Non-communicable diseases A global overview Professor Fatou Samba Ndiaye GAYE , MD Dalal Jamm Hospital BP 19001 Guediawaye Email: kinepierre1@gmail.com

Outline Definition Non-communicable disease mortality worldwide The Epidemiological Transition Global Burden of Disease Study Major risk factors Blood pressure Cholesterol Smoking, alcohol Diabete overweight Prevention

What are non-communicable diseases?

Noncommunicable Diseases A non-communicable disease is a disease that is NOT transmitted by another person, a vector, or the environment. You cannot pass it on to someone else. These diseases tend to come from inheriting a bad gene, environmental factors, or lifetime of poor behaviors.

“Lifestyle diseases” caused by “behaviours” NCDs and risk factors “Lifestyle diseases” caused by “behaviours”

What are the main noncommunicable diseases? Heart disease and stroke Cancer Diabetes Chronic respiratory disease

The epidemiologic transition (Omran, 1971) Change in the balance of disease in a population from communicable diseases to non-communicable disease

Different countries at different stages of the epidemiological transition

Urbanisation

Drivers of the epidemiological transition in low and middle income countries Population ageing Major socio-economic changes (especially urbanisation) changes in risk factors such as diet, physical activity, smoking etc.

Classifying deaths and diseases (WHO) Communicable diseases [Group I] Those where death is directly due to the action of a communicable agent Non-communicable diseases Diseases [Group II] Cancer, diseases of various organ systems (eg respiratory, cardiovascular etc.), diabetes, mental health etc. External causes (injuries, poisonings and violence) [Group III]

Distribution of deaths in the world by sex, 2004 GBD report 2004 update, 2008

Importance of non-communicable diseases mortality

A global problem In 2004 there were 59 million deaths world-wide Non-communicable diseases accounted for 60% of these deaths and injuries and violence 10%. By 2020 it is estimated that non-communicable disease will account for 73% of all deaths GBD 2004 Update, 2008

NCDs are not a "rich country" problem The proportion of people who die prematurely from NCDs is highest in poorest countries Deaths from NCDs before the age of 70 as a percentage of total deaths from NCDs Source: WHO Global Health Estimates 2014 (Year: 2012), Deaths by age group

Mortality rates among men and women aged 15–59 years, region and cause-of-death group, 2004 GBD report 2004 update, 2008

Projected global deaths for selected causes, 2004–2030 GBD report 2004 update, 2008

Effect of key risk factors on mortality

Cholesterol and cardiovascular mortality

Ischaemic Heart Disease mortality (33 744 deaths) and total cholesterol Age at risk 80-89 256 128 70-79 64 60-69 32 50-59 16 Hazard ratio ( 95% CI) 40-49 8 Figure 1(a): IHD mortality (33 744 deaths) versus usual total cholesterol. Age-specific associations The hazard ratios are plotted on a floating absolute scale of risk (so each log hazard ratio has an appropriate variance assigned to it. NOTES: 1 mmol/L lower total cholesterol was associated with about a half , a third and a sixth lower IHD mortality in both sexes at ages 40-49, 50-69 & 70-89, respectively, throughout the main range of cholesterol in most developed countries, with no apparent threshold. Although the proportional differences in risk decrease with age, the absolute effects of cholesterol on annual IHD mortality rates are much greater at older than at younger ages. For example, the absolute difference in the annual risk of IHD death for a 1 mmol/L difference in total cholesterol was about 10 times greater at 80-89 than at 40-49 years of age. 4 2 1 0·5 4·0 5·0 6·0 7·0 8·0 Usual total cholesterol (mmol/L) UDV3:[VEP.PSC.FIGURES.TCHOL.240907]ihd-by-agesex-hettrend.ctrl: 24-SEP-2007 14:47:08.14

Stroke mortality (11 663 deaths) and total cholesterol by age 64 Age 80-89 32 16 70-79 8 Hazard ratio (& 95% CI) 4 60-69 Figure 4(a). Stroke mortality (11 663 deaths) versus usual total cholesterol. Age-specific associations for total stroke. Conventions as in figure 1(a). NOTES: There was a weak positive association between total cholesterol and total stroke mortality at ages 40-59 years, but little association at older ages. When the MRFIT and PSC findings were combined (table 2, webfigure 7), there was a weak positive association with total stroke at ages 40-59 and 60-69 years, but not at older ages. 2 40-59 1 4·0 5·0 6·0 7·0 8·0 Usual total cholesterol (mmol/L) UDV3:[VEP.PSC.FIGURES.TCHOL.240907]stroke-by-agecause-trend.ctrl: 24-SEP-2007 14:47:18.56

Smoking

Risk of myocardial infarction increases with every single cigarette smoked per day INTERHEART study 52 countries 12 461 cases, 14 637 controls Odds Ratio of Myocardial Infarction Never 1-2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19-20 >=21 Number of cigarettes smoked per day Source : K. K. Teo et al Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study Lancet 368 (9536):647-658, 2006.

