Statine für Jedermann ab 50? The Great Statin Debate Table of Content. medart Basel ` Juni 2011
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1 Statine für Jedermann ab 50? medart Basel ` Juni 2011 PD Dr. med. Raban Jeger Kardiologie Universitätsspital Basel Dr. Akira Endo (Sankyo) 1976 Synthesis of Compactin (Mevastatin) 2008 Albert Lasker Clinical Medical Research Award Statins: Effects and Indications Statins: Dose Range and Metabolism Statins = inhibitors of 3-Hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase Inhibit the biosynthesis of endogenous cholesterol Lower elevated blood cholesterol levels Exhibit pleiotropic effects Treatment of hyperlipidemia Primary and secondary prevention of coronary artery disease Armitage J. Lancet 2007; 370:
2 Cholesterol Synthesis Blanco-Colio LM. Kidney International, Vol. 63 (2003), pp Statins: Pleiotropy and Possible Indications for Use Statins: Proposed Mechanisms of Pleiotropy Mihos CG. International Journal of General Medicine 2011: Mihos CG. International Journal of General Medicine 2011: Primary Prevention of Cardiovascular Events Steinberg D J. Lipid Res. 2006;47: Primary Prevention of Cardiovascular Events Ray KK. Arch Intern Med. 2010;170(12):
3 The Dark Side of the Moon Desirable Effect Drug Undesirable Effect Statins: Safety and Side Effects Effects of Statins on Cause-specific Mortality Armitage J. Lancet 2007; 370: Cholesterol Treatment Trialists (CTT) Collaboration. Lancet 2010; 376: The Cardio-Renal Continuum Acquired risk factors / life events Risk factors Subclinical target organ damage Chronic renal disease Atherosclerosis Overt target organ damage MI ESRD CHF Birth Death 3
4 Cardiovascular Risk Factors in General Population Regional Variation of Cardiovascular Risk in Europe WHO Report on Global Health Risks 2009 Müller-Nordhorn J. Eur Heart J 2008 May;29(10): Epub 2008 Feb 5. Cluster of Cardiovascular Risk Factors Euro-Score for Low-risk Countries Bally K. Swiss Med Wkly 2010: Graham I. Eur Heart J 2007 Oct;28(19): Epub 2007 Aug 2 Hypercholesterolemia and Mortality Summary Prospective Studies Collaboration. Lancet 2007; 370:
5 Le Pari de Pascal Estimons ces deux cas: si vous gagnez, vous gagnez tout; si vous perdez, vous ne perdez rien. = Pensées, No. 233 Blaise Pascal ( ) STA TIN Pleiotropic Effects of Statins Vielen Dank für Ihre Aufmerksamkeit rjeger@uhbs.ch Blanco-Colio LM. Kidney International, Vol. 63 (2003), pp Efficacy of Statins by Baseline Prognostic Factor Side Effects: Risk of Myopathy and FDA Warning Cholesterol Treatment Trialists (CTT) Collaboration. Lancet 2010; 376: Egan A. N Engl J Med 2011 Jun 15. [Epub ahead of print] 5
6 Grenzwerte Dyslipidämie Cluster of Cardiovascular Risk Factors Gesamtcholesterin > 5.0 mmol/l (>200 mg/dl) oder LDL-C > 3.0 mmol/l (>120 mg/dl) oder Triglyzeride oder HDL-C ESH/ESC Guidelines for management of hypertension 2007 > 1.7 mmol/l (>155 mg/dl) < 1.0 mmol/l (<40 mg/dl, M) < 1.2 mmol/l (<48 mg/dl, F) Risk Factors Dieterle T. Hypertension Research (2010) 33, % Total Population Screened: n=2615 Hypertonus: n=275 Risk Stratification Including Standard Prodecures Framingham Study: Risk Factors and LVH SBP / SBP / SBP 180 / DBP DBP DBP RF 5 (2.3) 1 (0.5) 1 (0.5) 1 2 RF 55 (25.9) 25 (11.8) 10 (4.7) 3 RF or TOD or DM or ACC 64 (30.2) 40 (18.9) 11 (5.2) % of study population Included into risk stratification: Medical history Physical exam Blood tests incl. lipid profile, glucose ECG 0 low medium high CV risk estimates Dieterle T. Hypertension Research (2010) 33, Kannel WB. Am J Hypertens Jan;13(1 Pt 2):3S-10S Definition of Cardiovascular Risk Effects of Statins on Cancer Incidence Risk Framingham (10-year Risk for Cardiovascular Event) Euro-Score (10-year Risk for Fatal Cardiovascular Event) Low <10% <3% Intermediate 10-20% 3-5% High 20-30% 5-8% Very High >30% >8% Cholesterol Treatment Trialists (CTT) Collaboration. Lancet 2010; 376:
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