulting Kidney damage
Prevention of CVD and DM
 Levels of prevention
Primordial Primary Secondary Tertiary
When works Before a person even When a person becomes After the person is After the disease
becomes likely to be susceptible to a disease, exposed to the risk starts to show the
exposed to risk factors i.e. s/he is likely to be factors, and the sign symptoms
exposed to risk factors disease progress has
already started
(metabolic risk factors)

Which stage of Before stage of Stage of susceptibility Stage of subclinical Stage of Clinical
natural history susceptibility disease disease

Target group Whole population Selected group who are High risk people Patients
likely to be exposed to (already exposed to
risk factors risk factors)
Activities Policies implemented Prevents exposure to risk Early detection and Treatment to prevent
that target social and factors intervention. Aims to death and
economic factors for detect the pathological complication,
prevention of NCDs changes (metabolic risk rehabilitation
factors)
 Primordial prevention of NCDs

→ Anti tobacco policies

→ Food legislation (to prevent excess salt, sugar and unhealthy fat in processed food)

→ Building healthy city (that provides access to a healthy lifestyle for urban population)

→ Prioritizing NCDs in health system, by…

→ Training the health care providers to treat NCDs

→ Raising awareness about the NCDs

→ Incorporating NCD care to primary health care

 Primary prevention of NCDs
Focuses on prevention of exposure to risk factors

→ Stop tobacco consumption and maintain smoke free environment

→ Stop harmful use of alcohol

→ Consume healthy diet (low saturated and trans fat, low sugar, increased amount

→ Do physical activities (150 minutes a week), restrain from prolonged sitting

→ Limit salt consumption

→ Maintain healthy weight

→ Limit hormone use and practice breastfeeding

 Secondary prevention of CVD
Assessment of risk through
regular screening followed by
appropriate measures (risk can
be assessed by different scales)
 Secondary prevention of CVD
After determining that an individual has been exposed to risk factors, drug based and nondrug
based approach can be taken to minimize the impact of risk factor exposure
Nondrug based approach includes: Drug based approach includes:

→ Stop smoking → Antihypertensive (to lower blood

→ Reduce high fat, high sugar, high salt diet pressure)

→ Antidiabetic (to control blood sugar)

→ Become physically active
→ Lipid lowering (to lower blood lipid)
→ Maintain healthy weight
→ Antiplatelet (to make blood thinner)
→ Limit alcohol consumption
 Secondary prevention of DM

Mostly detects the person in prediabetic condition by measuring blood sugar level. Everyone should
regularly check their blood glucose after the age of 40 years. If prediabetic, the following lifestyle
modification can be done to prevent the occurrence of DM:

→ Eat a healthy diet – consume a lot of fruit and vegetables, avoid refined sugar and saturated fats

→ Be physically active – at least 30 minutes of regular, moderate-intensity activity on most days

→ Avoid tobacco use and limit consumption of alcohol

→ Maintain healthy weight

 Tertiary prevention of CVDs

→ Once a person suffers from heart attack or stroke, the mainstay of the tertiary prevention is
treatment of the patient to prevent death

→ Once the patient is stabilized, treatment is provided to prevent complication or prevent future
occurrence of the disease. This is done by providing medications that reduces the impact of risk
factors (anti-hypertensive, anti-platelet, lipid lowering)

→ Rehabilitation comes in the form of speech therapy and physiotherapy for stroke patients.
 Tertiary prevention of DM

→ Mainstay of T1DM treatment is insulin. Additionally engaging in regular exercise and taking a healthy diet is
also important
→ T2DM patients should follow a strict healthy diet, use insulin or blood glucose lowering drug, carry out
regular exercise and maintain a healthy weight
→ Discipline is very important for T2DM patients. They should have meal plan based on their weight, age and
activity. They should routinely check blood glucose testing before each meal and at bedtime during initial
control, and during illness. Their diet should contain more complex carbohydrate and less concentrated
sugars. If insulin is used, they should take extra food before vigorous exercise. They should avoid fasting and
feasting
 Tertiary prevention of DM

To prevent complication, DM patients should…

→ Monitor their blood pressure and take antihypertensive if required

→ Take care of their foot

→ Undergo regular screening and treatment for retinopathy (cause of blindness)

→ Check their blood lipid and take medications for blood lipid control if required

→ Undergo screening for early signs of diabetes-related kidney disease

Thank you