BRFSS, , *BMI

Size: px
Start display at page:

Download "BRFSS, , *BMI"

Transcription

1 The Epidemic of Obesity, Diabetes, and the Metabolic Syndrome Holly Novak, MD, FACC Obesity Trends* Among US Adults BRFSS, 1985 BRFSS=Behavioral Risk Factor Surveillance System. *Body Mass Index (BMI) 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1986 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25.

2 Obesity Trends* Among US Adults BRFSS, 1987 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1988 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1989 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25.

3 Obesity Trends* Among US Adults BRFSS, 199 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1991 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Adapted with permission from Mokdad AH et al. JAMA. 21;286: Obesity Trends* Among US Adults BRFSS, 1992 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25..

4 Obesity Trends* Among US Adults BRFSS, 1993 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1994 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1995 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25.

5 Obesity Trends* Among US Adults BRFSS, 1996 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1997 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 1998 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25.

6 Obesity Trends* Among US Adults BRFSS, 1999 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Obesity Trends* Among US Adults BRFSS, 2 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Adapted with permission from Mokdad AH et al. JAMA. 21;286: Obesity Trends* Among US Adults BRFSS, 21 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25.

7 Obesity Trends* Among US Adults BRFSS, 22 *BMI 3, or 3 lbs overweight for 5 4 woman. Accessed August 9, 25. Diabetes Can Appear Right Under Your Nose Midwest Heart Foundation.

8 Diabetes Mellitus: Prevalence in the US Diagnosed diabetes (in millions) x increase Year Adapted with permission from Diabetes Overview. Bethesda, Md: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; NIDDK publication NIH Kenny SJ et al. In: Diabetes in America. 2nd ed. Bethesda, Md: National Diabetes Data Group, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 1995: NIH publication No Midwest Heart Foundation. Diabetes: Atherosclerotic Complications Responsible for 8% of diabetic mortality 75% cases due to coronary artery disease (CAD) Results in >75% of all hospitalizations for diabetic complications 5% of type 2 diabetes patients have preexisting CAD 1/3 of patients presenting with myocardial infarction have undiagnosed diabetes mellitus Lewis GF. Can J Cardiol. 1995;11(suppl C):24C-28C. Midwest Heart Foundation. Type 2 Diabetes and CHD 7-Year Incidence of Fatal/Nonfatal MI (East West Study) 7-year incidence rate of MI P<.1 P<.1 45.% 18.8% 2.2% 3.5% No DM, No MI No DM, MI DM, No MI DM, MI Nondiabetic Diabetic CHD=coronary heart disease; MI=myocardial infarction; DM=diabetes mellitus. Haffner SM et al. N Engl J Med. 1998;339:

9 Post-MI Survival (5 Year): Diabetic Patients vs Nondiabetic Patients Survival (%) Men Women No DM DM Time from MI (months) Adapted with permission from Sprafka JM et al. Diabetes Care. 1991;14: Year Mortality in Diabetic and Nondiabetic Subjects After a First MI Days 1 year Hospitalization 28 days Out of hospital Mortality (%) DSW1 Diabetes No diabetes Diabetes No diabetes Men Women Miettinen H, et al. Diabetes Care. 1998;21: Midwest Heart Foundation. Age-Adjusted CVD Death Rates (MRFIT) Age-adjusted CVD death rate per 1, person years Nondiabetic Diabetic None Only 1 Only 2 All 3 No. of risk factors (total cholesterol, HTN, smoking) CVD=cardiovascular disease; MRFIT=Multiple Risk Factor Intervention Trial. Adapted with permission from Stamler J et al. Diabetes Care. 1993;16:

10 Slide 26 DSW1 What is Midwest Heart Foundation. If it's a reference, it seems incomplete. wordsetc@chesco.com, 8/11/25

11 Proteinuria Predicts Stroke and CHD Events in Type 2 Diabetes A: U-Prot <15 mg/l B: U-Prot 15 3 mg/l C: U-Prot >3 mg/l Survival curves for CV mortality Overall: P<.1 A B C Incidence (%) P< Months Stroke CHD Events U-Prot=Urinary protein concentration. Adapted with permission from Miettinen H et al. Stroke. 1996;27: LDL-C as a Predictor of CAD in Diabetic Patients 2 Hazard ratio LDL-C quartile mean LDL=low-density lipoprotein cholesterol; CAD=coronary artery disease. Adapted with permission from Howard BV et al. Arterioscler Thromb Vasc Biol. 2;2: HOT Trial: Effect of BP Control on CV Event Rate 3 Diabetic patients 25 Nondiabetic patients Major CV events per 1 patient-years <9 <85 <8 <9 <85 <8 Diastolic BP goal BP=blood pressure. Hansson L et al. Lancet. 1998;351:

12 The Effect of ASA on CV Risk in Patients With Diabetes Events per 1 patient-yrs % Reduction P<.2 Placebo ASA ASA=aspirin. N=452. BMJ. 1994;38: Ticking Clock Hypothesis Macrovascular Disease Microvascular Disease NGT IGT Hyperglycemia Haffner SM et al. JAMA. 199;263: Nurses Health Study: Elevated Risk of CVD Prior to Clinical Diagnosis of Type 2 Diabetes Relative risk Nondiabetic throughout the study Prior to diagnosis of diabetes After diagnosis of diabetes Diabetic at baseline Adapted with permission from Hu FB et al. Diabetes Care. 22;25:

