Traitements associés chez l hypertendu: Statines, Aspirine

Size: px
Start display at page:

Download "Traitements associés chez l hypertendu: Statines, Aspirine"

Transcription

1 Traitements associés chez l hypertendu: Statines, Aspirine Pr Jean-Jacques Mourad CHU Avicenne, Université Paris 13, Bobigny DU HTA, Mars 2012 jean-jacques.mourad@avc.aphp.fr

2 Global Mortality 2000: Impact of Blood Pressure and Cholesterol Attributable Mortality (in thousands; total 55,861,000) Ezzati M, et al. Lancet. 2002;360:

3 Relative Risk of CHD Mortality What Is Normal Cholesterol? Chen Z, et al. BMJ. 1991;303: Mean Usual Cholesterol (mmol/l, mg/dl) Relative risk of death (± SD) from CHD by quartiles of baseline total cholesterol in 9021 Chinese people with 8-13 years follow-up.

4 Coronary disease by usual SBP Floating Absolute Risk & 95% CI mmHg 70 + years RRR= 13% years RRR= 22% < 60 years RRR= 43% Burden of Disease Usual SBP (mmhg)

5 Increased Number of CV Events (MI) in Patients With Hypertension Plus Other CV Risk Factors Odds Ratio (99% CI) Smoking Diabetes Blood Pressure Lipids 3 Risk Factors 4 Risk Factors >20-Fold Increase OR (1.9 to 42.3) Risk Factors 1 Smoking (1) Diabetes (2) HTN (3) Lipids (4) All 4 + Obes + PS All RFs Risk Ratio 2.9 ( ) 2.4 ( ) 1.9 ( ) 3.3 ( ) 13.0 ( ) 42.3 ( ) 68.5 ( ) ( ) ( ) HTN = hypertension; MI = myocardial infarction; PS = psychosocial. Reproduced with permission from Yusuf S, et al. Lancet. 2004;364:

6 INDIVIDUAL GLOBAL CV RISK NON (OR HARDLY) MODIFIABLE RISK FACTORS MODIFIABLE RISK FACTORS AGE GENDER SOCIO-ECONOMIC STATUS FAMILIAL HISTORY PERSONAL HISTORY DIABETES MELLITUS SMOKING OVERWEIGHT SEDENTARITY BLOOD PRESSURE LIPID PROFILE

7 STATINES

8 ASCOT Study design 19,257 hypertensive patients ASCOT-BPLA atenolol ± bendroflumethiazide PROBE design amlodipine ± perindopril 10,305 patients TC 6.5 mmol/l (250 mg/dl) ASCOT-LLA atorvastatin 10 mg Double-blind placebo Investigator-lead, multinational randomised controlled trial

9 ASCOT LLA: Patient Population Risk Factor Profile All patients in ASCOT have hypertension plus 3 risk factors for CHD Hyperte nsion Age 55 ye ars M ale M icroalbum in/proteinuria Sm oker Fam ily history of early coronary disease Type 2 diabetes Plas m a TC:HDL-C 6 Certain ECG abnorm alities LVH Previous cerebrovascular events Peripheral vascular disease Basically primary prevention and no previous known CHD Patients With Risk Factor (%) Sever PS, et al. J Hypertens. 2001;19:

10 ASCOT-LLA: Primary End Point: Nonfatal MI and Fatal CHD 4 Atorvastatin 10 mg Number of events 100 Placebo Number of events 154 Cumulative incidence (%) HR = 0.64 ( ) 0 0,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 Years 36% reduction P = Sever PS, Dahlöf B, Poulter N, Wedel H, et al, for the ASCOT Investigators. Lancet. 2003;361:

11 ASCOT-LLA: Secondary End Point: Fatal and Nonfatal Stroke 3 Atorvastatin 10 mg Number of events 89 Placebo Number of events 121 Cumulative Incidence (%) ,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 Years 27% reduction HR = 0.73 ( ) P = Sever PS, Dahlöf B, Poulter N, Wedel H, et al, for the ASCOT Investigators. Lancet. 2003;361:

