Guidelines on cardiovascular risk assessment and management

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Guidelines on cardiovascular risk assessment and management"

Transcription

1 European Heart Journal Supplements (2005) 7 (Supplement L), L5 L10 doi: /eurheartj/sui079 Guidelines on cardiovascular risk assessment and management David A. Wood 1,2 * 1 Cardiovascular Medicine at the National Heart and Lung Institute, Imperial College, London, UK 2 Hammersmith Hospitals NHS Trust, London, UK KEYWORDS Atherosclerosis; Cardiovascular disease; Guidelines; Lifestyle modification; Obesity; SCORE; Treatment targets Cardiovascular disease is the major cause of premature death in most European populations. The underlying pathology is usually atherosclerosis. Cardiovascular disease is closely related to lifestyle and modifiable physiological factors, and risk factor modification has been shown to reduce cardiovascular morbidity and mortality. The current joint European Guidelines differ from previous ones in that the emphasis has moved from coronary heart disease prevention to cardiovascular disease prevention. The Systematic Coronary Risk Evaluation system is recommended to assess an individual s total cardiovascular risk. The guidelines define priorities for intervention and address lifestyle change and management of major cardiovascular risk factors to reduce cardiovascular events. Reduction of overweight and obesity is an important component in reducing cardiovascular risk. Cardiovascular disease is the major cause of death in adults in most European countries. It results in substantial disability and loss of productivity and contributes significantly to the escalating costs of health care, especially in the context of an ageing population. Cardiovascular disease accounts for 49% of all deaths in Europe and for 30% of all premature deaths (those occurring before 65 years). It is the major cause of premature death in most European populations: one in eight men and one in 17 women die from cardiovascular disease before 65 years. There are marked differences in cardiovascular disease mortality rates between countries. Trends of age and gender-standardized cardiovascular mortality from 1980 show down-sloping curves in Nordic, western, and southern Europe (except Greece) but stable or rising curves in central and eastern European countries. However, as cardiovascular disease is strongly related to age, its prevalence is rising. This, together with an improved cardiovascular disease treatment and survival rate, means that an increasing number of individuals in Europe are living with impaired cardiovascular health and are at risk of recurrent disease (re-infarction, * Corresponding author. address: recurrent stroke, heart failure, and sudden death). Therefore, the overall burden of cardiovascular disease is expected to increase in the coming decade. 1 The development of cardiovascular disease is strongly related to lifestyle factors such as diet, physical inactivity, and tobacco smoking. These promote adverse changes in biochemical and physiological characteristics, which in turn accelerate the development of atherosclerosis and associated thrombotic complications. It is increasingly clear that these cardiovascular risk factors interact with each other synergistically. There is now considerable evidence that lifestyle modification and risk factor management can slow the development of cardiovascular disease, both before and after the occurrence of an acute event. This evidence has been synthesized into recommendations on cardiovascular disease prevention in clinical practice, published by the Joint European Societies. 2 The Third Joint Task Force, which produced the 2003 joint European Guidelines, is a collaboration of eight groups: the European Society of Cardiology, European Society of Atherosclerosis, European Society of Hypertension, European Society of General Practice/Family Medicine, European Heart Network, International Society of Behavioural Medicine, European Association & The European Society of Cardiology All rights reserved. For Permissions, please