13 Clinical Identification of the Metabolic Syndrome (NCEP)* 1 Abdominal obesity (waist circumference) Men >4 in (>12 cm) Women >35 in (>88 cm) Triglycerides 15 mg/dl High-density lipoprotein (HDL) Men <4 mg/dl Women <5 mg/dl Blood pressure 13/ 85 mm Hg Fasting glucose 1 mg/dl 2 *Diagnosis is established when 3 of these risk factors are present. 1. National Institutes of Health. Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary. May 21. NIH Publication No Grundy SM et al. Circulation. 24;19: Metabolic Syndrome and Mortality All-Cause Mortality Cumulative hazard (%) Metabolic Syndrome Yes No RR % vs 92% Follow-up (y) Kuopio Ischaemic Heart Disease Risk Factor Study. Adapted with permission from Lakka H-M et al. JAMA. 22;288:279. Hazard Ratio* for CVD Mortality with the Metabolic Syndrome (Orange=Women; Blue=Men) No MetSyn MetSyn No Diabetes (.72, 6.) 1.96 (.99, 3.88) Diabetes 3.53 (.75, 16.7) 2.34 (.7, 7.82) 8.19 (3.51, 19.1) 3.9 (1.49, 6.43) San Antonio Heart Study. *Adjusted for age and ethnicity. 1.=no cardiovascular disease at baseline; MetSyn=metabolic syndrome (as defined by NCEP). Hunt KJ, et al. Circulation. 24;11:

14 Incident Diabetes After Stratification by IGT and the Metabolic Syndrome* P< P=.18 P<.1 IGT IGT NGT No Yes MetS *As defined by NCEP criteria. Adapted with permission from Lorenzo C et al. Diabetes Care. 23;26: Approaches to Therapy: Metabolic Syndrome/Diabetes The Basis for the Project Behavioral therapy Weight loss and increased physical activity Treat existing risk factors For nondiabetic patients with MetS, management should be intensified over and above global risk, but not to the level of a CHD risk equivalent Use of insulin-sensitizing therapies in nondiabetic patients with MetS No clinical trials support use in patients with MetS alone Some clinical trial support use for MetS patients with IGT DPP, STOP-NIDDM, TRIPOD OGTT=oral glucose tolerance test. Chiasson JL, et al, for the STOP-NIDDM Trial Research Group. Diabetologia. 24;47: Orchard TJ, et al, for the Diabetes Prevention Program Research Group. Ann Intern Med. 25;142: The Epidemic Key Takeaway Points The prevalence of obesity, metabolic syndrome, and diabetes continues to increase Diabetes is a major US health problem associated with atherosclerotic disease Renal function, LDL-C levels, and blood pressure are all predictive of CV risk in diabetic patients An increased risk of macrovascular complications precedes the development of hyperglycemia The metabolic syndrome increases risk for CVD mortality and is an independent predictor of diabetes LDL-C=low-density lipoprotein cholesterol.

15 Diabetes Education Initiative: A Collaboration for Intervention The American College of Cardiology Foundation in Collaboration With the Midwest Heart Foundation Diabetes and Cardiovascular Health: Reducing the Risk Holly Novak, MD, FACC Statins Should every patient get one?

16 4S Study Lowering Total Cholesterol Reduces Mortality in Patients With and Without Diabetes % risk reduction 24.7% Simvastatin Placebo Mortality (%) % 29 % risk reduction 7.9% 1.9% 5 With diabetes Without diabetes Pyorala K et al. Diabetes Care. 1997;2: Midwest Heart Foundation. Heart Protection Study Primary Prevention of CV Events in Patients With Diabetes and Without High LDL-C Diabetic patients in the Heart Protection Study 5963 High-risk patients >4 years Mean baseline LDL-C = 124 mg/dl Simvastatin 4 mg vs placebo 5-Year follow-up 22% Reduction in major CV events (P<.1) 27% reduction in 2462 patients with LDL-C <116 mg/dl 33% reduction in 2912 patients without CVD DSW3 HPS Collaborative Group. Lancet. 23;361:

17 Slide 44 DSW3 Is red font deliberate? 8/11/25

18 Statin Therapy Number Needed to Treat* Diabetic patients NNT Without CAD 14 With CAD 4 CAD=coronary artery disease. *Based on the HPS and 4S studies. HPS Collaborative Group. Lancet. 23;361: Pyorala K, et al. Diabetes Care. 1997;2: Primary Prevention of CV Events in Patients With Diabetes and Without High LDL-C Diabetic patients in CARDS Diabetic patients without CVD Mean baseline LDL-C = 116 mg/dl At least 1 additional CV risk factor Atorvastatin 1 mg vs placebo, 3.9-year follow-up 37% Decrease in major CV events (P=.1) ASCOT LLA Diabetic patients with no CHD Mean baseline LDL-C = 128 mg/dl At least 2 additional CV risk factors Atorvastatin 1 mg vs placebo, 3.3-year follow-up 23% Decrease in major CV events or procedures (P=.36) In diabetics without CAD, data support statin therapy regardless of LDL-C level CARDS=Collaborative Atorvastatin Diabetes Study. ASCOT-LLA=Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm. 1. Colhoun HM et al. Lancet. 24;364: Sever PS et al. Diabetes Care. 25;28: TNT: Low LDL-C Benefits Patients With Diabetes and CHD Post hoc analysis: 151 subjects with CHD Mean baseline LDL-C <1 mg/dl Atorvastatin 8 mg vs atorvastatin 1 mg, 4.9 year follow-up Atorvastatin 8 mg: LDL=77 mg/dl Atorvastatin 1 mg: LDL=99 mg/dl 25% reduction in risk of major CV events with atorvastatin 8 mg, compared to the 1-mg group (P=.26) Lowering LDL levels below suggested guidelines continues to benefit high-risk patients Shepherd J on behalf of the TNT Diabetes Subcommittee and the TNT Steering Committee. Presented at the Annual Meeting of the American Diabetes Association; June 13, 25; San Diego, California. Webcast available at Accessed August 1, 25.