12 European Heart Journal (2011) 32,

13 J Hypertens 2011; 29:

14 J Hypertens 2011; 29:

15 NEJM 2008;359:2195

16 We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo N Engl J Med 2008;359:

17 N Engl J Med 2008;359:

18 Hypertension. 2007;49:

19 Arch Intern Med. 2012;172(2):

20 Arch Intern Med. 2012;172(2):

21 Lancet 2010; 375:

22 JAMA. 2011;305(24):

23 ESH 2009 The benefit of combining a statin with antihypertensive treatment in hypertensive patients was well established by the ASCOT-LLA study, as summarized in the 2007 ESH/ESC guidelines. The negative results obtained with another statin in the ALLHAT study can be attributed to insufficient lowering of total cholesterol (11% in ALLHAT as compared with 20% in ASCOT). The beneficial effect of statin administration to patients without previous cardiovascular events has been strengthened by the findings of the JUPITER study, showing that lowering LDLcholesterol by 50% in patients with baseline values less than 130 mg/dl (3.4 mmol/l), but elevated C-reactive protein (CRP), reduced cardiovascular events by 44%. In conclusion, the recommendation given in the 2007 guidelines to consider statin therapy in hypertensive patients who have an estimated 10-year risk of cardiovascular events more than 20% can be reconfirmed, but the JUPITER study suggests that statin benefits can be observed also in patients with elevated CRP and at moderate cardiovascular risk (about 15% cardiovascular events in 10 years).

24 ASPIRINE

25 Problème nosologique: Qu appelle-on prévention primaire??

26 Lancet 2009;373:1849

27 Lancet 2009;373:1849

28 Lancet 2009;373:1849

29 Lancet 2009;373:1849

30 Lancet 2009;373:1849

31 Lancet 2009;373:1849

32 J Hypertens 2002; 20:

33 J Hypertens 2002; 20:

34 J Hypertens 2002; 20:

35 J Am Coll Cardiol 2010;56:956 65

36 J Am Coll Cardiol 2010;56:956 65

37 BMJ 2008;337:a1840

38 BMJ 2009;339:B4531

39 39876 femmes; âge moyen 55ans; HTA 26%; Tabagisme 13%; Obésité : 18.2%; Diabète 2.6%; Risque framingham <5% à 10 ans : 85% NEJM 2005

40 NEJM 2005

41

42 ESH 2009 In conclusion, the prudent recommendations of the 2007 ESH/ESC guidelines can be reconfirmed: antiplatelet therapy, in particular low-dose aspirin, should be prescribed to hypertensive patients with previous cardiovascular events; It can also be considered in hypertensive patients without a history of cardiovascular disease with reduced renal function or with a high cardiovascular risk. In patients receiving aspirin, careful attention should always be given to the increased possibility of bleeding,particularly gastrointestinal.

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

CLINICAL OUTCOME Vs SURROGATE MARKER

CLINICAL OUTCOME Vs SURROGATE MARKER CLINICAL OUTCOME Vs SURROGATE MARKER Statin Real Experience Dr. Mostafa Sherif Senior Medical Manager Pfizer Egypt & Sudan Objective Difference between Clinical outcome and surrogate marker Proper Clinical

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

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

The role of statins in patients with arterial hypertension

The role of statins in patients with arterial hypertension Invited review The role of statins in patients with arterial hypertension Trygve B. Tjugen 1, Sigrun Halvorsen 1, Reidar Bjørnerheim 1, Sverre E. Kjeldsen 1, 2 1University of Oslo, Department of Cardiology,

More information

Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway

Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway The Polypill A strategy to reduce cardiovascular disease by

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

surtout qui n est PAS à risque?

surtout qui n est PAS à risque? 3*25 min et surtout qui n est PAS à risque? 2018 ESC/ESH Hypertension Guidelines 2018 ESC-ESH Guidelines for the Management of Arterial Hypertension 28 th ESH Meeting on Hypertension and Cardiovascular

More information

Cholesterol lowering intervention for cardiovascular prevention in high risk patients with or without LDL cholesterol elevation