2 L6 D.A. Wood for the Study of Diabetes, and the International Diabetes Federation Europe. The 2003 European Guidelines differ from previous ones in that the emphasis has moved from coronary heart disease prevention to cardiovascular disease prevention. The latest World Health Organization statistics show that in women, coronary heart disease accounted for 23% of deaths, stroke for 18%, and other cardiovascular disease for 15%. (In contrast, cancer accounted for 27% of deaths in women.) The situation for men is similar. Therefore, it is important to target all patients with atherosclerotic disease, not just those with coronary artery disease. The guidelines define priorities and thresholds for treatment and treatment targets. The top priority is patients with established atherosclerotic disease, i.e. established coronary heart disease, peripheral artery disease, and cerebrovascular atherosclerotic disease. The second priority group is asymptomatic, apparently healthy, individuals who are identified as being at high risk of developing atherosclerotic cardiovascular disease in the foreseeable future, on the basis of a clustering of risk factors. This group of high-risk individuals includes patients with diabetes. Different multi-factorial risk models have been developed to assess the risk for development of cardiovascular disease. The European Guidelines recommend the use of the SCORE (Systematic Coronary Risk Evaluation) system. 3 The SCORE risk assessment system is derived from a large data set of prospective European studies. From an individual s age, gender, smoking habit, systolic blood pressure, and total cholesterol/hdl cholesterol ratio, it provides an estimate of their total risk of developing fatal cardiovascular disease over a period of 10 years. The importance of this approach is that the absolute risk of developing cardiovascular disease depends on the presence of multiple risk factors. Addressing a single risk factor, such as blood pressure, lipids, or glucose, in isolation misses the fundamental challenge of addressing all risk factors simultaneously, in order to reduce the risk of cardiovascular disease. The third priority group is close relatives of patients with early-onset atherosclerosis and asymptomatic individuals at particularly high risk (e.g. families with familial hypercholesterolaemia or other forms of inherited dyslipidaemia). From epidemiological studies, a great deal is known about the underlying causes of atherosclerosis and its thrombotic complications. However, it is a widely held misconception that the established cardiovascular risk factors (Figure 1) only explain about half of all the cardiovascular disease in the population. The recent INTERHEART case control study 4 clearly demonstrates the overwhelming importance of these risk factors. INTERHEART assessed potentially modifiable risk associated with myocardial infarction in 52 countries from each of the major regions of the world. It involved 262 centres and over patients with an initial myocardial infarction and a similar number of healthy controls. Analysis was based on cases and controls. Figure 1 Lifestyles and characteristics associated with the risk of cardiovascular events (adapted from De Backer et al. 2 ). The study showed convincingly that the major risk factors for cardiovascular disease are apob/apoa-1 ratio, smoking, diabetes, hypertension, abdominal obesity, psychosocial factors, consumption of fruit and vegetables, alcohol, and regular exercise (Table 1). All these risk factors were significantly related (P, ) either directly or inversely to the risk of a first myocardial infarction, with the exception of alcohol, which had a weaker association (P ¼ 0.03). Daily consumption of fruits or vegetables, moderate or strenuous exercise, and consumption of alcohol three or more times a week were protective. These risk factors collectively accounted for about 90% of the population attributable risk and hence are the major causes of atherosclerosis and its complications. The same associations were found in men and women at all ages and in all regions of the world. After multivariate analysis, raised apob/apoa-1 ratio and current smoking were the two strongest risk factors. The INTERHEART study has highlighted the importance of multiplicative risk. With all nine risk factors (current or former smoking, history of diabetes or hypertension, abdominal obesity, psychosocial stress, irregular consumption of fruits and vegetables, no alcohol intake, avoidance of regular exercise, and raised plasma lipids), the odds ratio was 129 when compared with not having any of these risk factors. Substituting the odds ratios for current smoking, the extremes of abdominal obesity (top vs. lowest tertile) and apob/apoa-1 ratio (top vs. lowest quintile) increased the odds ratio for all risk factors combined to 333, i.e. the chance of having an initial myocardial infarction is 333 times that of the healthy population (Figure 2). It is important to note that several of these cardiovascular risk factors apob/apoa-1 ratio, diabetes, hypertension, abdominal obesity, diet, and physical activity are included in the definitions of the metabolic syndrome and are closely related to obesity and the distribution of fat. Lifestyle modification Lifestyle modification is the foundation of any preventive cardiology programme, and the European Guidelines address the issue of lifestyle change. The aim is to help

