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1、CVD Prevention,Charlie Shaeffer,MD,FACC,Cardiovascular Deaths by Region in 1990:Global Burdon of Disease Study,1990,PredictedDue to CHDDue to StrokeIncrease by 2002No.(x 106)(%)(%)(%)Established market economies3.2532515Former socialist economies2.1503126India2.35220111China2.6305077Other Asia and I
2、slands1.33429106Sub-Saharan Africa0.82647114Latin America and Caribbean0.84432120Middle Eastern Crescent1.34716129,Cardiovascular Deaths,1990,“Cardiovascular death and incidence in China and India more than doubled between 1990 and 2000.”,Yusuf:WCC May 2002,Urbanization,Child Deaths and Infection To
3、bacco Use Physical Activity Fat Consumption Stress,Yusuf:WCC May 2002,“Can prevent 5/6 myocardial infarctions by smoking cessation and blood pressure and lipid control.”,Yusuf:WCC May 2002,Worldwide Tobacco Mortality,1998 4,000,000 deaths/year2030 10,000,000 deaths/year1/3 of all deathsHalf of these
4、 deaths will be in the 35-65 age group,with an average loss of 20-25 years of life,Non Cigarette Smokers,All Cigarette Smokers,10 0,79,114,64,122,44,135,AnginaPectoris,MyocardialInfarction,SuddenDeath,OBS.EXP.,Summary of NCEP ATP III*Guidelines LDL-C Goals,*National Cholesterol Education Program Adu
5、lt 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 equi
6、valents 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 inclu
7、de 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 65 years),age(men 45 years;women 55 years).HDL cholesterol 60 mg/dL counts
8、as a“negative”risk factor;its presence removes 1 risk factor from the total count.,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
9、.7197.295.7 2.21.242.39.9 1.10.3,Characteristic,Atorvastatin 80 mg(n=253),REVERSAL:Baseline Characteristics,56.69.2738730.55.6271870232.634.1 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 pravastatin,Data are mean percent change from baseline to 1
10、8-month follow-up.,-40,-30,-20,-10,0,10,Atorvastatin,Change From Baselinein Lipid Parameters,-50,Change from baseline(%),Total cholesterol,LDL-cholesterol,-25.2,-18.4,5.6,-6.8,-46.3*,-34.1*,2.9,-20.0*,Triglycerides,HDL-cholesterol,Pravastatin,4,162 patients with an Acute Coronary Syndrome 10 days,AS
11、A+Standard Medical Therapy,“Standard Therapy”Pravastatin 40 mg,“Intensive Therapy”Atorvastatin 80 mg,Duration:Mean 2 year follow-up(925 events),Primary Endpoint:Death,MI,Documented UA requiring hospitalization,revascularization(30 days after randomization),or Stroke,PROVE IT-TIMI 22:Study Design,2x2
12、 Factorial:Gatifloxacin vs.placebo,Double-blind,Patient population:CHDLDL-C:130-250 mg/dL(3.4-6.5 mmol/L)Triglycerides 600 mg/dL(6.8 mmol/L),Study Design,Primary efficacy outcome measure:Time to occurrence of a major CV event:CHD deathNonfatal,non-procedure-related MIResuscitated cardiac arrestFatal
13、 or nonfatal stroke,Atorvastatin 10 mg,Open-label run-inn=15,464,8 weeks,Atorvastatin 10 mgLDL-C target:100 mg/dL(2.6 mmol/L),Median follow-up=4.9 years,Atorvastatin 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=4995,n=5006,Baseline,Baseline Patient Characteristics,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 death,Mortality,
