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UDC 616.12 - 008 (574)
MEDICAL AND SOCIAL PROBLEM OF CARDIOVASCULAR DISEASES IN KAZAKHSTAN
L. M. Pivina1, Zh. T. Moldagalieva2, Zh. E. Muzdubayeva 1, T. I. Belikhina3, A. M. Markabayeva1,T. Zhunussova4
1 Semey State Medical University, Kazakhstan;
2 Diagnostic and Consultative Center, Semey, Kazakhstan;
3 Research Institute for Radiation Medicine and Ecology, Semey, Kazakhstan;
4 International Atomic Energy Agency, Vienna, Austria
Introduction. In the most developed countries cardiovascular diseases (CVD) take the highest rank in the structure of mortality, they are a major cause of disability, and the question of their prevention is medical and social problems.
The aim of the study is analysis of structure, morbidity and mortality rates from cardiovascular diseases in Kazakhstan and particularly in the East Kazakhstan Region, in comparison with worldwide rates.
Methods. Descriptive analysis of statistical data on demographics, mortality and morbidity rates in the Kazakhstan population using official information from statistical compilations "Health of the population of Kazakhstan and activities of public health organizations" for 2011-2013, as well as global data statistics about cardiovascular diseases using databases "PubMed", "Cochrane library", "Research Gate" system, and the annual reports of the WHO.
Results. Mortality from CVD is 52.8% of the total mortality of the Kazakhstan population. This is mainly due to Ischemic heart disease and cerebrovascular diseases, which proportion in CVD mortality structure is 47.7% and 36.4%, respectively.
In 2013 mortality rate from CVD in Kazakhstan was 256.76 per 100,000; in the East Kazakhstan Area it was one of the highest in the country - 361.44 per 100,000. In the rural areas these figures were significantly lower than in urban areas: 203.63 per 100,000; in the East Kazakhstan region - 403.7. Morbidity rate from CVD was 2463.1 per 100,000, for women these rates were 2612.5 per 100,000. Incidence rate of hypertension in Kazakhstan was 1172.5 per 100,000 (for women - 1352.3); in the East Kazakhstan region - 1084.6 per 100,000 (for women - 1548.0). The incidence of coronary heart disease was 507.4 and 519.8 per 100,000, respectively.
Conclusion: CVD mortality in Kazakhstan is in 3-4 times higher than in highly developed countries, which needs in implementation the prevention programs.
Key words: cardiovascular diseases, mortality, morbidity, prevention
МЕДИКО-СОЦИАЛЬНАЯ ПРОБЛЕМА БОЛЕЗНЕЙ СИСТЕМЫ КРОВООБРАЩЕНИЯ В РЕСПУБЛИКЕ КАЗАХСТАН
Л. М. Пивина1, Ж. Т. Молдагалиева2, Ж. Е. Муздубаева1, Т. И. Белихина3, А.М. Маркабаева1, Т. Жунусова4
1 Государственный медицинский университет города Семей, Казахстан Консультативно-диагностический центр, г. Семей, Казахстан 3 НИИ радиационной медицины и экологии г. Семей, казахстан 4 Международное Агентство по атомной энергетике, Вена, Австрия
Введение. В большинстве развитых стран болезни системы кровообращения (БСК) занимают наиболее высокое ранговое место в структуре смертности населения, являются основной причиной инвалидизации, а вопрос их профилактики является не только медицинской, но и социальной проблемой.
Целью исследования явился анализ структуры, показателей смертности и распространенности болезней системы кровообращения среди населения Казахстана и, в частности, Восточно-Казахстанского региона, в сравнении с общемировыми показателями.
Методы. Дескриптивный анализ статистических данных, характеризующих демографическую ситуацию, показатели смертности и распространенности болезней системы кровообращения с использованием официальной информации из казахстанских статистических сборников, а также мировых статистических данных с использованием поисковых баз данных "PubMed"", "Cochrane library", системы "Research Gate".
Результаты. Смертность от БСК составляет 52,8 % в структуре общей смертности населения Казахстана. Этот показатель определяется, главным образом, двумя причинами - ИБС и цереброваскулярными заболеваниями, доля которых в структуре смертности от БСК в целом соответственно составляет 47,7% и 36,4%. В 2013 году показатель смертности от БСК в Казахстане составил 256.76 на 100,000; в Восточно-Казахстанской области (ВКО) он был одним из наиболее высоких - 361.44 на 100,000. В сельской местности он был значительно ниже, чем в городах: 203.63 на 100,000; в ВКО - 403.7. Показатель распространенности БСК был 2463.1 на 100,000, для женщин - 2612.5 на 100,000. Заболеваемость артериальной гипертонией в Казахстане в целом составила 1172.5 на 100,000 (для женщин - 1352.3); в ВКО - 1084.6 на 100,000 (для женщин - 1548.0), ИБС - 507.4 и 519.8 на 100,000 соответственно.