19 ACEIs/ARBs Should every patient get one? ACE Inhibitors Reduce CV and Renal Risk in Patients With Diabetes UKPDS Tight blood pressure control reduced micro- and macrovascular risk UKPDS, FACET, CAPPP, ABCD meta-analysis ACEIs reduce risk of CV and renal disease more effectively than other antihypertensive agents MICRO-HOPE ACEIs reduce CV risk in patients who are normotensive at baseline ACEI=angiotensin converting enzyme inhibitors UKPDS=UK Prospective Diabetes Study; FACET=Fosinopril vs Amlodipine Cardiovascular Events CAPPP=Captopril Prevention Project;ABCD=Appropriate BP Control in Diabetes. MICROHOPE = Microalbuminuria, Cardiovascular Renal Outcomes: Heart Outcomes Prevention Evaluation. UK Prospective Diabetes Study Group. BMJ. 1998;317:73-713; UK Prospective Diabetes Study Group. BMJ. 1998;317:713-72;Pahor M, et al. Diabetes Care. 2;23: ; HOPE Study Investigators. Lancet. 2;355:

20 Effect of Intensive Multiple Risk Factor Management on CV Endpoints in Patients with Type 2 Diabetes and Microalbuminuria 6 N=16; follow-up=7.8 years Primary composite end point* (%) 4 2 Conventional therapy 2% Absolute Risk Reduction Aggressive treatment of : Intensive therapy Microalbuminuria with ACEIs, ARBs, or combination Hypertension Hyperglycemia Dyslipidemia Secondary prevention of CVD Months of follow-up Primary composite end point: conventional therapy (44%) and intensive therapy (24%). * Death from CV causes, nonfatal MI, CABG, PCI, nonfatal stroke, amputation, or surgery for peripheral atherosclerotic artery disease. Behavior modification and pharmacologic therapy. Adapted with permission from Gaede P et al. N Engl J Med. 23;348: Steno 2: Key Takeaway Compared to conventional treatment, aggressive management of risk factors results in significant decreases in CV risk Treat to Goal!

21 Scientific Statements: Diabetes, CV Disease, and Hypertension AHA Scientific Statement on Diabetes and CVD BP goal in hypertension: <13/85 mm Hg ACE inhibitors favored as antihypertensive agents ACE inhibitors probably slow progression of nephropathy, even in normotensive patients JNC VII Report on Diabetic Hypertension Combinations of 2 or more drugs to achieve BP goal (13/8 mm Hg) Thiazide-diuretics, β-blockers, ACEIs, ARBs, CCBs reduce CVD and stroke incidence ACEIs/ARBs reduce progression of diabetic nephropathy and reduce albuminuria ARBS reduce progression of macroalbuminuria Grundy SM, et al. Circulation. 1999;1: Chobanian AV, et al. JAMA. 23;289: ADA 22 Clinical Practice Guidelines Treatment of hypertension in patients with diabetes Initial drug therapy: ACEI, ARBs, β-blockers, diuretics If >55 yrs, without hypertension but with another CV risk factor, consider an ACE inhibitor Treat to target of <13 mm Hg systolic With diabetic nephropathy Hypertensive type 2 diabetic patients ARBs are the drugs of choice Type 1 diabetic patients ACE inhibitors are preferred Combination of ACEI and ARBs will decrease albuminuria more than either agent alone If ACEI or ARBs are used, monitor serum potassium for development of hyperkalemia American Diabetes Association. Diabetes Care. 22;25(suppl 1):S71-S73, S85-S89 Recommendation ACEIs and ARBs in DM Recommend the use of an ACEI and/or ARB in all type 2 DM patients with at least 1 additional CV risk factor, and/or microalbuminuria Consider the use of ACEI and/or ARB in all other patients with type 2 DM

22 β-blockers Should every patient get one? Does it matter which one you use? β-blockers in Diabetes: UKPDS UKPDS (1998) Captopril vs atenolol 9-year follow-up Similar decreases in BP Similar decreases in diabetic complications UKPDS=UK Prospective Diabetes Study. UK Prospective Diabetes Study Group. BMJ. 1998;317: β-blockers in Diabetes: Gemini Study Design Carvedilol vs metoprolol 1235 diabetic patients with hypertension and receiving RAS blockers 35 week follow up Results* Similar decreases in BP Carvedilol had no effect on A1C; metoprolol A1C Carvedilol albumin/creatinine ratio, compared to metoprolol (16%, P=.3) * At 5 months.gemini=glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives. Bakris GL, et al. JAMA. 24;292:

23 Effect of Antihypertensive Medication on Renal Function in Hypertensive Patients With Type 2 Diabetes 52 Patients with NIDDM, nephropathy, and hypertension Annual decline in creatinine clearance (ml/min/1.73m 2 ) with each medication ACE inhibitor 1. Non-DCCP 1.4 β-blocker 3.5* *P=.1 vs ACE I; P=.4 vs Non-DCCP. Bakris GL, et al. Kidney Int. 1996;5: Recommendation β-blockers in DM Recommend the use of β-blocker in all type 2 DM patients with heart failure, CAD and/or history of MI Consider the use of β-blocker in all other patients with type 2 DM Remember the ABCs for Diabetes Care A aspirin/a1c (goal 6.5%) B blood pressure control (goal <13/8 ) C cholesterol (LDL <1, non-hdl <13) D diet E exercise Treat to Goal! LDL=low density lipoprotein; HDL=high density lipoprotein.