Cholesterol lowering intervention for cardiovascular prevention in high risk patients with or without LDL cholesterol elevation TrialResults-center.org www.trialresultscenter.org Cholesterol lowering intervention for cardiovascular prevention in high risk patients with or without LDL cholesterol elevation A systematic review and

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

Talking about blood pressure

Talking about blood pressure Talking about blood pressure Mrs Khan 56 BP 158/99 BMI 32 Total cholesterol 5.4 (HDL 0.8) HbA1c 43 She has been promising to do more exercise and eat more healthily for the last 2 years but her weight

More information

APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES

APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES Main systematic reviews secondary studies on the general effectiveness of statins in secondary cardiovascular prevention (search date: 2003-2006) NICE.

More information

Lessons from Recent Atherosclerosis Trials

Lessons from Recent Atherosclerosis Trials Lessons from Recent Atherosclerosis Trials Han, Ki Hoon MD PhD Asan Medical Center Seoul, Korea Change of concept Primary vs. secondary prevention Low risk vs. High risk High Risk CHD and equivalents CHD

More information

In the Literature 1001 BP of 1.1 mm Hg). The trial was stopped early based on prespecified stopping rules because of a significant difference in cardi

In the Literature 1001 BP of 1.1 mm Hg). The trial was stopped early based on prespecified stopping rules because of a significant difference in cardi Is Choice of Antihypertensive Agent Important in Improving Cardiovascular Outcomes in High-Risk Hypertensive Patients? Commentary on Jamerson K, Weber MA, Bakris GL, et al; ACCOMPLISH Trial Investigators.

More information

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION

VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION VALUE OF ACEI IN THE MANAGEMENT OF HYPERTENSION Dr Catherine BESEME Paris 6 th December 2005 6 th International Congress of Bangladesh Society of Medicine Hypertension is a risk factor at the source, with

More information

Statins in the elderly : Is there a rationale?

Statins in the elderly : Is there a rationale? Statins in the elderly : Is there a rationale? Pr B Boland After a communication by Dr. Manfred Gogol EAMA, Sion, June, 2006 1 RCTs with Statins Meta-Analysis, 1999 182 abstracts or research papers 29

More information

Potential synergy between lipid-lowering and blood-pressure-lowering, and Single pill benefit in patient s adherence

Potential synergy between lipid-lowering and blood-pressure-lowering, and Single pill benefit in patient s adherence Potential synergy between lipid-lowering and blood-pressure-lowering, and Single pill benefit in patient s adherence Park, Chang Gyu Korea University Guro Hospital ASCOT-BPLA and LLA Primary Objectives

More information

Evaluation of C-reactive protein prior to and on-treatment as a predictor of benefit

Evaluation of C-reactive protein prior to and on-treatment as a predictor of benefit Evaluation of C-reactive protein prior to and on-treatment as a predictor of benefit from atorvastatin. A cohort analysis from the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm Peter S Sever,

More information

9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t?

9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t? Primary Prevention of Heart Disease: What works? What doesn t? Samia Mora, MD, MHS Associate Professor, Harvard Medical School Associate Physician, Brigham and Women s Hospital October 2, 2015 Financial

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

Hypertension Update Clinical Controversies Regarding Age and Race

Hypertension Update Clinical Controversies Regarding Age and Race Hypertension Update Clinical Controversies Regarding Age and Race Allison Helmer, PharmD, BCACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 22, 2017 DISCLOSURE/CONFLICT

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

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for + Update on Lipid Management Stacey Gardiner, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin + The stats on heart disease Over the past 10 years for which statistics

More information

Young high risk patients the role of statins Dr. Mohamed Jeilan

Young high risk patients the role of statins Dr. Mohamed Jeilan Young high risk patients the role of statins Dr. Mohamed Jeilan KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures

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

Hypertension Update 2009

Hypertension Update 2009 Hypertension Update 2009 New Drugs, New Goals, New Approaches, New Lessons from Clinical Trials Timothy C Fagan, MD, FACP Professor Emeritus University of Arizona New Drugs Direct Renin Inhibitors Endothelin