Вывод: Показатели смертности и заболеваемости БСК в Казахстане в 3-4 раза выше, чем в развитых странах, что требует внедрения профилактических программ.
Ключевые слова: болезни системы кровообращения, смертность, распространенность, профилактика.
КАЗАХСТАН РЕСПУБЛИКАСЫНДАГЫ КАНАЙНАЛЫМЫ ЖУЙЕЛЕР1Н1И АУРУЛАРЫ МЕДИЦИНАПЫК -ЭЛЕУМЕТТ1К МЭСЕЛЕС1
П. М. Пивина1, Ж. Т. Молдагалиева2, Ж. Е. Муздубаева1, Т. И. Белихина3, А. М. Маркабаева1, Т. Жунусова4
1 Семей каласыныц Мемлекеттк медицина университету Казакстан
2 Семей каласыныц Консультативт - диагностикалык орталык, Казахстан
3 Семей каласыныц Радиациялык медицина жэне экология ГЗИ, Казакстан
4 Атомдык энергетика бойынша Хальщаральщ Агент™, Вена, Австрия
Юр^пе. Кептеген дамыган мемлекеттерде канайналымы жYЙесi аурулары (КЖА) тургындардыц елiм - жтм курылымында ец жогары рангiлiк орын алуда, мYгедектiлiктiц негiзгi себебi болып табылады, ал олардыц алдын алу сурагы тек кана медициналык емес, сонымен катар элеуметтiк мэселе болып табылады.
Казакстан халкыныц арасында жэне атап айтканда Шыгыс Казакстан аумагында, жалпыдYниежYзiлiк керсеткiштермен салыстырганда канайналымы жYЙесi ауруларыныц курылымын, елiм -жiтiм керсеткiштерiн жэне таралуын талдау зерттеу максаты болып табылады.
Эд^терк Казакстандык статистикалык жинактардан, сол сиякты "PubMed"", "Cochranelibrary", "ResearchGate" жYЙе мэлiметтерiнiц iздестiру базаларын пайдаланумен дYниежYзiлiк статистикалык мэлiметтердi ресми акпараттарды колданумен канайналымы жYЙесi ауруларыныц елiм - жтм жэне таралуы керсеткiштерiн, демографиялык жагдайды сипаттайтын статистикалык мэлiметтерге дескрептивт талдау.
Нэтижелерi. Казакстан халкыныц жалпы елiм - жiтiм курылымында КЖА-дан елiм - жiтiм 52,8% курайды. Бул керсеткiш басты-басты екi себептермен аныкталады - ЖИА жэне цереброваскулярлы аурулармен, КЖА - дан елiм - жiтiм курылымындагы оныц Yлесi жалпы тиiсiнше 47,7% жэне 36,4% курайды. 2013 жылы Казакстандагы КЖА - дан елiм - жтм керсеткш 100,000 шакканда 256.76 курады; Шыгыс Казакстан облысында (ШКО) ол ец жогаргылардыц бiрi болды - 100,000 шакканда 361.44. Ауылдык аумактарда ол калаларга караганда кебiнесе темен: 100,000 шакканда 203.63; ШКО - 403.7. КЖА таралу керсеткш 100,000 шакканда 2463.1, эйелдерде - 100,000 шакканда 2612.5 болды. Казакстанда жалпы артериалды гипертониямен аурушацдык 100,000 шакканда 1172.5 курады (эйелдерде - 1352.3);
шкр - 100,000 шаланда 1084.6 (эйелдерде - 1548.0), ЖИА - 100,000 шаланда тиiсiнше 507.4 жэне 519.8.
Тужырымдар Казакстанда, дамыган елдерге Караганда КЖА влiм - жiтiм жэне аурушандык кврсеткiштерi 3-4 ретке жогары, ол алдын алу багдарламаларын енгiзудi талап етедi. Кiлт свздер: канайналымы жYЙесi аурулары, влiм - жтм, таралуы, профилактика.
