Slide 2 WHO CVD Atlas. 2002. WHO Stroke Atlas. 2002. The Burden
of CVD in Asia: Stroke Deaths by Country, 2002 2 Slide 3 WHO CVD
Atlas. 2002. WHO Stroke Atlas. 2002. The Burden of CVD in Asia: CHD
Deaths by Country, 2002 3 Slide 4 Age-Standardized Stroke and CHD
Death Rates by Country, 2002 Ueshima H et al. Circulation.
2008;118:2702-2709. 4 Slide 5 Stroke Type in China
Sino-MONICA-Beijing project indicate from 1984 to 2004 the
incidence of hemorrhagic stroke declined by 1.7% annually the
incidence of ischemic stroke increased by 8.7% annually Stroke
subtypes in urban areas ICH = Intracranial hemorrhage, SAH =
subarachnoid hemorrhage, undet = undetermined Jiang et al. Stroke.
2006;37:63-68. Zhao et al. Stroke. 2008;39:1668-1674. Beijing
Shanghai Ischemic ICH SAH Undet 5 Slide 6 Projected Stroke and CHD
Increase to 2030: Effect of Population Aging and Risk-Factor
Changes in China Moran et al. Circ Cardiovasc Qual Outcomes.
2010;3;243-252. 6 Slide 7 Burden of Diabetes in Asia Chan JC et al.
JAMA. 2009;301:2129-2140. 40 35 30 25 20 15 10 5 0
AfricaEMMEEuropeNorth America SACASEAWestern Pacific
AfricaEMMEEuropeNorth America SACASEAWestern Pacific No. with
Diabetes Age group, y 20-39 40-59 60-79 No. With Diabetes
(millions) 600,000 500,000 400,000 300,000 200,000 100,000 0 Deaths
Attributable to Diabetes, Ages 20-79 Years Men Women No. of Deaths
7 Slide 8 Asia Eastern Europe Established Market Economies Major
Cerebrovascular Events 12 10 8 6 4 2 0 0124 3 P < 0.0001
Cumulative Incidence High Cumulative Incidence of Stroke in Asians
With Type 2 Diabetes 8 Clarke PM et al. PLoS Med. 7:e1000236.
doi:10.1371/journal.pmed.1000236. Slide 9 Increase in
Age-Standardized Mean Total Cholesterol Levels in East and
Southeast Asia and Pacific Region, 1980-2008 Farzadfar et al.
Lancet. 2011;377:578-586. Southeast Asia: Cambodia, Indonesia, Lao
Peoples Democratic Republic, Malaysia, Maldives, Myanmar,
Philippines, Sri Lanka, Thailand, Timor-Leste, Vietnam East Asia:
China, Hong Kong (China), Macau (China), Democratic Peoples
Republic of Korea, Taiwan, Brunei, Darussalam, Japan, Republic of
Korea, Singapore, islands of Oceania 9 Men Women Slide 10
Relationship of CHD Mortality With Usual Total Cholesterol by Age:
Prospective Studies Collaboration 80-89 70-79 60-69 50-59 40-49 Age
at risk 1 mmol/L total cholesterol 15% risk 18% risk 28% risk 42%
risk 56% risk Usual total cholesterol (mmol/L) 4050607080 05 1 2 4
8 16 32 64 128 256 Hazard ratio (floating absolute risks & 95%
CI) 900,000 participants from 61 prospective cohort studies (10%
from Japan or China) Prospective Studies Collaboration. Lancet.
2007;370:1829-1839. Overall, 1 mmol/L lower total cholesterol risk
by 1/3 10 Slide 11 Association of Stroke Mortality With Usual Total
Cholesterol by Age: Prospective Studies Collaboration Prospective
Studies Collaboration. Lancet. 2007;370:1829-1839. Usual Total
Cholesterol, mmol/L 80-89 1.06 (1.00-1.13) 70-79 1.04 (0.99-1.09)
60-69 1.02 (0.97-1.08) 40-59 0.90 (0.84-0.97) Age at risk:
4050607080 1 2 4 8 16 32 64 Hazard Ratio (floating absolute risks
& 95% CI) HR (95% CI) per 1 mmol/L 11 Slide 12 Relationship of
Cholesterol Level to CV Mortality in Asians: Asia Pacific Cohort
Studies Collaboration 29 cohorts 352,033 individuals 283,544 Asians
68,489 Australians/New Zealanders 2 million person-years of
follow-up 4841 cardiovascular deaths 12 Zhang X et al. Int J
Epidemiol. 2003;32:563-572. Slide 13 Association Between Usual
Cholesterol Level and CHD Death or Nonfatal MI: Asia Pacific Cohort
Studies Collaboration Zhang X et al. Int J Epidemiol.
2003;32:563-572. Mean usual total cholesterol (mmol/L) MI =
myocardial infarction. 0.7 1.0 1.4 2.0 3.0 4.55.05.56.06.5 CHD
death in the entire study population 0.7 1.0 1.4 2.0 3.0
4.55.05.56.06.5 Hazard ratio 1 mmol/L lower total cholesterol
associated with 35% (26%-44%) lower coronary death CHD death or
nonfatal MI in the entire study population 13 Slide 14 Association
Between Usual Cholesterol Level and Stroke: Asia Pacific Cohort
Studies Collaboration Mean usual total cholesterol (mmol/L) Zhang X
et al. Int J Epidemiol. 2003;32:563-572. Fatal stroke in the entire
study population 0.8 1.0 1.2 1.5 4.55.05.56.06.5 Fatal or nonfatal
stroke in the entire study population 4.55.05.56.06.5 0.8 1.0 1.2
1.5 Hazard ratio 14 Slide 15 Association Between Usual Cholesterol
Level and Ischemic Stroke: Asia Pacific Cohort Studies
Collaboration Mean usual total cholesterol (mmol/L) Zhang X et al.
Int J Epidemiol. 2003;32:563-572. Analyses are stratified by study
and sex and adjusted for age at risk, systolic blood pressure (BP),
and smoking. Fatal or nonfatal ischemic stroke 4.55.05.56.06.5 0.6
0.8 1.2 2.0 1.0 1.5 4.55.05.56.06.5 0.6 0.8 1.2 2.0 1.0 1.5 Fatal
ischemic stroke Hazard ratio 1 mmol/L lower total cholesterol
associated with 25% (13%-40%) lower ischemic stroke (fatal or
nonfatal) 15 Slide 16 Association Between Usual Cholesterol Level
and Hemorrhagic Stroke: Asia Pacific Cohort Studies Collaboration
Analyses are stratified by study and sex, and adjusted for age at
risk, systolic BP, and smoking. Zhang X et al. Int J Epidemiol.
2003;32:563-572. 4.55.05.56.06.5 0.6 0.8 1.2 2.0 1.0 1.5 Fatal
hemorrhagic stroke Mean usual total cholesterol (mmol/L) Hazard
ratio 4.55.05.56.06.5 0.6 0.8 1.2 2.0 1.0 1.5 Fatal or nonfatal
hemorrhagic stroke 1 mmol/L lower total cholesterol associated with
20% (8%-30%) higher hemorrhagic stroke (fatal) 16 Slide 17 Summary
Stroke is the leading cause of death in the East Asia and Western
Pacific region CV risk factors and CV mortality are projected to
increase Increased cholesterol levels are a major cause of the high
risk for ischemic stroke in Asian Pacific countries 17