More information

CVD risk assessment using risk scores in primary and secondary prevention

CVD risk assessment using risk scores in primary and secondary prevention CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities

More information

Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial

Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial European Heart Journal (2006) 27, 2982 2988 doi:10.1093/eurheartj/ehl403 Clinical research Coronary heart disease Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian

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

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

JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH

JNC 8 -Controversies. Sagren Naidoo Nephrologist CMJAH JNC 8 -Controversies Sagren Naidoo Nephrologist CMJAH Joint National Committee (JNC) Panel appointed by the National Heart, Lung, and Blood Institute (NHLBI) First guidelines (JNC-1) published in 1977

More information

Ten Year Risk for CVD Event by Systolic HTN and CVD Risk Factors (Where s Age?)

Ten Year Risk for CVD Event by Systolic HTN and CVD Risk Factors (Where s Age?) Prevention and Treatment of CVD in Older Patients with Diabetes and Pre Diabetes: Hypertension and Dyslipidemia ASP Workshop on Diabetes Mellitus and Cardiovascular Disease in Older Adults Pentagon City

More information

How to Reduce Residual Risk in Primary Prevention

How to Reduce Residual Risk in Primary Prevention How to Reduce Residual Risk in Primary Prevention Helene Glassberg, MD Assistant Professor of Medicine Section of Cardiology Hospital of the University of Pennsylvania Philadelphia, PA USA Patients with

More information

Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension

Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Outcomes and Perspectives of Single-Pill Combination Therapy for the modern management of hypertension Prof. Massimo Volpe, MD, FAHA, FESC, Chair of Cardiology, Department of Clinical and Molecular Medicine

More information

The All Wales Medicine Strategy Group (AWMSG) is asked to support implementation of the following prescribing indicators.

The All Wales Medicine Strategy Group (AWMSG) is asked to support implementation of the following prescribing indicators. ENCLOSURE 5 APPENDIX 1 Paper presented to AWMSG in June 2006 AWPAG considered comments recorded in AWMSG minutes in July 2006 Paper subsequently updated and brought back to AWMSG for endorsement This paper

More information

Calculating RR, ARR, NNT

Calculating RR, ARR, NNT Calculating RR, ARR, NNT In a trial RR = Event rate (eg # of people with one stroke/ total people) in treatment group/event rate in the control group. ARR = Event rate in control group minus the event

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

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study Panel Discussion: Literature that Should Have an Impact on our Practice: The Study Kaiser COAST 11 th Annual Conference Maui, August 2009 Robert Blumberg, MD, FACC Ralph Brindis, MD, MPH, FACC Primary

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

1. Which one of the following patients does not need to be screened for hyperlipidemia:

1. Which one of the following patients does not need to be screened for hyperlipidemia: Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:

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

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

BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS

BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS BEST PRACTICE MANAGEMENT: CARDIOVASCULAR RISKS Neil R Poulter ICCH, Imperial College London BHIVA: October 10th, 2008 Background CVD is the biggest single killer in the world CVD rates are increasing High

More information

Antiplatelet Therapy in Primary CVD Prevention and Stable Coronary Artery Disease. Καρακώστας Γεώργιος Διευθυντής Καρδιολογικής Κλινικής, Γ.Ν.

Antiplatelet Therapy in Primary CVD Prevention and Stable Coronary Artery Disease. Καρακώστας Γεώργιος Διευθυντής Καρδιολογικής Κλινικής, Γ.Ν. Antiplatelet Therapy in Primary CVD Prevention and Stable Coronary Artery Disease Καρακώστας Γεώργιος Διευθυντής Καρδιολογικής Κλινικής, Γ.Ν.Κιλκίς Primary CVD Prevention A co-ordinated set of actions,

More information

An example of a systematic review and meta-analysis

An example of a systematic review and meta-analysis An example of a systematic review and meta-analysis Sattar N et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375: 735-742. Search strategy

More information

Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence

Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence Karen E. Aspry, M.D., M.S., ABCL, FACC Assistant Professor of Medicine (Clinical) Alpert Medical School of Brown University

More information

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona,

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Jamaica At the end of this presentation the participant

More information

Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review.

Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review. ISPUB.COM The Internet Journal of Cardiovascular Research Volume 7 Number 1 Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review. C ANYANWU, C NOSIRI Citation C ANYANWU, C NOSIRI.

More information

The underestimated risk of

The underestimated risk of Earn 3 CPD Points online The underestimated risk of hypertension Dr David Webb Johannesburg Introduction The high and increasing worldwide burden of hypertension is a major global health challenge. Hypertension

More information

Treatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center

Treatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center Treatment of Cardiovascular Risk Factors Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center Disclosures: None Objectives What do risk factors tell us What to check and when Does treatment

More information

Best Medical Therapy for asymptomatic carotid disease

Best Medical Therapy for asymptomatic carotid disease Best Medical Therapy for asymptomatic carotid disease Richard Bulbulia Consultant Vascular Surgeon and Co-PI ACST-2 MRC Population Health Research Unit CTSU, Nuffield Department of Population Health University

More information

The future of coronary heart disease prevention

The future of coronary heart disease prevention The future of coronary heart disease prevention David S Wald MA MD MRCP, Consultant Cardiologist and Senior Lecturer, Wolfson Institute of Preventive Medicine, and London Chest Hospital Barts and The London,

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

What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline?

What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? Salim S. Virani, MD, PhD, FACC, FAHA Associate Professor, Section of Cardiovascular Research Baylor

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

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

Modern Lipid Management:

Modern Lipid Management: Modern Lipid Management: New Drugs, New Targets, New Hope Kirk U. Knowlton, M.D Director of Cardiovascular Research Co Chief of Cardiology Why lower LDL C in those without evidence of CAD (primary prevention)

More information

Dyslipidemia: Lots of Good Evidence, Less Good Interpretation.

Dyslipidemia: Lots of Good Evidence, Less Good Interpretation. Dyslipidemia: Lots of Good Evidence, Less Good Interpretation. G Michael Allan Evidence & CPD Program, ACFP Associate Professor, Dept of Family, U of A. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure

More information

Is it an era for statin for life?

Is it an era for statin for life? Is it an era for statin for life? Mohamed Abdel Ghany Professor of Cardiology Cairo University Cardiovascular Disease (CVD) is the leading global cause of death 1 Dyslipidemia as a main Risk Factor for

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

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

SESSION 3 11 AM 12:30 PM

SESSION 3 11 AM 12:30 PM SESSION 3 11 AM 12:30 PM for the Primary Prevention of Cardiovascular Disease: A Personalized Approach SPEAKER Samia Mora MD, MHS Presenter Disclosure Information The following relationships exist related

More information

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu

More information

Landmark Clinical Trials.

Landmark Clinical Trials. Landmark Clinical Trials 1 Learning Objectives Discuss clinical trials and their role in lipid and lipoprotein treatment in cardiovascular prevention. Review the clinical trials of lipid-altering drug

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

Lipid Panel Management Refresher Course for the Family Physician

Lipid Panel Management Refresher Course for the Family Physician Lipid Panel Management Refresher Course for the Family Physician Objectives Understand the evidence that was evaluated to develop the 2013 ACC/AHA guidelines Discuss the utility and accuracy of the new

More information

Dyslipidemia in women: Who should be treated and how?