Библиографическая ссылка:
Пивина Л. М., Молдагалиева Ж. Т., Муздубаева Ж. Е., Белихина Т. И., Маркабаева А.М., Жунусова Т. Медико-социальная проблема болезней системы кровообращения в Республике Казахстан / / Наука и Здравоохранение. 2015. №2. С. 50-59.
Pivina L. M., Moldagalieva Zh. T., Muzdubayeva Zh. E., Belikhina T. I., Markabayeva A. M., Zhunussova T. Medical and social problem of cardiovascular diseases in Kazakhstan. Nauka i Zdravoohranenie [Science & Healthcare]. 2015, 2, pp. 50-59.
Пивина Л. М., Молдагалиева Ж. Т., Муздубаева Ж. Е., Белихина Т. И., Маркабаева А. М. Жунусова Т. Казакстан Республикасындагы канайналымы жYЙелерiнiц аурулары медициналы; - элеуметж мэселеа / / Гылым жэне Денсаулы; сактау. 2015. №2. Б. 50-59.
Introduction
In the most developed countries cardiovascular diseases (CVD) take the highest rank in the structure of mortality, they are a major cause of disability, and the question of their prevention is medical and social problems [24]. CVD comprises any disease that affects the cardiovascular system, and includes heart disease, vascular diseases of the brain and kidney, and peripheral artery disease. These diseases have multifactorial aetiology but the underlying pathophysiology generally involves atherosclerosis and/or hypertension.
CVD constitutes a major component of the global burden of disease [15]. Ischemic heart disease and stroke are the leading causes of death worldwide, and they rank first and third in life-years lost. With aging societies, the burden of CVD has risen continuously over the past two decades. Their importance has also increased in terms of disability-adjusted life-years [17] -ischemic heart disease and stroke ranked first and second in 2010. This overall picture is remarkable given that worldwide a decrease in ischemic heart disease for individuals aged 35-64 years between the mid-1980s and mid-1990s has been demonstrated [22], and that this trend has continued until now in most Western countries [11, 18, 19]. Both prevention and treatment contributed approximately half to the CVD mortality decrease.
CVD is strongly connected to lifestyle, especially the use of tobacco, unhealthy diet habits, physical inactivity, and psychosocial stress [23]. The major risk factors for CVD include smoking, obesity, physical inactivity, diabetes, hypertension and high blood cholesterol levels
[14, 4]. Constitutional non-modifiable risk factors are age, gender, ethnicity and family history [21]. The World Health Organization (WHO) has stated that over three-quarters of all CVD mortality may be prevented with adequate changes in lifestyle. CVD prevention, remaining a major challenge for the general population, politicians, and healthcare workers alike, is defined as a co-ordinated set of actions, at public and individual level, aimed at eradicating, eliminating, or minimizing the impact of CVDs and their related disability. The bases of prevention are rooted in cardiovascular epidemiology and evidence-based medicine [12].
The aim of the study is analysis of structure, morbidity and mortality rates from cardiovascular diseases in Kazakhstan and particularly in the East Kazakhstan Region, in comparison with worldwide rates.
Methods
We have conducted a descriptive analysis of statistical data on demographics, mortality and morbidity rates in the Kazakhstan population using official information from statistical compilations "Health of the population of Kazakhstan and activities of public health organizations" for 20112013, as well as global data statistics about cardiovascular diseases using databases "PubMed", "Cochrane library", "Research Gate" system, and the annual reports of the WHO.
Results
Mortality from cardiovascular diseases is 52.8% of the total mortality of the Kazakhstan population. This rate is mainly due to two causes: Ischemic heart disease and Cerebrovascular diseases, which proportion in the structure of mortality from CVD is 47.7% and 36.4% respectively (figure 1) [1].
Figure 1. Structure of mortality including mortality from CVD in the Kazakhstan, 2011
In 2012 overall mortality rate in Kazakhstan was 9.01 per 1,000 population; in 2013 - 8.41 per 1,000 population, while in the East Kazakhstan region these figures were 11.81 and 11.19 per 1,000 respectively. Mortality rate from CVD was 256.76 and 207.40, respectively, in the East Kazakhstan Area it was one of the highest in the country - 361.44 and 330.46 per 100,000, respectively, in 2012 and 2013 (figure 2). In the rural areas these figures were significantly lower than in urban areas. Thus, among the city residents in 2012 general mortality rate from CVD was 300.58 per 100,000, while in rural areas -203.63; in the East Kazakhstan region - 403.7 and 302.23, respectively [2].