24 Diabetes and Heart Failure Epidemiology of Diabetic Heart Failure Framingham Study (risk of HF in diabetic patients) 2x diabetic males 5x diabetic females 4x young diabetic males 8x young diabetic females US HMO prevalence study With diabetes, HF developed at a rate of 3.3% per year Each 1% elevation in hemoglobin A1C leads to a 15% increase in frequency of HF HF=heart failure. Kannel WB et al. JAMA. 1979;241: Nichols GA. Diabetologia. 2;43(suppl A2):7. Chue CU et al. Circulation. 1998;98(suppl 1):721. Framingham Heart Study 3-Year Follow-up of CVD Events in Patients With Diabetes (Ages 35 64) 1 8 Men Women Risk ratio Total CVD CHD Cardiac Intermittent Stroke failure claudication P<.1 for all values, except stroke (P<.5). Wilson PWF, Kannel WB. In: Ruderman N et al, eds. Hyperglycemia, Diabetes and Vascular Disease. New York, NY: Oxford University Press; ( Figure 2.5 from HYPERGLYCEMIA, DIABETES AND VASCULAR DISEASE, edited by Neil Ruderman et al, copyright 1992 by American Physiological Society. Used by permission of Oxford University Press, Inc.)

25 Insulin Resistance in CHF Fasting insulin (pmol/l) % * Insulin sensitivity (1-5 min/pmol/l) 6 3 7% Normal HF *P=.1; P=.7. Swan JW et al. Eur Heart J. 1994;15: Therapies Demonstrated to Reduce Mortality in HF ACEI (ARB) β-blockers Aldosterone antagonists Hydralazine-isosorbide dinitrate ICD LVEF 35, Class I, II, or III Cardiac resynchronization LVEF 35%, QRS 13 ms, Class III or IV* *By NY Heart Association criteria. ACEI=angiotensin converting enzyme inhibitor; ARB=angiotensin receptor blocker; ICD=implantable cardioverter defibrillator; LVEF=left ventricular ejection fraction. 1. The CONSENSUS Trial Study Group. N Engl J Med. 1987;316: Packer M et al. N Engl J Med. 1996;334: Pitt B et al. N Engl J Med. 1999;341: Moss A et al. N Engl J Med. 1996;335: Abraham WT et al. N Engl J Med. 22;346: Aldosterone Blockade in HF Probability of survival (%) RALES: Randomized Aldactone Evaluation Study Follow-up (months) Spironolactone Placebo RR.7 (.6.82) P<.1 NYHA=New York Heart Association patients NYHA II, III, and IV, average age 65 and LVEF.35, on ACEI, loop diuretic, ± digoxin randomized to spironolactone 25 mg PO qd vs placebo. Adapted with permission from Pitt B et al. N Engl J Med. 1999;341:

26 Aldosterone Blockade With Eplerenone Reduces Mortality Post-MI in Diabetes and Nondiabetic Patients CV mortality or CV hospitalization No DM Diabetes Heterogeneity P= Eplerenone better Placebo better MI=myocardial infarction; CV=cardiovascular; DM=diabetes mellitus. N=6632, 32% diabetic patients. Pitt B et al. N Engl J Med. 23;348: Reprinted with permission. 23 Massachusetts Medical Society. Conclusions Diabetic patients are at elevated risk for HF Combined neurohormonal blockade with the use of ACEI, aldosterone antagonists, and β-blockers is essential in the treatment of the type 2 diabetic patient with HF β-blockers and ACEI are useful in type 2 diabetic patients across the CVD continuum: before a CV event, for secondary prevention, and as soon as possible in HF Simple Steps to Reduce CV Events in Patients With Type 2 Diabetes ASA in all patients Statin in all patients ACE/ARB in all patients with additional risk factor; consider in all patients β-blocker in all patients with CAD/CHF or history of MI; consider in all patients Diet and exercise therapy Encourage smoking cessation Glucose management for small-vessel disease

How to Reduce CVD Complications in Diabetes?

