Look Closer Improving understanding of the leading cause of heart attack and stroke

1. Look Closer Improving understanding of the leading cause of heart attack and stroke This initiative is supported by sanofi-aventis and Bristol-Myers Squibb

2. Cardiovascular disease: what are we talking about? • Cardiovascular disease (CVD) is a condition which affects the blood vessels and their ability to supply oxygen-rich blood to vital organs. • Cardiovascular diseases include: • Coronary arterial disease: disease of the arteries supplying the heart (heart attack, unstable angina) • Cerebrovascular disease: disease of the arteries that supply the brain (stroke, Transient Ischaemic Attack or mini-stroke) • Peripheral arterial disease (PAD): a disease of the arteries supplying the limbs

3. Australia’s big killers Heart disease and stroke combined (cardiovascular disease) kill more people each year than cancer. Percentage of Australian deaths in 2002 by disease type Australian Bureau of Statistics, 2002

4. Australia’s biggest killers • Heart disease and stroke are currently Australia’s biggest killers, claiming one life every 10 minutes • Death rates are predicted to increase with the ageing population and increasing rate of obesity • 1 in 3 stroke victims die within one year • 1 in 4 people die within an hour of their first heart attack symptom, and 40% die within a year The shifting burden of cardiovascular disease in Australia, Access Economics and the National Heart Foundation, 2005

5. Major cause of disability • CVD is responsible for more than 600,000 healthy years of life lost in Australia* • Stroke is the leading cause of long term disability in adults in Australia. About one-third of people sustaining stroke die within 12 months and half of the survivors are disabled in the longer term* - this places a significant burden on families and the community+ * The shifting burden of cardiovascular disease in Australia, Access Economics and the National Heart Foundation, 2005 +The Atlas of Heart Disease and Stroke, World Health Organisation, 2004

6. Why Australians are at risk • Many Australians are still not managing their risk factors: • 7% smoke; • 56% are obese; • Many are not taking the medication necessary to manage their condition. Bhatt DL et al., on behalf of the REACH Registry Investigators. International prevalence, recognition and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180-189

7. A national health priority area ‘Cardiovascular disease is one of the biggest healthcare issues we face today’ ‘Improvements in the management of heart attacks and strokes are long overdue’ – Dr Erin Lalor, Chief Executive of the National Stroke Foundation, Australia.

8. Gaps in patient knowledge and support “It never dawned on me that I was at high risk of having a heart attack. When I was first diagnosed with diabetes, my doctor told me how to control my diabetes but he never explained what was happening inside my body. Had someone given me this kind of information at the start, I would have been more motivated to change my lifestyle, which could have prevented my heart attack.” Ross Devlin, aged 60 from Toronto, Canada, suffered his first heart attack in 1991 and has had 2 further heart attacks since then.

9. Gaps in patient knowledge and support “If I had known more about my condition I would have been more motivated to change my lifestyle. The doctor only told me about what I needed to do (lose weight) to manage my diabetes. The doctor never explained why I needed to lose weight and how it was affecting my body.” Jackie Chaline, aged 60, from Paris, France, was diagnosed with diabetes at the age of 50, and has high blood pressure and high cholesterol.

10. Gaps in patient knowledge and support “Without the knowledge and understanding of the disease, it can be difficult for patients to recognise the urgency of taking preventative action. Without the correct information, patients are less likely to change their lifestyle or consider medication to reduce their risk of suffering a heart attack or stroke.”Dr Erin Lalor, Chief Executive of the National Stroke Foundation, Australia.

11. A new way of explaining the disease process Heart attack and stroke: the disease process explained • The underlying disease starts with a progressive build-up of cholesterol and other fatty materials on the artery walls to form plaque, a process known as ‘atherosclerosis’. • Eventually this build-up may harden and narrow the arteries, making the artery wall less elastic and making it difficult for the blood to flow freely. In hardened arteries, plaque is often unstable and can suddenly rupture, damaging the wall. • Like a scab forming on a cut, blood platelets try to heal the rupture by sticking together, forming a clot. This process is called ‘atherothrombosis’. • When blood clots form in an artery, they reduce or completely block the flow of blood to specific parts of the body. If this happens in arteries leading to the heart or brain, a heart attack or stroke can occur. Mas JL, “Atherothrombosis: management of patients at risk”, International Journal of Clinical Practice, April 2005; 59: 407-414

12. Summary • The problem: heart attack and stroke are still Australia’s leading killers, and there is therefore an urgent need to improve management • A key reason: CVD is a complicated disease. As many patients do not fully understand the disease process, they often fail to follow the advice from their doctor about medication and lifestyle changes • The way forward: providing information on how and why heart attacks and strokes occur, to help patients fully understand the need to take action to reduce their risk