Almaty City Astana City East Kazakhstan North Kazakstan Pavlodar South Kazakhstan Mangistau Kysylorda Kostanay Karaganda Zhambyl West Kazakhstan Atyrau Almaty Aktyube Akmola Kazakhstan
2013 2012
50
100
150
200
250
300
350
400
450
Figure 2. Mortality rate due to cardiovascular diseases in Kazakhstan, 2012-2013 (per 100,000).
Compared standardized mortality rates in some countries the death rate from the CVD in the Republic of Kazakhstan was about average one for the countries of the former Soviet Union: in 2010 it was 621.09 per 100,000 population (in Russia -673.7; in Kyrgyzstan - 701.93, Uzbekistan -754.15; Ukraine - 667.14, in the Confederation of Independent States as a whole - 674.49). It should be noted that in European countries with highly developed economies this rate was in 3-4 times
lower. For example, in the UK the mortality rate from CVD in 2010 was 164.19, in Germany - 195.2 per 100,000 (Figure 3).
In general, age-standardized mortality rate from CVD per 100,000 population in the world in 2013 was 293.2 (280.4; 306.1); from coronary heart disease - 137.8 (123.9, 148.2); from cerebrovascular diseases - 110.1 (101.8, 122.2); from ischemic stroke - 57.3 (49.3; 62.9); from hemorrhagic stroke - 52.8 (48.0; 62.3) (Table 1).
0
Table 1.
Age-standardized world death rate per 100000) from cardiovascular diseases in 2013.
Cardiovascular diseases Age-standardized world death rate (per 100000) in 2013
Rate CI
Total CVD 293,2 280,4; 306,1
Ischemic heart disease 137,8 123,9; 148,2
Cerebrovascular diseases 110,1 101,8; 122,2
Ischemic stroke 57,3 49,3; 62,9
Hemorrhagic stroke 52,8 48,0; 62,3
It should be noted that in the majority of both developed economically countries and developing countries mortality from coronary heart disease and stroke leaded in the structure of general
mortality. The only exceptions are some countries in Central and Latin America, South Africa, where communicable diseases and injuries dominated in the structure of general mortality [10].
800 700 600 500 400 300 200 100 0
Kazakhstan Russia Kyrgyzstan Uzbekistan Ukraina
■ ■
UK
Gernany Denmark
Figure 3. Age-standardized mortality rates from CVD in the countries of CIS and Europe, 2010 (per 100,000)
Prevalence of CVD in Kazakhstan in 2012 was 12838.3 per 100,000, in 2013 - 13391.6. Morbidity rate from CVD in 2012 was 2,454.0; in 2013 -2463.1 per 100,000, for women these rates were
Almaty City Astana City East Kazakhstan North Kazakstan Pavlodar South Kazakhstan Mangistau Kysylorda Kostanay Karaganda Zhambyl West Kazakhstan Atyrau Almaty Aktyube Akmola Kazakhstan
2620.7 and 2612.5 per 100,000, respectively. In the East Kazakhstan region, these figures were 2603.7 and 2737.3, respectively, (for women 2920 and 2654.0 per 100,000) (Figure 4).
2013 2012
500 1000 1500 2000 2500 3000 3500 4000 4500 5000
Figure 4. Prevalence rate for CVD in the regions of Kazakhstan, 2012-2013 (per 100,000).
0
The prevalence of hypertension in Kazakhstan according to data of different researchers varies from 15.2 to 27.0%, the prevalence of hypertension in urban and rural areas are the same, which is comparable to international data [3].
Incidence rate of hypertension in Kazakhstan in 2012 was 1,173.3, in 2013 - 1172.5 per 100,000 (for women - 1356.0 and 1352.3,
Almaty City Astana City East Kazakhstan North Kazakstan Pavlodar South Kazakhstan Mangistau Kysylorda Kostanay Karaganda Zhambyl West Kazakhstan Atyrau Almaty Aktyube Akmola Kazakhstan
respectively). In the East Kazakhstan region, these rates were 1319 and 1084.6 per 100,000 (for women the figures were again higher than for men - 1226.9 and 1548.0 per 100,000, respectively) (figure 5). The incidence of coronary heart disease in Kazakhstan in 2012 was 507.4 in 2013 - 500.6 per 100,000, in East Kazakhstan region - 493.1 and 519.8, respectively.
2013 2012
500
1GGG
1500
2000
2500
3000
0
Figure 5. Incidence rate of hypertension in Kazakhstan, 2012-2013 (per 100,000).