3 Guidelines on cardiovascular risk assessment and management L7 Table 1 Data from the INTERHEART study showing risk of acute myocardial infarction associated with risk factors in the overall population 4 Risk factor Controls (%) Cases (%) OR (99% CI) adjusted for age, sex, and smoking OR (99% CI) adjusted for all risk factors ApoB/ApoA-1 ratio (5 vs. 1) ( ) 3.25 ( ) Current smoking ( ) 2.87 ( ) Diabetes ( ) 2.37 ( ) Hypertension ( ) 1.91 ( ) Abdominal obesity (3 vs. 1) ( ) 1.62 ( ) All psychosocial 2.51 ( ) 2.67 ( ) Vegetables and fruit daily ( ) 0.70 ( ) Exercise ( ) 0.86 ( ) Alcohol intake ( ) 0.91 ( ) All combined ( ) ( ) The odds ratio of is derived by combining all risk factors, including current and former smoking vs. never smoking, top two tertiles vs. the lowest tertile of abdominal obesity, and top four quintiles vs. the lowest quintile of apob/apoa-1. Including only current smoking vs. never smoking, the top vs. the lowest tertile for abdominal obesity, and the top vs. the lowest quintile for apob/apoa-1, the odds ratio increases to (adapted with permission from Yusuf et al. 4 ). Figure 2 Risk of acute myocardial infarction associated with exposure to multiple risk factors. 4 The odds ratios are based on current vs. never smoking, top vs. lowest tertile for abdominal obesity, and top vs. lowest quintile for apob/apoa-1. (Adapted with permission from Yusuf et al. 4 ) patients with coronary heart disease or other atherosclerotic disease and healthy high-risk individuals to stop smoking, to make healthy food choices, to be physically active and, as part of that, to reduce weight and the distribution of weight. The rising tide of obesity in Europe, and elsewhere in the world, is of medical and public health concern. In several European countries, including Finland, the UK, Germany, Hungary, and Belgium, around one-fifth of the adult population are obese [defined by body mass index (BMI).30 kg/m 2 ]. In most countries, obesity prevalence is similar in men and women, with the exception of Turkey where prevalence is considerably higher in women than men. It is not only the current prevalence of obesity that is of concern, but also the time trends in obesity. Between 1981 and 1998, some European countries, including the UK, showed a rapid increase in obesity prevalence, whereas in others, such as Italy and Sweden, obesity prevalence remained at a lower, although not ideal, level. Trends in obesity prevalence in men and women have followed the same direction in the individual countries. There are powerful social, economic, and cultural determinants of obesity in different European populations. This population burden impacts upon our patients. The European Society of Cardiology EUROASPIRE (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) surveys of risk factor management in patients with established coronary heart disease highlight the need for more effective lifestyle intervention. The surveys show considerable potential to reduce risk in patients with established coronary heart disease, because many are not achieving the lifestyle and risk factor goals. EUROASPIRE I was carried out in in nine European countries 5 to assess risk factor management in patients with established coronary heart disease (following acute myocardial infarction or ischaemia, coronary artery bypass surgery, or coronary angioplasty). A second similar survey, EUROASPIRE II, 6 was carried out in in 15 European countries to see whether preventive cardiology had improved since the first survey. In EUROASPIRE I, 3569 patients were interviewed and in EUROASPIRE II, 5556 patients were interviewed. In EUROASPIRE I, 25.3% of patients were obese (BMI 30 kg/m 2 ). In EUROASPIRE II, the prevalence of obesity in these high-risk patients had increased to 32.8%. 7 The increase in obesity was seen across each of the participating countries. Inaddition,inEUROASPIREII,themajorityofpatientswas found to have gained weight following the development of coronary heart disease. 8 Between hospital admission for the index event and interview [carried out at least 6 months (median 1.4 years), after hospital discharge], 24.3% of patients had a weight increase of 5kg (Figure 3).

