Chronic Diseases Overview

Clinical Sciences: Medical and Neurological Conditions Chronic Illness

• Presentation topic: Clinical Sciences: Medical and Neurological conditions Chronic Illness
• Presenter: Tony Wong, Assistant Professor of Practice, PolyU

Lecture Outline

• Chronic diseases in Hong Kong
• Risk factors of chronic diseases
• Common chronic diseases:
  • Hypertension
  • Diabetes mellitus
  • Kidney disease
  • Heart disease

Chronic Illness

• Definition: A permanent, non-reversible condition lasting at least 3 months.
• Characteristics:
  • Uncertain etiology
  • Originates at young and mid-ages
  • Multiple risk factors (typically appear 20-30 years after birth)
  • Slow progression with many prevention opportunities
  • Preventable but often not preventable by vaccines or cured by medication
  • Interferes with an individual's physical, psychological and social functioning
  • Requires long-term and systematic treatment approach

HK Figures Statistic from 2020

• Persons with chronic diseases in Hong Kong, from 2013-2020:
  • From 1,375,200 (2013) to 1,799,100 (2020)
  • From 19.2% (2013) to 24.1% (2020) of the total population
• Living arrangements:
  • 95.6% living in households
  • 4.4% living in institutions

Persons with Chronic Diseases by Age

• Data presented in a table showing the number of persons with chronic diseases across different age groups and genders within the population of Hong Kong in 2020
• Young people are also susceptible to getting chronic diseases

Prevalence

• Prevalence rates of various chronic diseases in Hong Kong for 2013 and 2020, broken down by disease type, presented in charts.
  • Hypertension, Diabetes, Hypercholesterolemia, Heart Disease are the prevalent types

Main Chronic Diseases and Risk Factors

• Table illustrating common modifiable risk factors, intermediate risk factors, and main chronic diseases associated with those factors for chronic diseases.
  • Factors: Unhealthy diet, Physical inactivity, Smoking
  • Example diseases: Heart disease, Stroke, Diabetes, Chronic respiratory diseases & Cancer

Healthy Eating Food Pyramid - Diet and Nutrition

• Include the five basic food groups (grains, fruits, vegetables, meat & fish, milk & milk products, etc.)
• Active in decreasing fat, salt, and sugar intake.
• WHO recommends a daily intake of at least 400 grams of fruit and vegetables.

Overweight and Obesity

• Unhealthy diet and inadequate fruit and vegetable consumption increase risks for cardiovascular diseases, stomach cancer, and colorectal cancer.
• Too much salt intake is correlated with blood pressure and cardiovascular disease
  • WHO recommendation: <5g per person per day
• Too much fat intake is linked to heart disease. Higher unsaturated fatty acids from vegetable sources and polyunsaturated fatty acids reduce Type II DM risk.
• Body Mass Index (BMI) is used to classify overweight and obesity.
  • Overweight: BMI ≥ 23 (for Asians)
  • Obesity: BMI ≥ 30

Physical Inactivity

• Benefits of physical activity (for all ages ≥17 and adults 18-64 ):
  • Reduces hypertension, coronary heart disease, stroke, diabetes, breast and colon cancer & risks of depression, and hip or vertebral fractures
  • Improves fitness and healthier BMI
• Benefits of physical activity (for older adults ≥65):
  • Reduces risk of fall, functional and role limitations and improves cognitive function & bone and functional health
• WHO recommendations concerning physical activity (adults aged 18-64):
  • At least 150-300 minutes of moderate-intensity aerobic physical activity per week or 75-150 minutes of rigorous-intensity physical activity per week, or an equivalent combination
  • Muscle-strengthening activities should be performed involving major muscle groups on 2 or more days a week with bouts of at least 10 minutes duration

Smoking

• Smoking is hazardous to health, causing a variety of problems throughout the body.
• Key organs affected by smoking include the brain, throat, heart, lung, pancreas, intestines and kidneys and can cause baby health problems.

Smoking prevalence in Hong Kong

• Recorded smoking rates in Hong Kong from 1982 through 2016

Atherosclerosis, Periodontal Disease, etc.

• Diagram illustrating the various negative health consequences related to smoking
• Includes specific diseases like cancer, reduced fertility, erectile dysfunction, etc.

Blood Pressure

• Blood pressure is the force of blood against the arteries.
• Blood pressure varies throughout the day based on activity level, stress, and emotion.
• Highest blood pressure usually occurs during activity, lowest blood pressure usually occurs during sleep.
• Determinants of blood pressure include factors like activity level and stress.

Hypertension

• Major risk factor for chronic diseases (stroke, heart disease, renal disease)

• Blood pressure varies and can be influenced by factors like activity levels, fluid status, and anxiety.