Dyslipidemia in women: Who should be treated and how? Dyslipidemia in women: Who should be treated and how? Lale Tokgozoglu, MD, FACC, FESC Professor of Cardiology Hacettepe University Faculty of Medicine Ankara, Turkey. Cause of Death in Women: European

More information

Causes of Poor BP control Rates

Causes of Poor BP control Rates Goals Of Hypertension Management in Clinical Practice World Hypertension League (WHL) Meeting Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular

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

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

Characteristics and Future Cardiovascular Risk of Patients With Not-At- Goal Hypertension in General Practice in France: The AVANT AGE Study

Characteristics and Future Cardiovascular Risk of Patients With Not-At- Goal Hypertension in General Practice in France: The AVANT AGE Study ORIGINAL PAPER Characteristics and Future Cardiovascular Risk of Patients With Not-At- Goal Hypertension in General Practice in France: The AVANT AGE Study Yi Zhang, MD, PhD; 1 Helene Lelong, MD; 2 Sandrine

More information

Using Cardiovascular Risk to Guide Antihypertensive Treatment Implications For The Pre-elderly and Elderly

Using Cardiovascular Risk to Guide Antihypertensive Treatment Implications For The Pre-elderly and Elderly Using Cardiovascular Risk to Guide Antihypertensive Treatment Implications For The Pre-elderly and Elderly Paul Muntner, PhD MHS Professor and Vice Chair Department of Epidemiology University of Alabama

More information

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

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 legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 6 October 2010

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 6 October 2010 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 6 October 2010 CRESTOR 5 mg, film-coated tablet B/30 (CIP code: 369 853-8) B/90 (CIP code: 391 690-0) CRESTOR 10 mg,

More information

Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice

Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice Pathogenesis of atherosclerosis A decades-long disease course Inflammation Selectins ICAM IL M-CSF CRP

More information

The earlier BP control the better cardiovascular outcome. Jin Oh Na Cardiovascular center Korea University Medical College

The earlier BP control the better cardiovascular outcome. Jin Oh Na Cardiovascular center Korea University Medical College The earlier BP control the better cardiovascular outcome Jin Oh Na Cardiovascular center Korea University Medical College Index Introduction HOPE-3 Trial Sprint Study Summary Each 2 mmhg decrease in SBP

More information

h i g h b l o o d p r e s s u r e

h i g h b l o o d p r e s s u r e h i g h b l o o d p r e s s u r e where are we at? The recent literature has raised doubts about the role of ßblockers for lowering blood pressure and the New Zealand Guidelines Group is updating the Assessment

More information

LIST OF ABBREVIATIONS

LIST OF ABBREVIATIONS Diabetes & Endocrinology 2005 Royal College of Physicians of Edinburgh Diabetes and lipids 1 G Marshall, 2 M Fisher 1 Research Fellow, Department of Cardiology, Glasgow Royal Infirmary, Glasgow, Scotland,

More information

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan Tailored Statin Treatment for Type 2 Diabetes Han, Ki Hoon Asan Medical Center University of Ulsan 1 Cardiovascular disease ; No1. death (2001) respiratory tract infection Other NCD S HIV/AIDS deaths during

More information

journal of medicine The new england Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein Abstract

journal of medicine The new england Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein Abstract The new england journal of medicine established in 1812 november 20, 2008 vol. 359 no. 21 to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein Paul M Ridker, M.D., Eleanor Danielson,

More information

Kanyini Guidelines Adherence with the Polypill (Kanyini GAP)

Kanyini Guidelines Adherence with the Polypill (Kanyini GAP) Kanyini Guidelines Adherence with the Polypill (Kanyini GAP) Disclosures Funded by the National Health and Medical Research Council of Australia. Dr Reddy s Laboratories Ltd manufactured and supplied polypills

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

Weigh the benefit of statin treatment: LDL & Beyond

Weigh the benefit of statin treatment: LDL & Beyond Weigh the benefit of statin treatment: LDL & Beyond Duk-Woo Park, MD, PhD Heart Institute, University of Ulsan College of Medicine, Asan Medical, Seoul, Korea FOURIER Further cardiovascular OUtcomes Research

More information

In-Ho Chae. Seoul National University College of Medicine

In-Ho Chae. Seoul National University College of Medicine The Earlier, The Better: Quantum Progress in ACS In-Ho Chae Seoul National University College of Medicine Quantum Leap in Statin Landmark Trials in ACS patients Randomized Controlled Studies of Lipid-Lowering

More information

Statins after 80 years old. Pros/Cons symposium. 13 th EUGMS Congress Nice Sept 2017