4 L8 D.A. Wood Figure 3 Distribution of weight changes between time of hospital admission for acute coronary event or procedure and time of interview (6 months after the index event) in EUROASPIRE II. (Adapted with permission from De Bacquer et al. 8 ) The overall prevalence of overweight (BMI kg/m 2 )at the time of interview was 48.2% (51.2% in men and 38.6% in women). Thus, around three-quarters of patients with coronary heart disease were either overweight or obese. Furthermore, 28.1% of patients had abdominal overweight (waist circumference.80 cm in women and.94 cm in men) and 51.7% had abdominal obesity (waist circumference.88 cm in women and.102 cm in men). These data indicate the considerable challenge that we face in terms of lifestyle intervention in patients with coronary heart disease and other atherosclerotic disease, as well as in high-risk individuals in the population. Treatment targets The more successful we are at achieving lifestyle changes, the lower the requirement for antihypertensive and lipid lowering and glucose lowering therapies. The European Guidelines set the following targets in high risk patients for blood pressure and lipid levels:. blood pressure,140/90 mmhg,. total cholesterol,4.5 mmol/l (175 mg/dl),. LDL cholesterol,2.5 mmol/l (100 mg/dl). When these targets are not achieved by lifestyle change, blood pressure lowering and cholesterol lowering drugs should be used. It is important to recognize that lifestyle impacts on the ability to control blood pressure and lipids, despite the use of antihypertensive and lipid lowering therapies. This was demonstrated in the EUROAS- PIRE II analysis. 8 Among patients being treated with lipid lowering agents, 42.7% of normal weight patients were still above the cholesterol target of 5 mmol/l. In contrast, 49.6% of overweight patients and 52.7% of obese patients were still above the target cholesterol level. A similar situation pertained for control of blood pressure in patients taking blood pressure lowering drugs: 42.4% of normal weight patients were still above the blood pressure target of 140/90 mmhg compared with 51.1% of overweight patients and 56.0% of obese patients. The definition of metabolic syndrome in the European Guidelines is the same as that used in the National Cholesterol Education Program. The diagnosis of metabolic syndrome is made when three or more of the following features are present:. waist circumference.102 cm in males and.88 cm in women,. serum triglycerides 1.7 mmol/l (150 mg/dl),. HDL cholesterol,1 mmol/l (,40 mg/dl) in males or,1.3 mmol/l (,50 mg/dl) in females,. blood pressure 130/85 mmhg,. plasma glucose 6.1 mmol/l (110 mg/dl). This is a pragmatic clinical definition. It does not depend on the measurement of insulin, and once again it emphasizes the multi-factorial nature of the causes of atherosclerosis and its complications and the development of diabetes. More recently, a consensus definition developed by the International Diabetes Federation has emphasized the importance of central obesity. 9 Individuals are defined as having a metabolic syndrome if they are centrally obese (defined as waist circumference 94 cm for Europid men and 80 cm for Europid women, with ethnicity specific values for other groups) and have any two of the following four factors:. raised triglyceride level:.150 mg/dl (1.7 mmol/l), or specific treatment for this lipid abnormality;. reduced HDL cholesterol:,40 mg/dl (0.9 mmol/l) in males and,50 mg/dl (1.1 mmol/l) in females, or specific treatment for this lipid abnormality;. raised blood pressure: systolic BP 130 mmhg or diastolic BP 85 mmhg, or treatment of previously diagnosed hypertension;. raised fasting plasma glucose (FPG): 100 mg/dl (5.6 mmol/l), or previously diagnosed Type 2 diabetes. (If.5.6 mmol/l or 100 mg/dl, OGTT is strongly recommended but is not necessary to define the presence of the syndrome.)