The incidence of myocardial infarction in 2012 in Kazakhstan was 57.9 per 100,000, in East Kazakhstan region - 154.3 and 142, 7, respectively. The incidence of cerebrovascular disease in 2012 was 193.3 per 100,000, in 2013 - 208.1, in East Kazakhstan region - 214.5 and 252.7, respectively (Table 2).
From 2006 to 2010, age-adjusted CHD prevalence in the United States declined overall from 6.7% to 6.0% (Table 1). In 2010, the prevalence of CHD was greatest among persons aged >65 years (19.8%), followed by those aged 45--64 years (7.1%) and those aged 18--44 years (1.2%). CHD prevalence was greater among men (7.8%) than women (4.6%). Among racial/ethnic populations, CHD prevalence was greatest among American Indians/Alaska Natives (11.6%), followed by blacks (6.5%), Hispanics (6.1%), whites (5.8%), and Asians or Native Hawaiians/Other Pacific Islanders (3.9%). By race and sex in 2010, the greatest male prevalence were among American
Indian/Alaska Natives (14.3%) and whites (7.7%), and the greatest females prevalence were among American Indian/Alaska Natives (8.4%) and blacks (5.9%) [6]
In Europe, the burden remains high: CVD remains a major cause of premature deaths and loss of DALYs—a composite of premature death and living with the disease. It is not widely appreciated that CVD is the main cause of premature death in women: CVD was responsible for 42% of all deaths below 75 years of age in European women and for 38% of all deaths at 75 years in men. However, a decline in age-standardized CHD and CVD mortality has been observed in many European countries between the 1970s and 1990s, with the earliest and most prominent decrease in the more affluent countries, illustrating the potential for prevention of premature deaths and for prolonging healthy life expectancy. In several eastern European countries, however, CVD and CHD mortality remains high [18].
Table 2.
Incidence of separate
VD forms in the Kazakhstan regions, 2012-2013 (per 100,000)
Region Ischemic Heart Disease Myocardial Infarction Cerebrovascular
diseases
2012 2013 2012 2013 2012 2013
Kazakhstan 507.4 500.6 57.9 57.5 193.3 208.1
Akmola 434.8 487.1 83.9 87.8 156.3 144.9
Aktyube 351.8 349.9 28.1 28.1 186.2 176.0
Almaty 587.6 631.9 35.1 38.7 126.5 120.2
Atyrau 375.6 309.8 44.3 45.4 109.9 113.1
West Kazakhstan 355.6 323.8 38.5 38.7 202.1 182.3
Zhambyl 967.9 708.9 33.5 33.9 304.6 421.4
Karaganda 354.9 421.4 80.4 75.6 209.8 200.0
Kostanay 284.6 285.1 54.7 56.9 183.3 177.9
Kysylorda 252.5 258.0 11.3 10.9 129.4 157.7
Mangistau 552.0 520.2 28.0 24.4 114.3 112.8
South Kazakhstan 482.1 475.3 40.7 42.4 195.3 194.1
Pavlodar 365.1 327.2 61.6 59.5 239.8 219.2
North Kazakstan 483.1 515.1 131.4 138.5 428.4 508.3
East Kazakhstan 493.1 519.8 154.3 142.7 214.5 237.2
Astana City 213.8 199.6 21.6 13.4 218.0 252.7
Almaty City 980.8 971.6 45.8 53.0 140.0 192.5
Discussion
''Coronary heart disease (CHD) is now the leading cause of death worldwide; it is on the rise and has become a true pandemic that respects no borders''. This statement from 2009 on the website of the WHO11 does not differ much from the warning issued in 1969 by its Executive Board: 'Mankind's greatest epidemic: CHD has reached enormous proportions striking more and more at younger subjects. It will result in coming years in the greatest epidemic mankind has faced unless we are able to reverse the trend by concentrated research into its cause and prevention' [13]. The second major CVD-stroke-is another substantial cause of death and disability. For these reasons, the fifth JTF guidelines refer to the total burden of atherosclerotic CVD.
The choice of total burden of atherosclerotic CVD may give the impression that nothing has changed over the past 40 years, but this is not true. On the contrary, the epidemic has been and still is extremely dynamic and is influenced by both changes in cardiovascular risk factors and in increased opportunities for targeted interventions to prevent and treat CVD. This results in ups and downs of cardiovascular morbidity and mortality over relatively short periods with wide variability across the globe, including developing countries where the major proportion of all events occurs nowadays. In different parts of the world, the dynamics of the epidemic vary greatly in pattern, magnitude, and timing [25]. In Europe, the burden
remains high: CVD remains a major cause of premature deaths and loss of DALYs-a composite of premature death and living with the disease. It is not widely appreciated that CVD is the main cause of premature death in women: CVD was responsible for 42% of all deaths below 75 years of age in European women and for 38% of all deaths at 75 years in men [9].