How to Reduce CVD Complications in Diabetes? How to Reduce CVD Complications in Diabetes? Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Framingham Heart Study 30-Year

More information

Cedars Sinai Diabetes. Michael A. Weber

Cedars Sinai Diabetes. Michael A. Weber Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor

More information

Cardiovascular Complications of Diabetes

Cardiovascular Complications of Diabetes VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary

More information

The Metabolic Syndrome: Is It A Valid Concept? YES

The Metabolic Syndrome: Is It A Valid Concept? YES The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA

More information

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

Treatment to reduce cardiovascular risk: multifactorial management

Treatment to reduce cardiovascular risk: multifactorial management Treatment to reduce cardiovascular risk: multifactorial management Matteo Anselmino, MD PhD Assistant Professor San Giovanni Battista Hospital Division of Cardiology, Department of Internal Medicine University

More information

Management of Hypertension in the Diabetic Patient:

Management of Hypertension in the Diabetic Patient: Management of Hypertension in the Diabetic Patient: Nicolas W. Shammas, MS, MD Research Director, Cardiovascular Medicine, PC Presentation Objectives To review: The relationship between HTN, insulin resistance

More information

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD

More information

Management of Cardiovascular Disease in Diabetes

Management of Cardiovascular Disease in Diabetes Management of Cardiovascular Disease in Diabetes Radha J. Sarma, MBBS, FACP. FACC. FAHA. FASE Professor of Internal Medicine Western University of Health Sciences. Director, Heart and Vascular Center Western

More information

The Burden of the Diabetic Heart

The Burden of the Diabetic Heart The Burden of the Diabetic Heart Dr. Ghaida Kaddaha (MBBS, MRCP-UK, FRCP-london) Diabetes Unit Rashid Hospital Dubai U.A.E Risk of CVD in Diabetes Morbidity and mortality from CVD is 2-4 fold higher than

More information

The Diabetes Link to Heart Disease

The Diabetes Link to Heart Disease The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM

More information

Kidney and heart: dangerous liaisons. Luis M. RUILOPE (Madrid, Spain)

Kidney and heart: dangerous liaisons. Luis M. RUILOPE (Madrid, Spain) Kidney and heart: dangerous liaisons Luis M. RUILOPE (Madrid, Spain) Type 2 diabetes and renal disease: impact on cardiovascular outcomes The "heavyweights" of modifiable CVD risk factors Hypertension

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

Established Risk Factors for Coronary Heart Disease (CHD)

Established Risk Factors for Coronary Heart Disease (CHD) Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland

More information

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select

More information

Antihypertensive Trial Design ALLHAT

Antihypertensive Trial Design ALLHAT 1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes

More information

How would you manage Ms. Gold

How would you manage Ms. Gold How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56

More information

Prevention And Treatment of Diabetic Nephropathy. MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan

Prevention And Treatment of Diabetic Nephropathy. MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan Prevention And Treatment of Diabetic Nephropathy MOH Clinical Practice Guidelines 3/2006 Dr Stephen Chew Tec Huan Prevention Tight glucose control reduces the development of diabetic nephropathy Progression

More information

Metformin should be considered in all patients with type 2 diabetes unless contra-indicated

Metformin should be considered in all patients with type 2 diabetes unless contra-indicated November 2001 N P S National Prescribing Service Limited PPR fifteen Prescribing Practice Review PPR Managing type 2 diabetes For General Practice Key messages Metformin should be considered in all patients

More information

T. Suithichaiyakul Cardiomed Chula

T. Suithichaiyakul Cardiomed Chula T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial

More information

Treating Hypertension in Individuals with Diabetes

Treating Hypertension in Individuals with Diabetes Treating Hypertension in Individuals with Diabetes Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any

More information

The Clinical Unmet need in the patient with Diabetes and ACS

The Clinical Unmet need in the patient with Diabetes and ACS The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge

More information

Update in Cardiology Pharmacologic Management of Cardiovascular Risk. Christopher C. Roe, MSN, ACNP

Update in Cardiology Pharmacologic Management of Cardiovascular Risk. Christopher C. Roe, MSN, ACNP Update in Cardiology Pharmacologic Management of Cardiovascular Risk Christopher C. Roe, MSN, ACNP Objectives 1. Verbalize understanding of new pharmacologic guidelines in the treatment of hypertension

More information

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes

Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select

More information

Firenze 22 settembre 2007

Firenze 22 settembre 2007 Istituto di di medicina dello sport di di Firenze AMES Prevenzione cardiovascolare e cambiamenti negli stili di vita Firenze 22 settembre 2007 Orientamenti attuali per un intervento farmacologico e non

More information

Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures

Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, Financial Disclosures Hypertension Guidelines: Are We Pressured to Change? Oregon Cardiovascular Symposium Portland, Oregon June 6, 2015 William C. Cushman, MD Professor, Preventive Medicine, Medicine, and Physiology University

More information

ATP IV: Predicting Guideline Updates

ATP IV: Predicting Guideline Updates Disclosures ATP IV: Predicting Guideline Updates Daniel M. Riche, Pharm.D., BCPS, CDE Speaker s Bureau Merck Janssen Boehringer-Ingelheim Learning Objectives Describe at least two evidence-based recommendations

More information

On May 2001, the Third Adult

On May 2001, the Third Adult THE RISK OF DIABETES: CAN WE IMPACT CHD THROUGH THE ATP III CHOLESTEROL GUIDELINES? * Based on a presentation given by Steven M. Haffner, MD, MPH ABSTRACT Diabetes has been recognized among diabetologists

More information

Cardiovascular Risk Reduction and Other Co-Morbidities in Type 2 Diabetes

Cardiovascular Risk Reduction and Other Co-Morbidities in Type 2 Diabetes Cardiovascular Risk Reduction and Other Co-Morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select

More information

The target blood pressure in patients with diabetes is <130 mm Hg

The target blood pressure in patients with diabetes is <130 mm Hg Controversies in hypertension, About Diabetes diabetes and and metabolic Cardiovascular syndrome Risk ESC annual congress August 29, 2011 The target blood pressure in patients with diabetes is

More information

Diabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center

Diabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??