5 Guidelines on cardiovascular risk assessment and management L9 For patients with Type 2 diabetes, the treatment goals in the European guidelines include glycaemic targets. In addition, there are clearly defined blood pressure and lipid targets for patients with diabetes, supported by recent evidence from randomized controlled trials (Table 2). It is now clear that in the diabetic population and in patients with impaired glucose regulation, it is as important to address blood pressure and lipids as it is to address the glucose level. The European guidelines have lower blood pressure and lipid targets in patients with Type 2 diabetes than in other patient groups:. blood pressure,130/80 mmhg,. total cholesterol,4.5 mmol/l (,175 mg/dl),. LDL cholesterol,2.5 mmol/l (,100 mg/dl). In terms of other prophylactic medication, there are five different classes of recommended drugs: antiplatelet therapies, beta-blockers, ACE-inhibitors, lipid lowering therapies (principally statins), and anticoagulants. These drugs have all been shown to reduce the risk of all-cause mortality in selected patient populations with established atherosclerotic disease. Aspirin (at least 75 mg) should be considered for all coronary heart disease patients and for those with cerebral atherosclerosis and peripheral atherosclerotic disease. Beta-blockers are recommended following myocardial infarction, and ACE-inhibitors are recommended in patients with symptoms or signs of heart failure at the time of myocardial infarction, or patients with chronic left ventricular dysfunction (ejection fraction,40%). Anticoagulants are recommended in selected patients with coronary heart disease. In healthy high-risk individuals, the armamentarium is more limited because the trial evidence is more limited. Aspirin (75 mg) is recommended in treated hypertensive patients and in men at particularly high risk of coronary heart disease. The lifestyle, risk factor, and therapeutic targets are important to achieve in our patients to reduce the incidence of first or recurrent clinical atherosclerotic events and to reduce the disability associated with cardiovascular disease. The data from INTERHEART 4 can Table 2 Treatment goals in patients with Type 2 diabetes (adapted from De Backer et al. 2 ) Goal HbA1c (DCCT standardized) 6.1 Venous plasma glucose Pre-prandial (fasting) 6.0 mmol/l (,110 mg/dl) Self-monitored blood glucose Pre-prandial (fasting) mmol/l (70 90 mg/dl) Post-prandial mmol/l ( mg/dl) Blood pressure,130/80 mmhg Total cholesterol,4.5 mmol/l (,175 mg/dl) LDL cholesterol,2.5 mmol/l (,100 mg/dl) Figure 4 Reduced risk of acute myocardial infarction associated with not smoking, daily fruit/vegetables, regular physical activity, and moderate alcohol. (Adapted with permission from Yusuf et al. 4 ) be used to assess to what extent the risk of developing myocardial infarction could be reduced if effective lifestyle change is achieved (Figure 4). It shows, for example, that if a person stops smoking, they reduce their risk by about 65%. By not smoking, eating fruit and vegetables, taking exercise, and moderate alcohol consumption, the risk of developing myocardial infarction could be reduced by 81%. Conclusion Implementing preventive strategies based on current scientific knowledge would avert the majority of premature coronary heart disease worldwide. For patients, this would mean both a better quality of life in terms of less disability and also a longer life. The challenge for physicians is to translate this knowledge into effective preventive care. Key points. The priority group for cardiovascular disease prevention is patients with established cardiovascular disease.. In asymptomatic, apparently healthy individuals, preventive strategies should depend on the assessment of the individual s total cardiovascular risk.. The prevalence of overweight and obesity is increasing in patients with coronary heart disease. This has a major impact on cardiovascular risk and can also limit the response to antihypertensive and lipid lowering therapy.. The INTERHEART study has shown that nine modifiable risk factors account for 90% of the population attributable risk of myocardial infarction. Conflict of interest: The author has lectured at Abbott-sponsored symposia.

6 L10 D.A. Wood References 1. European Society of Cardiology. Cardiovascular Diseases in Europe: Euro Heart Survey and National Registries of Cardiovascular Diseases and Patient Management Sophia Antipolis, France: ESC. 2. De Backer G, Ambrosioni E, Borch-Johnsen K et al. European Society of Cardiology Committee for Practice Guidelines. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2003;10(Suppl. 1):S1 S Conroy RM, Pyorala K, Fitzgerald AP et al. SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24: Yusuf S, Hawken S, Ounpuu S et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case control study. Lancet 2004;364: EUROASPIRE Study Group. EUROASPIRE: a European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. Eur Heart J 1997;18: EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II. Eur Heart J 2001;22: EUROASPIRE Study Group. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 2001;357: De Bacquer D, De Backer G, Cokkinos D et al. for the EUROASPIRE II study group. Overweight and obesity in patients with established coronary heart disease: are we meeting the challenge? Eur Heart J 2004;25: International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. (14 April 2005).

