Cardiovascular Disease CVD High levels of preventable chronic

Cardiovascular Disease (CVD)

High levels of preventable chronic disease, injury and mental health problems Students learn to: – Research and analyse CVD, cancer and ONE other condition by investigating: • • • The nature of the problem Extent of the problem Risk factors and protective factors The sociocultural, socioeconomic and environmental determinants Groups at risk

Cardiovascular Disease (CVD) • CVD refers to damage to, or disease of, the heart, arteries, veins and/or smaller blood vessels. There are 3 main types of CVD: – Coronary heart disease – Cerebrovascular disease (stroke) – Peripheral vascular disease • CVD has been identified as a health priority area because it is a major health and economic burden on Australia. It’s one of the leading causes of sickness and death in Australia (36% of all deaths in 2010). • CVD can be attributed to a number of modifiable risk factors. The potential for change is evident and recent statistics reveal a decline in the death rate from coronary heart disease

The nature of CVD • CVD is a general term covering all diseases of the heart and circulatory system: • Coronary Heart Disease – the poor supply of blood to the muscular walls of the heart by its own blood supply vessels, the coronary arteries • Stroke – the interruption of the supply of blood to the brain • Peripheral Vascular Disease – diseases of the arteries, arterioles and capillaries that affect the limbs, usually reducing blood supply to the legs. • CVD is most evident as stroke, heart attack, angina, heart failure and peripheral vascular disease. Atherosclerosis (the build up of fatty and/or fibrous material on the interior walls of arteries) is the underlying cause of most of these conditions.

The nature of CVD (Atherosclerosis) • Atherosclerosis is the build up of fatty and/or fibrous material on the interior walls of arteries. • This build up hinders the flow of blood to the body’s tissues and increases blood pressure. • May occur in any artery in the body – greatest threat to an individual’s heart is when the blockage occurs in arteries leading to the brain, the eyes or legs or the heart.

The nature of CVD (Arteriosclerosis) • Arteriosclerosis (hardening of the arteries) is a degenerative disease that affects most people to some extent as part of the process of ageing. • It often begins in childhood. • A form of atherosclerosis, it develops as the fatty or fibrous deposits build up and the arteries become harder and less elastic.

The nature of CVD (Coronary Heart Disease) • Coronary heart disease – also called ischaemic heart disease, manifests as a heart attack or angina. • Results from blockages of the coronary arteries, usually caused by fatty deposits.

The nature of CVD (Heart Attack) • Heart attack is also known as myocardia infarction, coronary thrombosis and coronary occlusion. • Generally caused by a complete closure of a coronary artery by atherosclerosis, it may also occur when a blood clot forms and blocks a narrowed artery. • Any cessation of oxygenated blood flow to any part of the heart results in tissue death – this is a heart attack.

The nature of CVD (Angina) • Angina is chest pain that occurs when the heart has an insufficient supply of oxygenated blood. • It is not really a disease but a symptom of oxygen deprivation. • Angina is generally caused by coronary atherosclerosis. The narrowed arteries allow enough oxygenated blood to flow to the heart, but chest pain or tightness occurs when the heart becomes overloaded by exertion, excitement or overeating.

The nature of CVD (Stroke) • A stroke results from a blockage of the blood flow to the brain. (also known as cerebrovascular disease). It occurs either when the blood supply to the brain is interrupted by a clot or atherosclerosis, or when a burst blood vessel haemorrhages into the brain. • Hypertension (high blood pressure) is a risk factor for a stroke. Blood vessels directly damaged as a result of high blood pressure tend to either rupture more easily or result in an aneurysm (is the ballooning of the arterial wall due to thinning and weakening).

The nature of CVD (Peripheral Vascular Disease) • Peripheral vascular disease usually affects the arteries, arterioles and capillaries of the leg and feet. • The blood supply to the muscles of the legs is damaged by atherosclerosis and/or arteriosclerosis. This slows the blood to the leg muscles, walking results in a cramping feeling. • In extreme cases – can lead to gangrene and amputation of the foot or limb.

