AN ASSESSMENT OF THE PRIMARY PREVENTION CONTROL PROGRAM OF PHC PREVENTIVE

CARDIOLOGY CLINIC AMONG PATIENTS AT RISK FOR CVD: A Retrospective Cohort Study

Preventive Cardiology Division,

Philippine Heart Center

INTRODUCTION

• According to Global Burden of Disease Study estimate, CVD accounted for 10% of global disease burden, with a projected rise to almost 15% by 2020.

• Cardiovascular disease is the single most common cause of death in the world.

• Risk factor management should be thought of as prevention or treatment of the atherosclerotic disease process itself and, as such, should be included as an integral part of any management plan for the many acute or chronic manifestations of this disease.

PREVALENCE OF RISK FACTORS

11.8

25.3 26.624.9

4.68.5

34.8

17.4

34.8

4.8

0

5

10

15

20

25

30

35

40

%

Dans A. et al National Nutrition and Health Survey (NNHeS): Atherosclerosis-related Diseases and Risk Factors. 2003 and 2008

OBEJCTIVES

• General Objective:– Evaluate effectiveness of the primary prevention

control program for CVD of the Preventive Cardiology Division of the Philippine Heart Center.

• Specific Objectives:– Determine the mean change of the SBP, DBP, FBS

and lipid profile from baseline and on follow-up.– Determine the percentage of patients who eventually

developed CVD.

METHODOLOGY• Trial Design

– Retrospective cohort trial. • Inclusion Citeria

– Adults > 21 years old– Any one of the major risk factors.– Any one of the predisposing risk

factors but with at least 1 major risk factor.

– Patients with a minimum follow-up period of 3 consecutive years and at least 2 follow-ups per year will be included in the efficacy analysis of the study.

• Exclusion Criteria– Patients are considered ineligible

to participate if they have an existing atherosclerotic cardiovascular disease (e.g. CAD, CVA, etc.)

MAJOR RISK FACTORS

•Hypertension

•Diabetes mellitus

•Dyslipidemia

PREDISPOSING RISK FACTORS

• Obesity

• Physical inactivity

• Family history of premature CHD

INTERVENTION

• Health Education• Nutrition Counseling• Exercise Prescription• Guideline for the management of

individual risk factors provided by the following:– NCEP-ATP III– JNC VII– ADA’s Standards of Diabetes Care

RESULTS

• From February 2002 to December 2009, there were a total of 1008 patients who are actively following up at our clinic.

• Out of the 1008 patients being seen at our clinic, 148 patients, satisfied the inclusion criteria for assessment of efficacy of treatment intervention.

RESULTS

Male

Female

< 40

41-60

61-80

> 80

N = 1008 patients

Sex:

Age:

0

10

20

30

40

50

60

70

80

Hypertensive

Diabetes Mellitus

Dyslipidemia

Obese

Present Smoker

RESULTS

Male

Female

< 40

41-60

61 - 80

> 800

10

20

30

40

50

60

70

80

90

100

Hypertensive

Diabetes Mellitus

Dyslipidemia

Obese

Present Smoker

N = 148 patients

BP on follow-up

0

20

40

60

80

100

120

140

160

SBP mmHg

DBP mmHg

BP reduction from baseline of 11/20 mmHg (p< 0.05)

FBS on follow-up

0

20

4060

80

100

120140

160

180

Baseline 6 mos 24 mos 48 mos 72 mos

FBS mg/dL

FBS mean reduction of 51 mg/dL from baseline (p = 0.79).

Lipid Profile on follow-up

0

50

100

150

200

250

Baseline 12 mos 48 mos 84 mos

Total Chol

Triglycerides

HDL

LDL

TC mean reduction = 24mg/dl (p=0.49); TG mean reduction = 55mg/dl (p=0.002); HDL mean reduction = 1mg/dl (p=ns); LDL mean reduction = 11mg/dl (p=ns)

RESULTS

• During the seven years follow-up:– six patients (4 males and 2 females) died due

to cardiovascular disease – three (2 males and 1 female) died from other

causes

• One female patient had myocardial infarction.

• Two males had cerebrovascular accident.

Conclusions

• The results of our intervention on our patients enrolled in the Primary Prevention Clinic showed a reduction in the CV risk factors.

• Though the BP reduction was significant, the target blood pressure set by the guidelines was not achieved.

• There were reductions in the FBS, TC and LDL-C but was not statistically significant.

• There was a significant decrease in TG and a non-significant small decrease in HDL-C.

Recommendations

• Strengthening of the health education programs, including the nutrition counseling, should be done.

• Exercise programs that will address the concern on obesity should be strengthened.

• Intervention programs to help stop smoking should also be initiated.

An ounce of

prevention is

better than a

pound of cure.

Thank you!