EUROPEAN SURVEY OF CARDIOVASCULAR DISEASE PREVENTION AND DIABETES EUROASPIRE IV. GUY DE BACKER Ghent University,Belgium

EUROPEAN SURVEY OF CARDIOVASCULAR DISEASE PREVENTION AND DIABETES EUROASPIRE IV. GUY DE BACKER Ghent University,Belgium EUROPEAN SURVEY OF CARDIOVASCULAR DISEASE PREVENTION AND DIABETES EUROASPIRE IV GUY DE BACKER Ghent University,Belgium ESC Congress 2012, aug.25-29th, Munich, Germany ESC Congress 2012, aug.25-29th, Munich,

More information

Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies

Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies A Consensus Statement from the European Atherosclerosis Society

More information

2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary

2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary 2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Becky McKibben, MPH; Seth

More information

Depok-Indonesia STEPS Survey 2003

Depok-Indonesia STEPS Survey 2003 The STEPS survey of chronic disease risk factors in Indonesia/Depok was carried out from February 2003 to March 2003. Indonesia/Depok carried out Step 1, Step 2 and Step 3. Socio demographic and behavioural

More information

Cardiac rehabilitation for coronary patients: lifestyle, risk factor and therapeutic management. Results from the EUROASPIRE II survey

Cardiac rehabilitation for coronary patients: lifestyle, risk factor and therapeutic management. Results from the EUROASPIRE II survey European Heart Journal Supplements (2004) 6 (Supplement J), J17 J26 Cardiac rehabilitation for coronary patients: lifestyle, risk factor and therapeutic management. Results from the EUROASPIRE II survey

More information

Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk. Eberhard Standl

Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk. Eberhard Standl Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk Eberhard Standl European Heart House Sophia Antipolis Thursday, June 17, 2010 IDF Diabetes Atlas 2009: Global Numbers Still

More information

Stroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital

Stroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke

More information

Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals

Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals European Heart Journal Supplements (2004) 6 (Supplement A), A12 A18 Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals University of Sydney, Sydney, NSW, Australia

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

Diabetes Control and Complications in Public Hospitals in Malaysia

Diabetes Control and Complications in Public Hospitals in Malaysia ORIGINAL ARTICLE Diabetes Control and Complications in Public Hospitals in Malaysia Mafauzy M. FRCP For the Diabcare-Malaysia Study Group, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian,

More information

Prevention in Europe

Prevention in Europe Prevention in Europe Geneviève Derumeaux Créteil University, France Ian M Graham Trinity College, Dublin ESC: 2016 Lipid guidelines 2016 Joint Prevention Guidelines Cardiovascular disease in Europe Nick

More information

SIGN 149 Risk estimation and the prevention of cardiovascular disease. Quick Reference Guide July Evidence

SIGN 149 Risk estimation and the prevention of cardiovascular disease. Quick Reference Guide July Evidence SIGN 149 Risk estimation and the prevention of cardiovascular disease Quick Reference Guide July 2017 Evidence ESTIMATING CARDIOVASCULAR RISK R Individuals with the following risk factors should be considered

More information

European Guidelines on CVD Prevention Fourth Joint European Societies Task Force on cardiovascular disease prevention in clinical practice

European Guidelines on CVD Prevention Fourth Joint European Societies Task Force on cardiovascular disease prevention in clinical practice European Guidelines on CVD Prevention Fourth Joint European Societies Task Force on cardiovascular disease prevention in clinical practice September 2007 1 Recent developments in CVD prevention in Europe

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

C-Reactive Protein and Your Heart

C-Reactive Protein and Your Heart C-Reactive Protein and Your Heart By: James L. Holly, MD Inflammation is the process by which the body responds to injury. Laboratory evidence and findings at autopsy studies suggest that the inflammatory

More information

New ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Lipids. Professor Željko Reiner, MD, PhD, FRCP(Lond), FESC, FACC

New ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Lipids. Professor Željko Reiner, MD, PhD, FRCP(Lond), FESC, FACC New ES Guidelines on ardiovascular Disease Prevention in linical Practice Lipids Professor Željko Reiner, MD, PhD, FRP(Lond), FES, FA University Hospital enter Zagreb School of Medicine, University of

More information

Chronic Benefit Application Form Cardiovascular Disease and Diabetes

Chronic Benefit Application Form Cardiovascular Disease and Diabetes Chronic Benefit Application Form Cardiovascular Disease and Diabetes 19 West Street, Houghton, South Africa, 2198 Postnet Suite 411, Private Bag X1, Melrose Arch, 2076 Tel: +27 (11) 715 3000 Fax: +27 (11)