Statins after 80 years old. Pros/Cons symposium. 13 th EUGMS Congress Nice Sept 2017 Statins after 80 years old Pros/Cons symposium 13 th EUGMS Congress Nice 20-22 Sept 2017 Athanasios Benetos Conflict of interest: None The Statinissean War Two fearless fighters Athanasios the Athenian

More information

Since the release of the National Cholesterol PROCEEDINGS FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT

Since the release of the National Cholesterol PROCEEDINGS FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT Since the National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP III) guidelines, 3 large

More information

York, New York, USA. Received 22 March 2010 Revised 5 October 2010 Accepted 17 November 2010

York, New York, USA. Received 22 March 2010 Revised 5 October 2010 Accepted 17 November 2010 592 Original article Impact of atorvastatin among older and younger patients in the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm David J. Collier a, Neil R. Poulter b, Björn Dahlöf c, Peter

More information

CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM

CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM Principles of Decision Making Knowing the patient s true state is often unnecessary Does my patient

More information

Decline in CV-Mortality

Decline in CV-Mortality Lipids id 2013 What s Changed? Christopher Granger, MD Disclosure Research contracts: AstraZeneca, GSK, Merck, Sanofi- Aventis, BMS, Pfizer, The Medicines Company, Medtronic Foundation, and Boehringer

More information

How to Achieve Better Cardiovascular Outcome in Hypertensive Patients. Seoul National University Hospital

How to Achieve Better Cardiovascular Outcome in Hypertensive Patients. Seoul National University Hospital How to Achieve Better Cardiovascular Outcome in Hypertensive Patients t Yong-Jin Kim, MD Seoul National University Hospital Global Burden of CV Disease Cause 1990 2020 Millions (%) Millions (%) CHD 6.2

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

ADVANCE post trial ObservatioNal Study

ADVANCE post trial ObservatioNal Study Hot Topics in Diabetes 50 th EASD, Vienna 2014 ADVANCE post trial ObservatioNal Study Sophia Zoungas The George Institute The University of Sydney Rationale and Study Design Sophia Zoungas The George Institute

More information

well-targeted primary prevention of cardiovascular disease: an underused high-value intervention?

well-targeted primary prevention of cardiovascular disease: an underused high-value intervention? well-targeted primary prevention of cardiovascular disease: an underused high-value intervention? Rod Jackson University of Auckland, New Zealand October 2015 Lancet 1999; 353: 1547-57 Findings: Contribution

More information

Management of The Patients with Hypertension and High Risk Cardiovascular Disease

Management of The Patients with Hypertension and High Risk Cardiovascular Disease Management of The Patients with Hypertension and High Risk Cardiovascular Disease Songsak Kiatchoosakun, MD. Cardiology, Medicine Khon Kaen University CVD and Hypertension: Worldwide Morbidity and Mortality

More information

The TNT Trial Is It Time to Shift Our Goals in Clinical

The TNT Trial Is It Time to Shift Our Goals in Clinical The TNT Trial Is It Time to Shift Our Goals in Clinical Angioplasty Summit Luncheon Symposium Korea Assoc Prof David Colquhoun 29 April 2005 University of Queensland, Wesley Hospital, Brisbane, Australia

More information

Rikshospitalet, University of Oslo

Rikshospitalet, University of Oslo Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular

More information

A: Epidemiology update. Evidence that LDL-C and CRP identify different high-risk groups

A: Epidemiology update. Evidence that LDL-C and CRP identify different high-risk groups A: Epidemiology update Evidence that LDL-C and CRP identify different high-risk groups Women (n = 27,939; mean age 54.7 years) who were free of symptomatic cardiovascular (CV) disease at baseline were

More information

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant

More information

Blood Pressure Targets: Where are We Now?

Blood Pressure Targets: Where are We Now? Blood Pressure Targets: Where are We Now? Diana Cao, PharmD, BCPS-AQ Cardiology Assistant Professor Department of Clinical & Administrative Sciences California Northstate University College of Pharmacy

More information