The extent of CVD in Australia • The National Health Survey 2007 -2008 found that 3. 4 million Australians have CVD and it is a leading cause of death. It is the most costly disease group for the nation – $5. 9 billion or 11% of total health expenditure. MORTALITY • CVD accounted for 32% of all deaths among Australians in 2010 • Coronary heart disease – leading cause of death in both males (15. 9%) and females (14. 3%) in 2010 • Cerebrovascular disease (Stroke) – next leading cause of death – males (5. 9%) and females (9. 8%) in 2010 • Other heart disease accounted for 4. 7% of all deaths in males and females (6%) in 2010 • Death rates from CVD have declined considerably and continue to fall • The declining prevalence of CVD is mainly due to: – A reduction in the levels of risk factors (reduction in smoking, monitoring hypertension and diet modification) – Improved medical care and treatment MORBIDITY • CVD is a leading cause of disability – approx. 1. 4 million Australians • CVD accounted for 6% of hospitalisations in 2007 -08. Of these, 34% were due to coronary heart disease, 10% heart failure and 5% peripheral vascular disease

Risk factors and protective factors for CVD • Major risk factors for developing CVD include some that cannot be controlled or modified. Such as: – Family history – Gender (men more so that women – oestrogen hormone is a protective factor) – Advancing age • Major risk factors that can be modified or eliminated by lifestyle or medical include: – – – Smoking (doubled by heavy smokers) Raised blood fat levels (high cholesterol) High blood pressure Obesity and overweight Abdominal obesity Physical inactivity • Major protective factors that reduce the chance of developing CVD include: – – – Regular physical activity Low fat and cholesterol diet Low alcohol consumption Health weight Manage stress Avoid tobacco smoke

• Low socioeconomic status and unemployment increases risk due to limited health choices • People with low education rates are more a risk due to less knowledge about health choices and how the access health services Environmental • People with a family history • Ethnicity – ATSI are more at risk, Asians are less at risk • Media influence on smoking rates Socioeconomic Sociocultural The Sociocultural, Socioeconomic & Environmental Determinants - CVD • People living in rural and remote areas are more at risk due to less access to health information, health services and technology

Groups at risk - CVD • The groups that have the greatest risk of developing CVD include: – – – – Tobacco smokers People with family history of the disease People with hypertension People who consume high fat diets – increase cholesterol levels People aged over 65 years Males Blue collar workers (labourers and tradespeople who may have higher levels of smoking, alcohol consumption and high fat diets

CANCER (LUNG, BREAST and SKIN)

High levels of preventable chronic disease, injury and mental health problems Students learn to: – Research and analyse CVD, cancer and ONE other condition by investigating: • • • The nature of the problem Extent of the problem Risk factors and protective factors The sociocultural, socioeconomic and environmental determinants Groups at risk

The nature of the problem - CANCER • In 2012 – the Cancer Council of Australia estimated that 120, 710 new cases would be diagnosed in that year. Although survival rates are improving due to early detection strategies and improved treatments, the incidence of several types of cancer is increasing. • Cancer refers to a diverse group of diseases that are characterised by the uncontrolled growth and spread of abnormal body cells. • Believed to originate from a single cell whose genetic material has been damaged or influenced by some foreign agent. • A tumour develops (is a swelling or enlargement caused by a clump of abnormal cells) • Leads to neoplasm (abnormal mass of cells that forces its way among healthy cells and interferes with their normal functioning). • Two different types of tumour: – Benign Tumours – not cancerous – Malignant Tumours – cancerous. If not treated – can cause sickness and death. • Metastases – are secondary or new tumours. They may develop some distance from the original malignant tumour – can affect the whole body with the disease.

The nature of the problem - CANCER • Medical experts suggest that around 90% of cancers are products of an individual’s environment and lifestyle. • Carcinogens are agents that are known to cause cancer. They include: – – – Chemicals Pollution Radiation Cigarette smoke Dietary factors Alcohol Classification Site Carcinoma Skin; membranes lining the respiratory, gastrointestinal and urinary tracts; the breasts Sarcoma Bones; cartilage; muscles Leukaemia Blood-forming organs such as bones, liver, spleen Lymphoma Infection-fighting organs (glands and spleen)

The extent of Cancer in Australia • The prevalence of cancer in Australia in increasing. Current estimates 1 in 2 males and 1 in 3 females will develop cancer before the age of 85. INCIDENCE • Cancer is the only major cause of death in Australia that is increasing in incidence in both males and females • Most significant increases have been for breast cancer, skin cancer and melanoma (malignant skin cancer) and prostate cancer. Main reason for increases in incidence are: – – Ageing population Better detection of cancer New diagnostic technology and screening programs Better reporting of cancer (mandatory by health-care personnel) • Most common cancers in Australia are: – Non-melanoma skin cancers • Most frequently occurring life-threatening cancers include: – Prostate cancer, colorectal cancer, melanoma and lung cancer in men – Breast cancer, colorectal cancer, melanoma and lung cancer in women • Cancer occurs more frequently in males that females, except the 25 -54 year group. Women are almost 3 times more prevalent due to cancer of the cervix, breast, ovary and uterus)

The extent of Cancer in Australia MORTALITY • Cancer accounted for 30% of all deaths in Australia in 2010 – 33. 1% males and 26. 5% females. • In 2010 the major types of cancer that account for deaths in Australia include lung, bowel, prostate, breast and pancreatic cancers. • Lung cancer is the main cause of cancer death. Rates have decreased in males and increased in females (male rates are still 3 times those of females). • Overall cancer mortality rates have decreased – could further be reduced by changes to lifestyle, increased knowledge and awareness of risk factors and symptoms, effective screening programs and early detection. • Men have a higher risk of being diagnosed and dying of cancer (due to food, tobacco and alcohol use. Also work in more ‘at risk’ environments) • Risk of developing cancer increases with age. With an ageing population – number of cancer cases can expect to rise. • In 2010 the average of death from cancer in Australia was 73 for both men and women.