More information

BDS, MSc, MSPH, MHPE, FFPH, ScD. Associate Prof. of Epidemiology and Biostatistics. Associate Prof. Medical Education

BDS, MSc, MSPH, MHPE, FFPH, ScD. Associate Prof. of Epidemiology and Biostatistics. Associate Prof. Medical Education Yusuf Al-Gau Gau d BDS, MSc, MSPH, MHPE, FFPH, ScD Associate Prof. of Epidemiology and Biostatistics Associate Prof. Medical Education Jordan University of Science & Technology Alarming high prevalence

More information

Classes of recommendations

Classes of recommendations Classes of recommendations Levels of evidence Quality of evidence used in GRADE Percentage of the decrease in deaths from coronary heart disease attributed to treatments and risk factor changes in different

More information

EuroPrevent 2010 Fatal versus total events in risk assessment models

EuroPrevent 2010 Fatal versus total events in risk assessment models EuroPrevent 2010 Fatal versus total events in risk assessment models Pekka Jousilahti, MD, PhD,Research Professor National Institute for Health and Welfare, Finland Risk assessment models Estimates the

More information

Case Study #4: Hypertension and Cardiovascular Disease

Case Study #4: Hypertension and Cardiovascular Disease Helen Jang Tara Hooley John K Rhee Case Study #4: Hypertension and Cardiovascular Disease 7. What risk factors does Mrs. Sanders currently have? The risk factors that Mrs. Sanders has are high blood pressure

More information

Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003

Cardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003 Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,

More information

Non communicable Diseases in Egypt and North Africa

Non communicable Diseases in Egypt and North Africa Non communicable Diseases in Egypt and North Africa Diaa Marzouk Prof. Community Medicine Faculty of Medicine, Ain Shams University Egypt 11 th March 2012 Level of Income North African countries according

More information

What s New in Bariatric Surgery?

What s New in Bariatric Surgery? Bariatric Surgery: Update for the General Surgeon What s New in Bariatric Surgery? 2,000 B.C. 2,000 A.D. 1. America keeps getting fatter without an end in sight. 2. Bariatric surgery is not just about

More information

Heart Health. Team Member Workbook Session 1 LEARN IDENTIFY ACT. Learn about HTHU Level 3 and the point system

Heart Health. Team Member Workbook Session 1 LEARN IDENTIFY ACT. Learn about HTHU Level 3 and the point system LEARN Learn about HTHU Level 3 and the point system 01 IDENTIFY Identify the major risk factors for cardiovascular disease and how to improve our cardiovascular health 03 02 ACT Begin our Session 1 Goal

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

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

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center THE END! CHANGABLE Blood pressure Diabetes Mellitus Hyperlipidemia Atrial fibrillation Nicotine Drug abuse Life style NOT CHANGABLE

More information

The role of physical activity in the prevention and management of hypertension and obesity

The role of physical activity in the prevention and management of hypertension and obesity The 1 st World Congress on Controversies in Obesity, Diabetes and Hypertension (CODHy) Berlin, October 26-29 2005 The role of physical activity in the prevention and management of hypertension and obesity

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

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

Hypertension, Hyperlipidemia and Obesity. Mi-CCSI

Hypertension, Hyperlipidemia and Obesity. Mi-CCSI Hypertension, Hyperlipidemia and Obesity Mi-CCSI Objectives Review the prevalence of hypertension, hyperlipidemia and obesity Correlation of the 3 conditions Discuss why it is important to treat these

More information

Audit of cholesterol management among primary care patients in rural southern Italy

Audit of cholesterol management among primary care patients in rural southern Italy O R I G I N A L R E S E A R C H Audit of cholesterol management among primary care patients in rural southern Italy N Buono 1, F Petrazzuoli 1, F D'Addio 1, C Farinaro 1, JK Soler 2 1 National Italian

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

Prof. Dr. Gabor Ternak

Prof. Dr. Gabor Ternak Prof. Dr. Gabor Ternak Noninfectious diseases can't be passed from one person to another. Instead, these types of diseases are caused by factors such as the environment, genetics and lifestyle. The term