However, a decline in age-standardized CHD and CVD mortality has been observed in many European countries between the 1970s and 1990s, with the earliest and most prominent decrease in the more affluent countries, illustrating the potential for prevention of premature deaths and for prolonging healthy life expectancy. In several eastern European countries, however, CVD and CHD mortality remains high [7].
Prevention of CVD ideally starts during pregnancy and lasts until the end of life. In daily practice, prevention efforts are typically targeted at middle-aged or older men and women with established CVD (i.e. secondary prevention) or those at high risk of developing a first cardiovascular event [e.g. men and women with combinations of smoking, elevated blood pressure (BP), diabetes or dyslipidaemia (i.e. primary prevention)]; CVD prevention in the young, the very old, or those with just a moderate or mild risk is still limited, but can result in substantial benefit. Prevention is typically categorized as primary or secondary prevention, although in CVD the distinction between the two is arbitrary in view of the underlying, gradually
developing atherosclerotic process. Since the instruction by Geoffrey Rose decades ago, two approaches towards prevention of CVD are considered: the population strategy and the high-risk strategy [20]. The population strategy aims at reducing the CVD incidence at the population level through lifestyle and environmental changes targeted at the population at large. This strategy is primarily achieved by establishing ad-hoc policies and community interventions. Examples include measures to ban smoking and reduce the salt content of food. The advantage is that it may bring large benefits to the population although it may offer little to the individual.
The impact of such an approach on the total number of cardiovascular events in the population may be large, because all subjects are targeted and a majority of events occur in the substantial group of people at only modest risk. In the high-risk approach, preventive measures are aimed at reducing risk factor levels in those at the highest risk, either individuals without CVD at the upper part of the total cardiovascular risk distribution or those with established CVD. Studies have shown that preventive measures (i.e. BP lowering and smoking cessation) are beneficial up to advanced age [5, 8 ]. These facts exemplify that prevention of CVD should be a lifelong effort.
Within the State Program of Health Care Development in Kazakhstan "Salamatty Kazakhstan", 2011 - 2015, it was planned forming the national screening program. Starting from 2011 it was planned a staged screening for early detection of cardiovascular diseases, and diabetes.
Screening for diseases of the cardiovascular system in Kazakhstan is carried out in the framework of guaranteed free medical care in all district clinics for men and women aged 18, 25, 30, 35, 40 years, 40 to 64 years, who do not have diagnosed heart disease and diabetes - 1 time in 2 years. During the screening they have been conducted a questioning to determine the risk factors (family history, smoking, physical inactivity, excessive alcohol consumption), the measurement of height and weight to detect excess weight, blood pressure measurement, the analysis of blood cholesterol and sugar. It allows you to identify individuals at high risk of cardiovascular mortality and to conduct the pharmacological and non- pharmacological prevention measures.
According to data of "Medinfo" company in 2011 screening examination for cardiovascular disease in Kazakhstan were conducted in the more than 2.5 million adults. As a result, more than 200
thousand (7.9% of examined people) were identified as the patients with heart disease. Most of these patients had not previously under the dispensary monitoring and did not receive the necessary treatment. Assign the necessary drugs, correction of lifestyle and diet, eliminating of bad habits significantly improve their prognosis and reduce the chance of cardiovascular mortality.
Conclusion
Thus, cardiovascular diseases caused by atherosclerosis, are widespread throughout the world. However, death rates from CVD in the developed countries is 3-4 times lower than in the countries of Eastern Europe and Central Asia. This may be due to the introduction of primary and secondary prevention, using a scientific approach based on evidence-based medicine and the development of cardiovascular diagnosis and surgery in countries with high economic level.
References:
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2. Статистический сборник «Здоровье населения РК и деятельность организаций здравоохранения в 2013 году». - Астана. 2014. 356 p. Chrome-extension: https://www.mzsr.gov.kz/ sites/default/files/2013_0.pdf
3. Статистический сборник «Здоровье населения РК и деятельность организаций здравоохранения в 2011 году». - Астана: 2012.