• Causes:

  • Essential Hypertension (no underlying cause)
  • Secondary Hypertension (underlying cause) e.g., renal problems, medications, tumors or hormone imbalances

• Risk factors for hypertension and high blood pressure:

  • Obesity
  • Stress/anxiety
  • High alcohol consumption
  • Salty diet
  • Family history of high blood pressure
  • Diabetes
  • Smoking
  • African American ethnicity

• Blood pressure categories, based on systolic and diastolic values:

  • Normal, Elevated, High Blood Pressure (Stage 1 & Stage 2), Hypertensive Crisis

Goal of Medical Management (BP Goals)

• Various associations and their recommendations regarding appropriate blood pressure limits (e.g., <130/80, <140/90, <130/80) for medical management of hypertension, focusing on preventing or managing complications.

Renal Disease

• Kidney function: Maintain body's internal chemical balance (homeostasis) by regulating water content & electrolyte concentrations.

• Kidneys clear metabolic waste (urea, uric acid, creatinine) and remove foreign chemicals (drugs, pesticides, etc.).

• Causes of renal failure:

  • Damage to kidney arteries (e.g., diabetes, high blood pressure)
  • Damage to nephrons, essential for proper oxygen & nutrient supply

• Investigation and diagnosis:

  • Blood tests (Creatinine, BUN, GFR)
  • Urine tests (Microalbuminuria/Urine Protein)
  • Imaging tests (Ultrasound, CT scan, kidney biopsy)

• Stages of chronic kidney disease (CKD): based on GFR levels

• Treatment (for End-stage renal failure):

  • Medication (anti-hypertensive, phosphorus-lowering, anemia medications, vitamin D)
  • Peritoneal or Hemodialysis
  • Kidney transplant.

Coronary Heart Disease (CHD)

• Major types include coronary artery disease (CAD), myocardial infarction (MI) and congestive heart failure (CHF).

Congestive Heart Failure (CHF)

• Prevalence: 5-10% in people aged 65 and above
• Mechanism: Heart's pumping power becomes impaired & unable to provide sufficient blood flow to meet the body's needs. Pressure increases, causing heart stretching and potentially thickening of the heart muscle walls. Kidneys respond to fluid retention.
• Symptoms: Includes lung congestion (shortness of breath, worse when lying down), dry cough, small nocturnal swelling (legs/ankles/feet), and significant weight gain.

Risk factors of CHF:

• Coronary heart disease
• Hypertension
• Valvular heart disease
• Pulmonary emboli
• Severe anaemia

Treatment of CHF:

• Lifestyle changes (e.g., reduced salt intake, cessation of smoking).
• Medications (e.g., diuretics, beta-blockers, ACE inhibitors).
• Treatment of underlying conditions like coronary heart disease

Other Cardiology Terminologies

• Acute Coronary Syndrome (ACS)
• STEMI and NSTEMI
• Atrial fibrillation
• Ventricular fibrillation
• Echocardiogram
• Ejection fraction

Electrocardiogram (ECG)

• A graphic representation of the electrical activity of the heart over time. Various waves and intervals are identified
• ECG of normal sinus rhythm

Myocardial Infarction (MI)

• Diagnosis: Includes ECG, blood tests (looking for cardiac markers like creatine phosphokinase (CPK) and high-sensitivity troponin I (hsTn1)), and cardiac catheterization/angiogram.
• Treatment: Thrombolytic agent, Percutaneous coronary intervention (PCI), and Coronary artery bypass graft (CABG).
• Modes of onset: Acute and insidious (angina pectoris, characterized by squeezing pain in the chest).

Angina Pectoris

• Causes: Temporary insufficient blood flow or significant reduction in blood flow to the heart caused by the coronary arteries.
• Symptoms: Typically squeezing pain in the chest that may radiate to other body parts, such as the jaw, arms, or back. Pain may last for one to several minutes.
• Types: Stable or chronic stable angina, unstable angina
• Diagnosis: Requires medical evaluation, which typically includes symptom assessment, and may involve diagnostics like ECG or cardiac catheterization (angiogram)
• Treatment: Nitroglycerin (nitro, NTG), Angioplasty (PCI)

PCI: Percutaneous Coronary Intervention

• Diagnostic and interventional procedures involving insertion of a catheter and balloon into an artery to open up a constricted vessel.

Cardiac Arrest

• Caused by malfunction of the heart's electrical system, resulting in sudden cessation of heart function.
• Ventricular fibrillation is one of the most common types of cardiac arrhythmias causing cardiac arrest.
• Treatment: Cardiopulmonary resuscitation (CPR) and defibrillation.

Resources

• Local Hong Kong resources for information regarding smart patients and the hospital authority.
• URLs for specific resources.