心血管疾病预防.pptx

CVD PreventionCharlie Shaeffer,MD,FACC Charlie Shaeffer,MD,FACC Cardiovascular Deaths by Region in 1990:Global Burdon of Disease Study,1990PredictedDue to CHDDue to StrokeIncrease by 2002No.(x 106)(%)(%)(%)Established market economies3.2532515Former socialist economies2.1503126India2.35220111China2.6305077Other Asia and Islands1.33429106Sub-Saharan Africa0.82647114Latin America and Caribbean0.84432120Middle Eastern Crescent1.34716129Cardiovascular Deaths,1990“Cardiovascular death and incidence in China and India more than doubled between 1990 and 2000.”Yusuf:WCC May 2002Yusuf:WCC May 2002UrbanizationA.Child Deaths and InfectionChild Deaths and InfectionB.Tobacco Use Tobacco UseC.Physical Activity Physical ActivityD.Fat Consumption Fat ConsumptionE.Stress StressYusuf:WCC May 2002“Can prevent 5/6 myocardial infarctions by smoking cessation and blood pressure and lipid control.”Yusuf:WCC May 2002Worldwide Tobacco Mortality1998 4,000,000 1998 4,000,000 deaths/yeardeaths/year2030 10,000,000 deaths/year2030 10,000,000 deaths/year 1/3 of all deaths1/3 of all deathsHalf of these deaths will be in the Half of these deaths will be in the 35-65 age group,with an average 35-65 age group,with an average loss of 20-25 years of lifeloss of 20-25 years of lifeNon Cigarette SmokersNon Cigarette SmokersAll Cigarette SmokersAll Cigarette Smokers10 010 0797911411464641221224444135135AnginaAnginaPectorisPectorisMyocardialMyocardialInfarctionInfarctionSuddenSuddenDeathDeathOBS.OBS.EXP.EXP.Summary of NCEP ATP III*Guidelines LDL-C Goals*National Cholesterol Education Program Adult Treatment Panel III.Therapeutic lifestyle changes include:(1)dietary changes:reduced intake of saturated fats and cholesterol and enhanced LDL lowering with plant stanols/sterols and increased soluble fiber;(2)weight reduction;and(3)increased physical activity.Coronary heart disease.CHD risk equivalents comprise:diabetes,multiple risk factors that confer a 10-year risk for CHD 20%,and other clinical forms of atherosclerotic disease(peripheral arterial disease,abdominal aortic aneurysm,and symptomatic carotid artery disease).Major risk factors(exclusive of LDL-C)that modify LDL-C goals include cigarette smoking,hypertension(BP 140/90 mmHg or on antihypertensive medication),low HDL cholesterol(40 mg/dL),family history of premature CHD(CHD in male first-degree relative 55 years;CHD in female first-degree relative 20%)100100130(100129:drug optional)2+Risk factors(10-year risk 20%)13013010-year risk 10%20%:13010-year risk 10%:16001 Risk factor160160190(160189:LDL-Clowering drug optional)Age*(years)Male(%)White(%)Body mass index*(kg/m3)Current smoker(%)Diabetes(%)Hypertension(%)TC*(mg/dLmmol/L)LDL-C*(mg/dLmmol/L)TG*(mg/dLmmol/L)HDL-C*(mg/dLmmol/L)55.89.8719030.56.5262068231.834.2 6.00.9150.227.9 3.90.7197.295.7 2.21.242.39.9 1.10.3 CharacteristicAtorvastatin 80 mg(n=253)REVERSAL:Baseline Characteristics56.69.2738730.55.6271870232.634.1 6.00.9150.225.9 3.90.7197.7105.6 2.21.142.911.4 1.10.3 Pravastatin 40 mg(n=249)*MeanSD*P0.001 vs pravastatinData are mean percent change from baseline to 18-month follow-up.-40-30-20-10010AtorvastatinChange From Baselinein Lipid Parameters-50Change from baseline(%)Total cholesterol LDL-cholesterol-25.2-18.45.6-6.8-46.3*-34.1*2.9-20.0*Triglycerides HDL-cholesterolPravastatin4,162 4,162 patients with an Acute Coronary Syndrome 10 days patients with an Acute Coronary Syndrome 925 events)Duration:Mean 2 year follow-up(925 events)Primary Endpoint:Death,MI,Documented UA requiring hospitalization,Primary Endpoint:Death,MI,Documented UA requiring hospitalization,revascularization(30 days after randomization),or Stroke revascularization(30 days after randomization),or Stroke PROVE IT-TIMI 22:Study Design2 2x2 Factorial:Gatifloxacin vs.placebox2 Factorial:Gatifloxacin vs.placeboDouble-blindDouble-blindPatient population:CHDLDL-C:130-250 mg/dL(3.4-6.5 mmol/L)Triglycerides 600 mg/dL(6.8 mmol/L)Study DesignPrimary efficacy outcome measure:Time to occurrence of a major CV event:CHD deathNonfatal,non-procedure-related MIResuscitated cardiac arrestFatal or nonfatal strokeAtorvastatin 10 mgOpen-label run-inn=15,464 8 weeks1-8 weeksScreening and wash-outn=18,469Atorvastatin 10 mgLDL-C target:100 mg/dL(2.6 mmol/L)Median follow-up=4.9 yearsAtorvastatin 80 mgLDL-C target:75 mg/dL(1.9 mmol/L)Double-blind periodn=10,001LDL-C 130 mg/dL(3.4 mmol/L)n=4995n=5006BaselineAtorvastatin 10 mg(n=5006)Atorvastatin 80 mg(n=4995)Age(mean SD),yearsMen(%)White(%)61 8.8819461 8.88194Cardiovascular risk factors(%)Current smokerHypertensionDiabetes mellitus135415135415Cardiovascular history(%)AnginaMICoronary angioplastyCoronary bypassCerebrovascular accident815854475825954475Baseline Patient CharacteristicsNo.of patients(%)Atorvastatin 10 mg(n=5006)Atorvastatin 80 mg(n=4995)All-cause mortality282(5.6)284(5.7)CardiovascularCHD deathStroke deathHemorrhagic stroke death155(3.1)127(2.5)8(0.2)2(0.0)126(2.5)101(2.0)7(0.1)3(0.1)NoncardiovascularCancerTraumaOther127(2.5)75(1.5)9(0.2)43(0.9)158(3.2)85(1.7)15(0.3)58(1.2)No single cause of death(by body system,or pathological process)and no single cancer type drove the non-significant difference in all-cause mortality between groupsNo statistically significant differences were observed between treatment groups for any cause of deathMortality