4. Anderson K. M., Wilson P. W., Odell P. M., Kannel W.B. An updated coronary risk profile. A statement for health professionals // Circulation. 2001. N 83. P. 356-362.
5. Bejan-Angoulvant T, Saadatian-Elahi M, Wright J.M., Schron E.B., Lindholm L.H., et al. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials // J Hypertens 2010. N 28. P. 1366-1372.
6. CDC. Behavioral Risk Factor Surveillance System. Available at http://www.cdc.gov/brfss. Accessed October 7, 2011.
7. Conroy R. M., Pyorala K., Fitzgerald A. P., Sans S., Menotti A., De Backer G, De Bacquer D, Ducimetiere P, Jousilahti P, Keil U, Njolstad I, Oganov R. G. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project // Eur Heart J. 2003. N 24. P. 987-1003.
8. Doolan D. M., Froelicher E. S. Smoking cessation interventions and older adults // Prog Cardiovasc Nurs. 2008. N23. P.119-127.
9. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
// European Heart Journal. 2012. N 33. P.1635-1701 doi: 10.1093/eurheartj/ehs092
10.Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study. 2013. 55p. Published Online December 18, 2014. http://dx.doi.org/10.1016/S0140-6736 (14) 61682
11. Kuch B., Heier M., W. von Scheidt, Kling B., Hoermann A., Meisinger C. 20-year trends in clinical characteristics, therapy and short-term prognosis in acute myocardial infarction according to presenting electrocardiogram: the MONICA/KORA AMI Registry (1985-2004) // J. Intern. Med. 2010. P 254-264.
12. Last J.M. A Dictionary of Epidemiology / 4th ed. New York: Oxford University Press; 2001. 138 p.
13. Levi F., Chatenoud L, Bertuccio P., Lucchini F., Negri E., La Vecchia C. Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update // Eur J Cardiovasc Prev Rehabil. 2009. N 16. P. 333350.
14.Lim S. S., Vos T., Flaxman A. D. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 // Lancet. 2012. N 380.P. 24-60.
15.Lozano R., Naghavi M., Foreman K., Lim S., Shibuya K., Aboyans V., et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 // Lancet, 2012, N 380 P. 95-128.
16.Mirzaei M, Truswell AS, Taylor R, Leeder SR. Coronary heart disease epidemics: not all the same // Heart 2009. N 95. P. 740-746.
17.Murray C.J., Vos T., Lozano R., M. Naghavi, A.D. Flaxman, C. Michaud, et al., Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 // Lancet, 2012, N 380 P. 197-223.
18. Peeters, W. J. Nusselder, Stevenson C., Boyko E. J., Moon L, Tonkin A., Age-specific trends in cardiovascular mortality rates in the Netherlands between 1980 and 2009 // Eur. J. Epidemiol. 2011. N 26. P.369-73.
19. Piotrowski W., Polakowska M., Koziarek J., Broda G. Sudden cardiovascular death rate and ischaemic heart disease death rate changes during the 5-year period of 2003-2008 // Kardiol. Pol. 2012. N 70. P. 1225-34.
20. Rose G. Sick individuals and sick populations // Int J Epidemiol. 1995. N14. P. 32-38.
21. Schunkert H., Erdmann J., Samani N.J., Genetics of myocardial infarction: a progress report // Eur. Heart J. 2010. N. 31. P. 918-25.
22. Tunstall-Pedoe H., Vanuzzo D., Hobbs M., Mahonen M., Cepaitis Z., Kuulasmaa K., et al. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations // Lancet, 2005. N 355. P. 688-700.
23.World Health Organization. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases / Report N. 916. 2002. 228 p.
24.World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011. 221 p.
25.World Health Organization, Regional Office for Europe. The Prevention and Control of Major Cardiovascular Diseases. Report of a Conference. 2009. Report N. 8214. 318 p.
References:
1. Statisticheskii sbornik «Zdorov'e naseleniya RK i deyatel'nost' organizatsii zdravookhraneniya v 2012 godu» [Statistical digest "Health status of the population of Republic of Kazakhstan and activities of health care organizations in 2012']. Astana: 2013 g. 325 p.
2. Statisticheskii sbornik «Zdorov'e naseleniya RK i deyatel'nost' organizatsii zdravookhraneniya v 2013 godu» [Statistical digest "Health status of the population of Republic of Kazakhstan and activities of health care organizations in 2013']. Astana: 2013 g. 356 p. Chrome-extension/https://www.mzsr.gov.kz/sites/ default/files/2013_0.pdf
3. Statisticheskii sbornik «Zdorov'e naseleniya RK i deyatel'nost' organizatsii zdravookhraneniya v
2011 godu» [Statistical digest "Health status of the population of Republic of Kazakhstan and activities of health care organizations in 2011']. Astana:
2012 g. 308 p.
