Ihd heart
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Understanding Ischemic Heart Disease (IHD): Global Burden, Risk Factors, and Prevention
Global Burden of Ischemic Heart Disease
Leading Cause of Death Worldwide
Ischemic heart disease (IHD) is recognized as the leading cause of death globally, with significant variations in incidence and mortality across different regions and income levels . The Global Burden of Disease (GBD) 2010 Study highlighted that IHD accounted for a substantial portion of global mortality and disability, with Eastern Europe and Central Asia experiencing the highest rates of IHD deaths, while regions like Asia Pacific High-Income and Sub-Saharan Africa had the lowest.
Trends Over Time
Between 1990 and 2010, the global burden of IHD increased by 29 million disability-adjusted life-years (DALYs), a 29% rise primarily driven by population aging and growth . Despite a decrease in age-standardized incidence rates of acute myocardial infarction and angina, the prevalence of ischemic heart failure saw a slight increase . This trend underscores the need for improved surveillance and uniform diagnostic standards to better understand and manage IHD globally.
Risk Factors for Ischemic Heart Disease
Thrombotic and Metabolic Factors
The Northwick Park Heart Study identified high levels of factor VII coagulant activity and plasma fibrinogen as significant risk factors for IHD, with these associations being stronger than those for cholesterol. This suggests that the biochemical disturbances leading to IHD may lie as much in the coagulation system as in cholesterol metabolism.
Influence of Subclinical Hypothyroidism
Subclinical hypothyroidism (SCH) has been associated with increased IHD prevalence and incidence, particularly in individuals younger than 65 years. This association is more pronounced in women, indicating that age and gender are critical factors in the relationship between SCH and IHD.
Socioeconomic and Lifestyle Factors
Country-level covariates such as metabolic and nutritional risk factors, education, and income levels significantly influence IHD mortality rates. For instance, countries like Ukraine and Kazakhstan have much higher age-standardized IHD mortality rates compared to the United States and the United Kingdom, despite a general decline in IHD mortality across these regions from 2005 to 2015.
Prevention and Intervention Strategies
Primary and Secondary Prevention in Rural Populations
In rural Australia, where the burden of IHD is higher than in metropolitan areas, interventions focused on primary and secondary prevention have shown effectiveness. However, there is a notable lack of targeted interventions, particularly for Aboriginal and Torres Strait Islander populations, highlighting the need for more inclusive and stratified approaches to IHD prevention.
Therapeutic Angiogenesis
Innovative treatments such as therapeutic angiogenesis, which promotes vascular growth to revascularize ischemic heart tissue, are being explored as alternatives to invasive surgical procedures. Approaches using proteins, genes, stem/progenitor cells, and microvesicles have shown promise in clinical trials, offering potential new avenues for IHD treatment.
Conclusion
Ischemic heart disease remains a critical global health issue, with significant variations in burden and risk factors across different regions and populations. Understanding these disparities and implementing targeted prevention and intervention strategies are essential for reducing the global impact of IHD. Continued research and improved surveillance are necessary to develop effective treatments and preventive measures tailored to the specific needs of diverse populations.
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