More information

Cardiologists and HbA1c: Novel Diabetes Drugs and Cardiovascular Disease Outcomes

Cardiologists and HbA1c: Novel Diabetes Drugs and Cardiovascular Disease Outcomes Biomarkers 2018 Cardiologists and HbA1c: Novel Diabetes Drugs and Cardiovascular Disease Outcomes Gregg C. Fonarow, MD, FACC, FAHA, FHFSA Elliot Corday Professor of Cardiovascular Medicine UCLA Division

More information

HYPERTENSION GUIDELINES WHERE ARE WE IN 2014

HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University

More information

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures

More information

CV Risk Management in Diabetes Mellitus

CV Risk Management in Diabetes Mellitus CV Risk Management in Diabetes Mellitus J R Minkoff MD, FACP Endocrinology Clinical Professor of Family and Community Medicine University of California, San Francisco Mr. B 40 y/o Latino male c/o fatigue,

More information

Accelerated atherosclerosis begins years prior to the diagnosis of diabetes

Accelerated atherosclerosis begins years prior to the diagnosis of diabetes Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Risk for atherosclerosis is 2 4 times greater in patients with diabetes CVD accounts for 65% of diabetic mortality >5% of patients

More information

ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic

ALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic 1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker

More information

Diabetes and Hypertension

Diabetes and Hypertension Diabetes and Hypertension William C. Cushman, MD, FAHA, FACP, FASH Chief, Preventive Medicine, Veterans Affairs Medical Center Professor, Preventive Medicine, Medicine, and Physiology University of Tennessee

More information

Update on CVD and Microvascular Complications in T2D

Update on CVD and Microvascular Complications in T2D Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine

More information

Dyslipidaemia. Is there any new information? Dr. A.R.M. Saifuddin Ekram

Dyslipidaemia. Is there any new information? Dr. A.R.M. Saifuddin Ekram Dyslipidaemia Is there any new information? Dr. A.R.M. Saifuddin Ekram PhD,FACP,FCPS(Medicine) Professor(c.c.) & Head Department of Medicine Rajshahi Medical College Rajshahi-6000 New features of ATP III

More information

Diabetic Nephropathy. Objectives:

Diabetic Nephropathy. Objectives: There are, in truth, no specialties in medicine, since to know fully many of the most important diseases a man must be familiar with their manifestations in many organs. William Osler 1894. Objectives:

More information

ALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status

ALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status 1 Introduction and Background Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors,

More information

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION 2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL

More information

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk

Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk Metabolic Syndrome Update 21 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes University of Colorado Denver Denver Health Medical Center The Metabolic

More information

Review of guidelines for management of dyslipidemia in diabetic patients

Review of guidelines for management of dyslipidemia in diabetic patients 2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University

More information

Dysglycaemia and Hypertension. Dr E M Manuthu Physician Kitale

Dysglycaemia and Hypertension. Dr E M Manuthu Physician Kitale Dysglycaemia and Hypertension Dr E M Manuthu Physician Kitale None Disclosures DM is MI equivalent MR FIT Objective was to assess predictors of CVD mortality among men with and without diabetes and

More information

Complications of Diabetes: Screening and Prevention

Complications of Diabetes: Screening and Prevention Complications of Diabetes: Screening and Prevention Dr Steve Cleland Consultant Physician GGH and QEUH Diabetes Staff Education Course June 17 Diabetic Complications Microvascular: Retinopathy Nephropathy

More information

Diabetes Mellitus: Implications of New Clinical Trials and New Medications

Diabetes Mellitus: Implications of New Clinical Trials and New Medications Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October

More information

Reframe the Paradigm of Hypertension treatment Focus on Diabetes

Reframe the Paradigm of Hypertension treatment Focus on Diabetes Reframe the Paradigm of Hypertension treatment Focus on Diabetes Paola Atallah, MD Lecturer of Clinical Medicine SGUMC EDL monthly meeting October 25,2016 Overview Physiopathology of hypertension Classification

More information

Position Statement on ALDOSTERONE ANTAGONIST THERAPY IN CHRONIC HEART FAILURE

Position Statement on ALDOSTERONE ANTAGONIST THERAPY IN CHRONIC HEART FAILURE Position Statement on ALDOSTERONE ANTAGONIST THERAPY IN CHRONIC HEART FAILURE Over 8,000 patients have been studied in two well-designed placebo-controlled outcome-driven clinical trials to evaluate the

More information

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE

DISCLOSURES OUTLINE OUTLINE 9/29/2014 ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE ANTI-HYPERTENSIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE DISCLOSURES Editor-in-Chief- Nephrology- UpToDate- (Wolters Klewer) Richard J. Glassock, MD, MACP Geffen School of Medicine at UCLA 1 st Annual Internal

More information

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy? Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists

More information

Causes of death in Diabetes

Causes of death in Diabetes Rates of CV events in Diabetes patients Respiratory4.2 Cancer 7.6 Diabetes 1.3 CV disease 17.3 Causes of death in Diabetes 250 200 150 100 50 0 per 10,000 person-years 97 151 243 Framingham 5 X increase

More information

The American Diabetes Association estimates

The American Diabetes Association estimates DYSLIPIDEMIA, PREDIABETES, AND TYPE 2 DIABETES: CLINICAL IMPLICATIONS OF THE VA-HIT SUBANALYSIS Frank M. Sacks, MD* ABSTRACT The most serious and common complication in adults with diabetes is cardiovascular

More information

Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension)

Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Lessons learned from AASK (African-American Study of Kidney Disease and Hypertension) Janice P. Lea, MD, MSc, FASN Professor of Medicine Chief Medical Director of Emory Dialysis ASH Clinical Specialist

More information

The Latest Generation of Clinical

The Latest Generation of Clinical The Latest Generation of Clinical Guidelines: HTN and HLD Dave Brackett Clinical Guideline Purpose Uniform approach Awareness of key details Diagnosis Treatment Monitoring Evidence based approach Inform

More information

Metabolic Syndrome and Chronic Kidney Disease

Metabolic Syndrome and Chronic Kidney Disease Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference

More information

Role of Neurohormonal Antagonists in Management of Patients With Hypertension, Metabolic Syndrome, and Diabetes

Role of Neurohormonal Antagonists in Management of Patients With Hypertension, Metabolic Syndrome, and Diabetes Role of Neurohormonal Antagonists in Management of Patients With Hypertension, Metabolic Syndrome, and Diabetes Gregg C. Fonarow, MD Approximately 1.1 million individuals will have a new or recurrent myocardial

More information

1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria

1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria 1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage

More information

Managing Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park.

Managing Hypertension in Diabetes Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park. Managing Hypertension in Diabetes 2015 Sean Stewart, PharmD, BCPS, BCACP, CLS Internal Medicine Park Nicollet Clinic St Louis Park Case Scenario Mike M is a 59 year old man with type 2 diabetes managed

More information

The New Hypertension Guidelines

The New Hypertension Guidelines The New Hypertension Guidelines Joseph Saseen, PharmD Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Disclosure Joseph Saseen reports no conflicts

More information

ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial

ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial 1 ALLHAT Role of Diuretics in the Prevention of Heart Failure - The Antihypertensive and Lipid- Lowering Treatment to Prevent Heart Attack Trial Davis BR, Piller LB, Cutler JA, et al. Circulation 2006.113:2201-2210.

More information

Environmental. Vascular / Tissue. Metabolics

Environmental. Vascular / Tissue. Metabolics Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood

More information

ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH

ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ. Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH ΑΡΥΙΚΗ ΠΡΟΔΓΓΙΗ ΤΠΔΡΣΑΙΚΟΤ ΑΘΔΝΟΤ Μ.Β.Παπαβαζιλείοσ Καρδιολόγος FESC - Γιεσθύνηρια ιζμανόγλειον ΓΝΑ Clinical Hypertension Specialist ESH Hypertension Co-Morbidities HTN Commonly Clusters with Other Risk

More information

Update in Hypertension

Update in Hypertension Update in Hypertension Eliseo J. PérezP rez-stable MD Professor of Medicine DGIM, Department of Medicine UCSF 20 May 2008 Declaration of full disclosure: No conflict of interest (I have never been funded

More information

Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary

Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary Neprilysin Inhibitor (Entresto ) Prior Authorization and Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1 Indication Entresto Reduce the risk of cardiovascular (sacubitril/valsartan) death

More information

( Diabetes mellitus, DM ) ( Hyperlipidemia ) ( Cardiovascular disease, CVD )

( Diabetes mellitus, DM ) ( Hyperlipidemia ) ( Cardiovascular disease, CVD ) 005 6 69-74 40 mg/dl > 50 mg/dl) (00 mg/dl < 00 mg/dl(.6 mmol/l) 30-40% < 70 mg/dl 40 mg/dl 00 9 mg/dl fibric acid derivative niacin statin fibrate statin niacin ( ) ( Diabetes mellitus,

More information

Hypertension Management in Diabetic Patients

Hypertension Management in Diabetic Patients Hypertension Management in Diabetic Patients Park, Chang G, MD, PhD Cardiovascular Center, Guro Hospital, Korea University Medical School Contents (Treatment of 2 Cases) Type 2 Diabetes Mellitus Hypertension

More information

Diabetes and Hypertension

Diabetes and Hypertension Diabetes and Hypertension M.Nakhjvani,M.D Tehran University of Medical Sciences 20-8-96 Hypertension Common DM comorbidity Prevalence depends on diabetes type, age, BMI, ethnicity Major risk factor for

More information

Update sulla terapia antiipertensiva e antiaggregante nel paziente cardiometabolico

Update sulla terapia antiipertensiva e antiaggregante nel paziente cardiometabolico Update sulla terapia antiipertensiva e antiaggregante nel paziente cardiometabolico G. Mazzanti UO Cardiologia Ospedale SS. Annunziata, Cento (FE) AUSL di Ferrara Antiplatelet therapy Aspirin Aspirin:

More information

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Elliot Sternthal, MD, FACP, FACE Chair New England AACE Diabetes Day Planning Committee Welcome and Introduction This presentation will:

More information

Hyperlipidemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes

Hyperlipidemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes ...PRESENTATIONS... Hyperlipidemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes Based on a presentation by Ronald B. Goldberg, MD Presentation Summary Atherosclerosis accounts for approximately

More information

Is there a mechanism of interaction between hypertension and dyslipidaemia?

Is there a mechanism of interaction between hypertension and dyslipidaemia? Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational

More information

ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES

ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES Pr. Michel KOMAJDA Institute of Cardiology - IHU ICAN Pitie Salpetriere Hospital - University Pierre and Marie Curie, Paris (France) DEFINITION A

More information

4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?

