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1、CVD Prevention,Charlie Shaeffer, MD, FACC,Cardiovascular Deaths by Region in 1990: Global Burdon of Disease Study, 1990,Predicted Due to CHD Due to Stroke Increase by 2002 No. (x 106) (%) (%) (%) Established market economies 3.2 53 25 15 Former socialist economies 2.1 50 31 26 India 2.3 52 20 111 Ch
2、ina 2.6 30 50 77 Other Asia and Islands 1.3 34 29 106 Sub-Saharan Africa 0.8 26 47 114 Latin America and Caribbean 0.8 44 32 120 Middle Eastern Crescent 1.3 47 16 129,Cardiovascular Deaths, 1990,“Cardiovascular death and incidence in China and India more than doubled between 1990 and 2000.”,Yusuf: W
3、CC May 2002,Urbanization, Child Deaths and Infection Tobacco 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/year
4、 2030 10,000,000 deaths/year 1/3 of all deaths Half of these 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,Angina Pectoris,Myocardial Infarction,Sudden Death,OBS. EXP.,Summary of NCEP ATP III*
5、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 reductio
6、n; 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
7、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 firs
8、t-degree relative 65 years), age (men 45 years; women 55 years). HDL cholesterol 60 mg/dL counts 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/dLm
9、mol/L) LDL-C* (mg/dLmmol/L) TG* (mg/dLmmol/L) HDL-C* (mg/dLmmol/L),55.89.8 71 90 30.56.5 26 20 68 231.834.2 6.00.9 150.227.9 3.90.7 197.295.7 2.21.2 42.39.9 1.10.3,Characteristic,Atorvastatin 80 mg (n=253),REVERSAL: Baseline Characteristics,56.69.2 73 87 30.55.6 27 18 70 232.634.1 6.00.9 150.225.9 3
10、.90.7 197.7105.6 2.21.1 42.911.4 1.10.3,Pravastatin 40 mg (n=249),*MeanSD,*P0.001 vs pravastatin,Data are mean percent change from baseline to 18-month follow-up.,-40,-30,-20,-10,0,10,Atorvastatin,Change From Baseline in Lipid Parameters,-50,Change from baseline (%),Total cholesterol,LDL-cholesterol
11、,-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,ASA + Standard Medical Therapy,“Standard Therapy” Pravastatin 40 mg,“Intensive Therapy” Atorvastatin 80 mg,Duration: Mean 2 year follow-up (925 events),Prim
12、ary Endpoint: Death, MI, Documented UA requiring hospitalization, revascularization ( 30 days after randomization), or Stroke,PROVE IT - TIMI 22: Study Design,2x2 Factorial: Gatifloxacin vs. placebo,Double-blind,Patient population: CHD LDL-C: 130-250 mg/dL (3.4-6.5 mmol/L) Triglycerides 600 mg/dL (6
13、.8 mmol/L),Study Design,Primary efficacy outcome measure: Time to occurrence of a major CV event: CHD death Nonfatal, non-procedure-related MI Resuscitated cardiac arrest Fatal or nonfatal stroke,Atorvastatin 10 mg,Open-label run-in n=15,464,8 weeks,Atorvastatin 10 mg LDL-C target: 100 mg/dL (2.6 mm
14、ol/L),Median follow-up = 4.9 years,Atorvastatin 80 mg LDL-C target: 75 mg/dL (1.9 mmol/L),Double-blind period n=10,001 LDL-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 groups No statistically significant differences were observed between treatment groups for any cause of death,Mortality,