Lung Cancer • • Lung cancer is currently the leading cause of cancer deaths in Australia for men and women. The female death rate is increasing Number of females smoking has fallen (only slightly) in the past few years. Mortality rate is high once lung cancer has been detected. Large portion of people die within the first 5 years of diagnosis.

Breast Cancer • Breast cancer is the second most common cause of cancer-related death in Australian women (lung cancer is number 1) • Affects 1 in 15 women. As women grow older, both the risk and the incidence of breast cancer rises. • No known cause – a number of factors increase the risk: – – – – Increasing age Family history High fat diet Obesity Early onset menstruation Late menopause Late first pregnancy or not having children • Early detection increases survival rate. • Regular breast self-examination for all women over 30 and mammographic screening every 2 years over 50 are vital to reduce mortality.

Skin Cancer • • Skin cancer and sunspots are the most common of all skin disease affecting Australians. Our skin cancer rates are the highest in the world. Incidence of skin cancer has quadrupled in the past 2 decades Approx. 50% of lifetime exposure occurs in early childhood and adolescent years – Basal Cell Carcinoma – a surface skin cancer that originates from the basal cells that underlie the surface cells. It is the most common type of skin cancer – Squamous Cell Carcinoma – a surface skin cancer that originates in the squamous or surface cells. It is the fastest growing form of skin cancer – Malignant Melanoma – cancer of the body cells that contain pigment and mainly affects the skin • Malignant Melanoma is common in both male and females 10 -59 years. • Will spread to other body parts unless detected early and treated • According to the Cancer Council – 1400 Australians die from melanoma and non-melanoma skin cancer each year.

Risk factors and protective factors for cancer • Following summary lists the major risk factors for the most common cancers. 1. Lung Cancer: I. III. Tobacco smoking Occupational exposure to cancer-causing agents (asbestos) Air pollution 2. Breast Cancer: I. III. IV. V. VII. Family history High fat diet Early onset menstruation Late menopause Obesity Benign breast disease Late age first pregnancy or childless 3. Skin Cancer: I. III. IV. Fair skin, fair or red hair/blue eyes combined with high sun exposure High number of hours in sunlight Prolonged exposure to sun in child and adolescent years Number and type of moles on the skin

Risk factors and protective factors for cancer • Factors that protect an individual against the most common types of cancer include: 1. Lung Cancer I. II. Avoid exposure to tobacco smoke Avoid exposure to hazardous materials such as asbestos 2. Breast Cancer I. III. Consume a diet high in fruits, vegetables and low in fat Practise self-examinations Regular mammograms if over 50 years old 3. Skin Cancer I. II. Avoid sunlight Reduce exposure to the sun by slip, slop, slap, seek and slide

The Sociocultural, Socioeconomic & Environmental Determinants - Cancer People with a family history of cancer are more at risk Incidence of lung cancer and cervical cancer is higher for ATSI. Have higher rates of smoking at earlier age and less access to health services If your family practices health-promoting behaviours, adopting healthy eating habits, the risk of cancer is reduced Low SES or unemployed have higher death rates as income can limit health choices (purchasing fresh fruit and vegetables Occupations involving repeated exposure to carcinogens – more at risk of lung cancer Working outdoors – lifeguards – exposure to sun Low education – poor education is linked to poor health choices and less knowledge on how to access and use health services Rural and remote areas – more at risk as they tend to have less access to health information, health services such as pap smears, technology and breast screening devices

Groups at risk - Cancer • Cancer, unlike CVD, is a significant cause of death in all age groups. The following summary lists the groups at higher risk of developing various cancers. 1. Lung Cancer I. III. IV. Cigarette smokers Exposure to occupational or environmental hazards Blue collar occupations Men and woman over 50 years 2. Breast Cancer I. III. IV. V. VI. Women who have never given birth Obese women Women aged over 50 years Direct relative with breast cancer Women who don’t practice self-examination Women who start menstruating at an early age or late menopause 3. Skin Cancer I. III. People with fair skin People in outdoor occupations People who spend too much time in the sun without protection