La terapia alla luce delle linee guida: oltre i beta-bloccanti e gli ace-inibitori
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1 Meet the expert: La cardiopatia ischemica cronica nell anziano La terapia alla luce delle linee guida: oltre i beta-bloccanti e gli ace-inibitori Giorgio Basile Ricercatore Geriatria Università di Messina
2 ? Cardiopatia ischemica cronica: Angina Stabile Microvascolare Vasospasmo Pregresso infarto miocardico Pregressa rivascolarizzazione Evidenza strumentale di ischemia miocardica
3 Epidemiology and prognosis of chronic stable angina (CSA) In Western countries an estimated / of the population have CSA the prevalence increase with age: - women ys: 5-7% - men ys: 4-7% - women ys: 10-12% - men ys: 14-15% 4.1 million deaths from CAD occur in Europe each year, with 82% > 65 ys, 46% in those aged > 75 ys; the annual death rate is %
4 Management of Chronic Stable Angina in Older Adults Aging Coronary Artery Disease Other possible causes of angina Comorbidity Polipharmacy Frailty Life expectancy
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15 Borden W, JAMA 2011 less than half were receiving OMT before PCI
16 Management of Chronic Stable Angina Lifestyle modifications Control of Cardiovascular Risk Factors Non invasive treatment/pharmacological therapy Symptomatic C.V. outcomes nitrates beta-blockers CCB trimetazidine Ivabradine ranolazine? Canakinumab
17 Aterosclerosi/trombo Statina, ASA
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21 Medical management of patients with SCAD
22 Medical management of patient with stable CAD Eur Heart J, August 30, 2013
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28 Fox K, Ford I, et al; BEAUTIFUL Investigators. Effect of ivabradine on cardiovascular outcomes in patients with stable coronary artery diseaseand left-ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized, controlled BEAUTIFUL trial. Eur heart Jour On line. Summary of observed cardiovascular risk reduction in angina patients New results in angina patients Predefined end point (n=1507) Hazard ratio Risk reduction Primary composite end point % All-cause mortality % CV death % Hospitalization for HF % Hospitalization for MI % Coronary revascularization %
29 Fox K, September 2014
30 Medical management of patient with stable CAD Eur Heart J, August 30, 2013
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33 Rassaf, Eur Heart J 2013
34 Medical management of patient with stable CAD Eur Heart J, August 30, 2013
35 Ranolazina: meccanismo d azione
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39 Wilson SR et al, JACC 2009; 53:
40 Qualità della vita nei pazienti con angina cronica dello Studio MERLIN-TIMI 36:
41 RANOLAZINA E METABOLISMO GLUCIDICO Chislom JW et al, Diabetes Care 2010
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43 Medical management of patient with stable CAD Eur Heart J, August 30, 2013
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49 Possible combinations of classes of antianginal drugs according to different comorbidities (Nat Rev Cardiol 2018; 15, 121) BB VER DILT IVAB High HR 70 bpm TRIM RAN DHP NITR NIC DHP NIC NITR TRIM RAN Bradycardia BB VER DILT IVAB Preferred Co-administered All possible Contraindicated or caution needed
50 TRIM RAN Microvascular angina BB VER DILT NITR NIC IVAB DHP VER DILT NITR NIC Coronary artery spasm IVAB RAN TRIM BB Preferred Co-administered All possible Contraindicated or caution needed
51 BB DHP VER DILT NITR NIC Hypertension TRIM RAN IVAB None TRIM RAN IVAB Hypotension BB VER DILT DHP NITR NIC Preferred Co-administered All possible Contraindicated or caution needed
52 BB Left ventricular dysfunction TRIM IVAB RAN NITR DHP VER DILT NIC BB IVAB Heart failure TRIM NITR RAN DHP VER DILT NIC Preferred Co-administered All possible Contraindicated or caution needed
53 BB VER DILT Atrial fibrillation TRIM RAN DHP NITR NIC IVAB DHP NITR IVAB Defect of atrioventricular conduction BB VER DILT Preferred Co-administered All possible Contraindicated or caution needed
54 RAN VER IVAB TRIM DILT NITR Diabetes mellitus BB BB VER DILT NITR NIC IVAB Chronic kidney disease TRIM RAN Preferred Co-administered All possible Contraindicated or caution needed
55 Chronic obstructive pulmonary disease IVAB VER DILT RAN TRIM NITR NIC Sel-BB Non Sel-BB Peripheral artery disease TRIM RAN IVAB VER DILT BB DHP NITR Preferred Co-administered All possible Contraindicated or caution needed
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58 Mild physical activity: easy walking, yoga, mild house work Moderate physical acitivity: fast walking, jogging, gardening, bicycling, dancing, swimming Vigorous physical activity: running, strenous sports or work Metabolic equivalents (METs) h/week 2 METs Mild 4 METs Moderate 8 METs Vigorous
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66 European Heart Journal, Volume 38, Issue 8, 21 February 2017, Pages
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68 Grazie per l attenzione!
Disclosures. Speaker s bureau: Research grant: Advisory Board: Servier International, Bayer, Merck Serono, Novartis, Boehringer Ingelheim, Lupin
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Treatment of Stable Coronary Artery Disease Pharmacotherapy
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