4. Anderson K. M., Wilson P. W., Odell P. M., Kannel W. B. An updated coronary risk profile. A statement for health professionals. Circulation. 2001. N 83. P. 356-362.
5. Bejan-Angoulvant T., Saadatian-Elahi M., Wright J.M., Schron E.B., Lindholm L.H., Fagard R., Staessen J.A., Gueyffier F. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized
controlled trials. J Hypertens 2010. N 28. P. 1366-1372.
6. CDC. Behavioral Risk Factor Surveillance System. Available at http://www.cdc.gov/brfss. Accessed October 7, 2011.
7. Conroy R.M., Pyorala K., Fitzgerald A.P., Sans S., Menotti A., De Backer G., De Bacquer D., Ducimetiere P., Jousilahti P., Keil U., Njolstad I., Oganov R.G. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003. N 24. P. 987-1003.
8. Doolan D.M., Froelicher E.S. Smoking cessation interventions and older adults. Prog Cardiovasc Nurs. 2008. N23. P.119-127.
9. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) // European Heart Journal. 2012. N 33. P.1635-1701 doi: 10.1093/eurheartj/ehs092
10. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study. 2013. 55p. Published Online December 18, 2014. http://dx.doi.org/10.1016/S0140-6736 (14) 61682
11.Kuch B., Heier M., von Scheidt W., Kling B., Hoermann A., Meisinger C. 20-year trends in clinical characteristics, therapy and short-term prognosis in acute myocardial infarction according to presenting electrocardiogram: the MONICA/KORA AMI Registry (1985-2004). J. Intern. Med. 2010. P 254-264.
12.Last J.M. A Dictionary of Epidemiology. 4th ed. New York: Oxford University Press; 2001. 138p.
13. Levi F., Chatenoud L., Bertuccio P., Lucchini F., Negri E., La Vecchia C. Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. Eur J Cardiovasc Prev Rehabil. 2009. N 16. P. 333-350.
14. Lim S.S., Vos T., Flaxman A.D. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012. N 380.P. 24-60.
15.Lozano R., Naghavi M., Foreman K., Lim S., Shibuya K., Aboyans V. et al., Global and
regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, N 380 P. 95-128.
16.Mirzaei M., Truswell A. S., Taylor R., Leeder S.R. Coronary heart disease epidemics: not all the same. Heart 2009. N 95. P. 740-746.
17.Murray C. J., Vos T., Lozano R., Naghavi M., Flaxman A. D., Michaud C., et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, N 380 P. 197-223.
18.Peeters, W. J. Nusselder, C. Stevenson, E. J. Boyko, L. Moon, A. Tonkin, Age-specific trends in cardiovascular mortality rates in the Netherlands between 1980 and 2009. Eur. J. Epidemiol. 2011. N 26. P.369-73.
19. Piotrowski W, Polakowska M., Koziarek J., Broda G., Sudden cardiovascular death rate and ischaemic heart disease death rate changes during the 5-year period of 2003-2008. Kardiol. Pol. 2012. N 70. P. 1225-34.
20. Rose G. Sick individuals and sick populations. Int J Epidemiol. 1995. N14. P. 32-38.
21.Schunkert H., Erdmann J., Samani N. J., Genetics of myocardial infarction: a progress report. Eur. Heart J. 2010. N. 31. P. 918-25.
22.Tunstall-Pedoe H., Vanuzzo D., Hobbs M., Mahonen M., Cepaitis Z., Kuulasmaa K., et al., Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet, 2005. N 355. P. 688-700.
23. World Health Organization. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. Report N. 916. 2002. 228 p.
24. World Health Organization. Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011. 221 p.
25. World Health Organization, Regional Office for Europe. The Prevention and Control of Major Cardiovascular Diseases. Report of a Conference. 2009. Report N. 8214. 318 p.
Контактная информация:
Пивина Людмила Михайловна - к.м.н., и.о. доцента кафедры внутренних болезней Государственного медицинского университета города Семей, г. Семей, Казахстан Почтовый адрес: Казахстан, 140007, г. Семей, ул. Киевская, дом 8. Телефон: 8 705 522 7300 E-mail: semskluda@rambler.ru