4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS? HYPERTENSION TARGETS: WHAT DO WE DO NOW? MICHAEL LEFEVRE, MD, MSPH PROFESSOR AND VICE CHAIR DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF MISSOURI 4/4/17 DISCLOSURE: MEMBER OF THE JNC 8 PANEL

More information

DISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.

DISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose. JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES Tiffany Dickey, PharmD Assistant Professor, UAMS COP Clinical Pharmacy Specialist, Mercy Hospital Northwest AR DISCLOSURE I

More information

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain

More information

ABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour

ABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour ABCD and Renal Association Clinical Guidelines for Diabetic Nephropathy-CKD. Management of Dyslipidaemia and Hypertension in Adults Dr Peter Winocour Dr Indranil Dasgupta Rationale No national practical

More information

Diabetes and the Heart

Diabetes and the Heart Diabetes and the Heart Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 6, 2012 Outline Screening for diabetes in patients with CAD Screening for CAD in patients with

More information

MANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION

MANAGEMENT OF HYPERTENSION: TREATMENT THRESHOLDS AND MEDICATION SELECTION Management of Hypertension: Treatment Thresholds and Medication Selection Robert B. Baron, MD MS Professor and Associate Dean Declaration of full disclosure: No conflict of interest Presentation Goals

More information

Hypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute

Hypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated

More information

Preventive Cardiology Scientific evidence

Preventive Cardiology Scientific evidence Preventive Cardiology Scientific evidence Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London Primary prevention

More information

Complications of Diabetes mellitus. Dr Bill Young 16 March 2015

Complications of Diabetes mellitus. Dr Bill Young 16 March 2015 Complications of Diabetes mellitus Dr Bill Young 16 March 2015 Complications of diabetes Multi-organ involvement 2 The extent of diabetes complications At diagnosis as many as 50% of patients may have

More information

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine

More information

Hypertension and Cardiovascular Disease

Hypertension and Cardiovascular Disease Hypertension and Cardiovascular Disease Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic,

More information

Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital

Hypertension and obesity. Dr Wilson Sugut Moi teaching and referral hospital Hypertension and obesity Dr Wilson Sugut Moi teaching and referral hospital No conflict of interests to declare Obesity Definition: excessive weight that may impair health BMI Categories Underweight BMI

More information

LDL cholesterol and cardiovascular outcomes?

LDL cholesterol and cardiovascular outcomes? LDL cholesterol and cardiovascular outcomes? Prof Kausik Ray, BSc (hons), MBChB, FRCP, MD, MPhil (Cantab), FACC, FESC Professor of Cardiovascular Disease Prevention St Georges University of London Honorary

More information

Hypertension is a major risk factor for

Hypertension is a major risk factor for OPTIMAL RISK MANAGEMENT OF THE HYPERTENSIVE PATIENT WITH MULTIPLE RISK FACTORS * Keith C. Ferdinand, MD, FACC ABSTRACT To determine the risk of cardiovascular disease in patients with hypertension, it

More information

Welcome and Introduction

Welcome and Introduction Welcome and Introduction This presentation will: Define obesity, prediabetes, and diabetes Discuss the diagnoses and management of obesity, prediabetes, and diabetes Explain the early risk factors for

More information

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32,

More information

Drugs to Treat Type 2 DM Demonstrate Reductions in Major Adverse Cardiovascular Events

Drugs to Treat Type 2 DM Demonstrate Reductions in Major Adverse Cardiovascular Events Drugs to Treat Type 2 DM Demonstrate Reductions in Major Adverse Cardiovascular Events How does all this play out when it comes to treating patients with type 2 DM who have chronic kidney disease? Therapeutic

More information

American Academy of Insurance Medicine

American Academy of Insurance Medicine American Academy of Insurance Medicine October 2012 Dr. Alison Moy Liberty Mutual Dr. John Kirkpatrick Thrivent Financial for Lutherans 1 59 year old male, diagnosed with T2DM six months ago Nonsmoker

More information

Disclosures. Learning Objectives. Hypertension: a sprint to the finish Ontario Pharmacists Association 1

Disclosures. Learning Objectives. Hypertension: a sprint to the finish Ontario Pharmacists Association 1 Disclosures I have no current or past relationships with commercial entities I have received a speaker s fee from the Ontario Pharmacists Association for this learning activity Laura Tsang PharmD Sunnybrook

More information

Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM

Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM OSHP 2014 Annual Meeting Oklahoma City, OK April 4, 2014 1 Objectives

More information

ADVANCES IN MANAGEMENT OF HYPERTENSION

ADVANCES IN MANAGEMENT OF HYPERTENSION Advances in Management of Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Prevalence 29%; Blacks 33.5%

More information

Clinical Recommendations: Patients with Periodontitis

Clinical Recommendations: Patients with Periodontitis The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;

More information

Difficult to Treat Hypertension

Difficult to Treat Hypertension Difficult to Treat Hypertension According to Goldilocks JNC 8 Blood Pressure Goals (2014) BP Goal 60 years old and greater*- systolic < 150 and diastolic < 90. (Grade A)** BP Goal 18-59 years old* diastolic

More information

Metabolic Syndrome: Why Should We Look For It?

Metabolic Syndrome: Why Should We Look For It? 021-CardioCase 29/05/06 15:04 Page 21 Metabolic Syndrome: Why Should We Look For It? Dafna Rippel, MD, MHA and Andrew Ignaszewski, MD, FRCPC CardioCase presentation Andy s fatigue Andy, 47, comes to you

More information

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults

JNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation

More information