Cardiovascular Disease Prevention: Current Knowledge, Future Directions

Transcription

1 Cardiovascular Disease Prevention: Current Knowledge, Future Directions Daniel Levy, MD Director, Framingham Heart Study Professor of Medicine, Boston University School of Medicine Editor-in-Chief, Journal of the American Society of Hypertension American College of Osteopathic Internists October 18, 2018

2 Disclosure of Relationships The views and opinions expressed in this presentation are those of the speaker and not necessarily those of the NIH or HHS No relationships with industry

3 Leading Causes of Death in the US Year Pneumonia/influenza 2. Tuberculosis 3. Diarrhea Life expectancy 48 (m) 51 (f) Today 1. Heart disease 2. Cancer 3. Stroke Life expectancy 75 (m) 80 (f) Source:

4 Naïve Beliefs About Healthy Lifestyles

5 Cardiovascular Disease Prevention: Current Knowledge, Future Directions Magnitude of the problem Traditional risk factors Emerging risk factors Genetic risk Future directions

6 The Big Five

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8 Risk of CHD Death According to SBP and DBP in MRFIT 4 3 Systolic Diastolic Relative Risk 2 1 Decile 0 Systolic BP (mm Hg) Diastolic BP (mm Hg) (lowest 10%) (highest 10%) <112 < Data from Stamler J, Stamler R, Neaton JD. Arch Intern Med 1993; 153:

9 Risk of Stroke Death According to SBP and DBP in MRFIT Relative Risk Decile Systolic BP (mm Hg) Diastolic BP (mm Hg) Systolic Diastolic (lowest 10%) (highest 10%) <112 < >151 >98 Data from Stamler J, Stamler R, Neaton JD. Arch Intern Med 1993; 153:

10 CHD Mortality: Prospective Studies Collaboration IHD Mortality (floating absolute risk and 95% CI) Usual Systolic Blood Pressure (mm Hg) years years years years years Prospective Studies Collaboration. Lancet. 2002;360: Usual Diastolic Blood Pressure (mm Hg) years years years years years

11 Stroke Mortality: Prospective Studies Collaboration Stroke Mortality (floating absolute risk and 95% CI) Usual Systolic Blood Pressure (mm Hg) years years years years Prospective Studies Collaboration. Lancet. 2002;360: Usual Diastolic Blood Pressure (mm Hg) years years years years

12 Hypertension Awareness, Treatment, and Control among Adults in the US NHANES ( , )

13 Prevalence of Hypertension Among Adults in the US NHANES

14 Trends in Prevalence of Hypertension among Adults in the US NHANES , , and

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16 Risk of Death from CHD: In 356,222 Men in the MRFIT Study 6 Year Rate per < >244 Cholesterol Level (mg/dl) Stamler et al. JAMA 1986;256:

17 Risk of Death from Coronary Heart Disease: In 356,222 Men in the MRFIT Study Stamler et al. JAMA 1986;256:2823

18 Cholesterol and CHD: Seven Countries Study CHD mortality rates (%) Northern Europe United States Southern Europe, Inland Southern Europe, Mediterranean Siberia Japan (2.60) (3.25) (3.90) (4.50) (5.15) (5.80) (6.45) (7.10) (7.75) (8.40) (9.05) Verschuren WMM et al. JAMA. 1995;274: TC mg/dl (mmol/l)

19 Prevalence of Elevated Cholesterol in Adults in the US National Health and Nutrition Examination Survey ( )

20 Trends in Prevalence of Elevated Cholesterol Levels Among Adolescents Age in the US NHANES , , and

21 Trends in Mean Cholesterol Levels in Adults in the US NHANES , , and

22 Trends in Elevated Cholesterol Levels in Adults in the US NHANES and

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24 Prevalence of Cigarette Smoking NHIS, ; NSDUH,

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26 Prevalence f Diabetes and Pre-Diabetes Among Adults in the US DM: FBG >125 mg/dl Pre-DM: FBG Centers for Disease Control and Prevention, National Diabetes Statistics Report, 2014

27 Trends in Prevalence of Diabetes among Adults in the US NHANES and

28 Diabetes Awareness, Treatment, and Control among Adults in the US NHANES

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31 Prevalence of Overweight and Obesity National Health and Nutrition Examination Survey (NHANES) 2011 to 2014

32 Prevalence of Obesity in Children and Adolescents National Center for Health Statistics

33 Prevalence of Obesity in Adults NHANES

34 Trends in Obesity National Center for Health Statistics 19

35 Prevalence of Obesity in Adults BRFSS, 2015

36 Prevalence of Obesity in Adults Whites Blacks BRFSS, 2015

37 Ideal Health Life s healthy 7 Risk factors Lifestyle factors

38 Ideal Health

39 Incidence of CVD by the number of ideal health factors Folsom et al. JACC 2011;57:1690

40 Prevalence of poor, intermediate, and ideal cardiovascular health among US children aged years National Center for Health Statistics, NHANES 2013 to 2014

41 Prevalence of poor, intermediate, and ideal cardiovascular health among US adults National Center for Health Statistics, NHANES 2013 to 2014

42 Completion of Draft Sequence of the Human Genome June 2000 I would be willing to make a prediction that within 10 years, we will have the potential of offering any of you the opportunity to find out what particular genetic conditions you may be at increased risk for, based upon the discovery of genes involved in common illnesses like diabetes, hypertension, heart disease, and so on. Francis Collins, June 26, 2000

43 Best Career Opportunities PRECISION MEDICINE!

44 Precision Medicine Tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes and to give all of us access to the personalized information we need to keep ourselves and our families healthier. President Obama, State of the Union Address, January 20, 2015

45 Polymorphisms in 9 Lipid Genes Predict Lipid Levels LDL APOB APOE HMGCR LDLR PCSK9 HDL ABCA1 CETP LIPC LPL Kathiresan et al. N Engl J Med March 20, 2008

46 Polymorphisms in 9 Lipid Genes Predict Lipid Levels LDL P=2x10-18 HDL P=3x10-24 Kathiresan et al. N Engl J Med March 20, 2008

47 Polymorphisms in 9 Lipid Genes Predict Risk of CVD Kathiresan et al. N Engl J Med March 20, 2008

48 Genetically Driven Drug Discovery

49 PCSK9 Mutations and CHD

50 Using Genetics to Determine Risk

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52 A Genetic Risk Score for Coronary Artery Disease

53 Performance of Genetic Risk Scores for Other Diseases A-Fib T2D IBD Breast Cancer

54 Performance of Genetic Risk Scores for 5 Diseases