Giving up smoking reduces risk

Prevention of noncommunicable diseases: a global PERSPECTIVE

Where to focus: 9 global NCD targets to be attained by 2025 (against a 2010 baseline) A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases At least a 10% relative reduction in the harmful use of alcohol A 10% relative reduction in prevalence of insufficient physical activity An 80% availability of the affordable basic technologies and essential medicines, incl. generics, required to treat NCDs A 30% relative reduction in prevalence of current tobacco use At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes A 30% relative reduction in mean population intake of salt/sodium Halt the rise in diabetes and obesity

PREVENTION The harmful use of alcohol contributes to over 200 health : cancers, cardiovascular diseases, and liver cirrhosis. Regular physical activity in adults reduces the risk of ischemic heart disease, stroke, diabetes, and breast and colon cancer. Sodium/salt intake : Hypertension and cardiovascular diseases are associated with increased consumption of dietary salt/sodium. High levels of salt/sodium consumption contribute to approximately 30% of hypertension cases World Health Organisation recommends reducing salt intake to less than 5 g/day (equivalent to 2 g/day of sodium) to reduce blood pressure and the risk of coronary heart disease and stroke.

PREVENTION L'usage nocif de l'alcool contribue à plus de 200 problèmes de santé: cancers, maladies cardiovasculaires et cirrhose du foie. L'activité physique régulière chez les adultes réduit le risque de cardiopathie ischémique, d'accident vasculaire cérébral, de diabète et de cancer du sein et du côlon. Apport en sodium / sel: L'hypertension et les maladies cardiovasculaires sont associées à une consommation accrue de sel / sodium alimentaires. Une consommation élevée de sel et de sodium contribue à environ 30% des cas d'hypertension L'Organisation mondiale de la santé recommande de réduire la consommation de sel à moins de 5 g / jour (équivalent à 2 g / jour de sodium) afin de réduire la tension artérielle et le risque de maladie coronarienne et d'accident vasculaire cérébral.

PREVENTION Tobacco use is a common risk factor for cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Raised or high blood pressure(hypertension), continues to have a negative impact on mortality and on the development of cardiovascular diseases. Uncontrolled raised blood pressure and/or hypertension can cause stroke, myocardial infarction, cardiac failure, dementia, renal failure, and blindness

PREVENTION L'usage du tabac est un facteur de risque commun des maladies cardiovasculaires, du cancer, des maladies respiratoires chroniques et du diabète. Une pression artérielle élevée ou élevée (hypertension) continue d'avoir un impact négatif sur la mortalité et le développement des maladies cardiovasculaires. Une élévation non contrôlée de la tension artérielle et / ou de l'hypertension artérielle peut provoquer un accident vasculaire cérébral, un infarctus du myocarde, une insuffisance cardiaque, une démence, une insuffisance rénale et la cécité

PREVENTION Raised blood glucose is a common effect of uncontrolled diabetes and may, over time, lead to serious damage to blood vessels, eyes, kidneys, and nerves, and increase the risk of heart attack and stroke Cardiovascular diseases are the leading cause of death in the Region. The main risk factors are tobacco use, obesity, hypertension, and high cholesterol Overweight and obesity : Obesity increases the likelihood of diabetes, hypertension, coronary heart disease, stroke and can negatively affects reproductive performance. The link between obesity, poor health outcomes, and all-cause mortality is well established

PREVENTION L'augmentation de la glycémie est un effet courant du diabète non contrôlé et peut, avec le temps, causer de graves lésions aux vaisseaux sanguins, aux yeux, aux reins et aux nerfs, et augmenter le risque de crise cardiaque et d'AVC. Les maladies cardiovasculaires sont la principale cause de décès dans la Région. Le tabagisme, l’obésité, l’hypertension et un taux de cholestérol élevé sont les principaux facteurs de risque. Surpoids et obésité: l'obésité augmente les risques de diabète, d'hypertension, de maladie coronarienne, d'accident vasculaire cérébral et peut affecter négativement les performances de reproduction. Le lien entre l'obésité, de piètres résultats pour la santé et la mortalité toutes causes confondues est bien établi

Conclusion-Summary Non-communicable diseases are now the most common cause of death world wide Increasing rates in low and middle income countries because of change in lifestyles (urbanisation) Key risk factors have very large effects : We have to be aware of the fact that one risk factor can lead to several non communicable diseases (eg : high cholesterol HTA, diabete, stroke, cancer…) Interventions are effective and can reduce burden The need to combine results and have large studies

Conclusion-Summary Les maladies non transmissibles sont maintenant la cause de décès la plus répandue dans le monde Augmentation des taux dans les pays à revenu faible et intermédiaire en raison du changement de mode de vie (urbanisation) Les principaux facteurs de risque ont des effets très importants: nous devons être conscients du fait qu’un facteur de risque peut entraîner plusieurs maladies non transmissibles (par exemple: taux élevé de cholestérol HTA, diabète, accident vasculaire cérébral, cancer,…) Les interventions sont efficaces et peuvent réduire le fardeau La nécessité de combiner les résultats et d'avoir de grandes études

Scale up action We are three years away from third high level meeting in 2018, so now is the time to for member states to deliver on the four time-bound commitments in the outcome document of 2014 (see also slide 5).

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