More information

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the

More information

Quality Payment Program: Cardiology Specialty Measure Set

Quality Payment Program: Cardiology Specialty Measure Set Quality Payment Program: Cardiology Specialty Set Title Number CMS Reporting Method(s) Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for

More information

The State of Play of Diabetes Indicators

The State of Play of Diabetes Indicators The State of Play of Diabetes Indicators South Australian and National Information Catherine Chittleborough Janet Grant Anne Taylor April 2003 Diabetes Clearing House Population Research and Outcome Studies

More information

Journal of the American College of Cardiology Vol. 48, No. 2, by the American College of Cardiology Foundation ISSN /06/$32.

Journal of the American College of Cardiology Vol. 48, No. 2, by the American College of Cardiology Foundation ISSN /06/$32. Journal of the American College of Cardiology Vol. 48, No. 2, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.03.043

More information

EAS Congress Innsbruck Highlights: A programme to excite, inspire and inform!

EAS Congress Innsbruck Highlights: A programme to excite, inspire and inform! Press release 84 th European Atherosclerosis Society Congress, Innsbruck, Austria For circulation 29 th May, 2016. 84 th Annual Congress of the European Atherosclerosis Society (EAS) May 29 th - June 1

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

International model for prevention of chronic disease: Finland experience

International model for prevention of chronic disease: Finland experience International model for prevention of chronic disease: Finland experience Erkki Vartiainen, MD, Professor, Assistant Director General 06/12/2011 Erkki Vartiainen 1 2 Start of the North Karelia project

More information

Reducing risk in heart disease

Reducing risk in heart disease Reducing risk in heart disease An expert guide to clinical practice for secondary prevention of coronary heart disease Prof Patricia Davidson (chair) Prof Nigel Stocks Dr Anu Aggarwal Ms Jill Waddell Ms

More information

Plasma fibrinogen level, BMI and lipid profile in type 2 diabetes mellitus with hypertension

Plasma fibrinogen level, BMI and lipid profile in type 2 diabetes mellitus with hypertension World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original

More information

Intervention Recommendations with Class of Recommendation and Level of Evidence

Intervention Recommendations with Class of Recommendation and Level of Evidence Intervention Recommendations with Class of Recommendation and Level of Evidence RISK: BLOOD PRESSURE CONTROL: LIPID Goal: to identify people who will benefit from risk reduction strategies Goal:

More information

Community Based Diabetes Prevention

Community Based Diabetes Prevention Community Based Diabetes Prevention Melanie Davies Professor of Diabetes Medicine Outline NIHR Programme Grant proposal and update to progress The Vascular Check programme HbA1c debate Algorithm to detect

More information

The 2012 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

The 2012 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice The 2012 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice Introduction «meet the Taskforce» Disclosure: no conflicts of interest On behalf of : The 5th Joint European Societies

More information

The ESC Registry on Chronic Ischemic Coronary Disease

The ESC Registry on Chronic Ischemic Coronary Disease EURObservational Research Programme The ESC Registry on Chronic Ischemic Coronary Disease Prof. Fausto J. Pinto, FESC, FACC, FASE, FSCAI Immediate Past-President, ESC University Hospital Sta Maria University

More information

Glycemic index, glycemic load, and the risk of acute myocardial infarction in middle-aged Finnish men:

Glycemic index, glycemic load, and the risk of acute myocardial infarction in middle-aged Finnish men: Glycemic index, glycemic load, and the risk of acute myocardial infarction in middle-aged Finnish men: The Kuopio Ischaemic Heart Disease Risk Factor Study Jaakko Mursu, Jyrki K. Virtanen, Tiina H. Rissanen,

More information

Coronary heart disease and stroke

Coronary heart disease and stroke 4 Coronary heart disease and stroke Overview of cardiovascular disease Cardiovascular disease (CVD), also called circulatory disease, describes a group of diseases which are caused by blockage or rupture

More information

Isolated Post-challenge Hyperglycemia: Concept and Clinical Significance

Isolated Post-challenge Hyperglycemia: Concept and Clinical Significance CLINICAL PRACTICE Isolated Post-challenge Hyperglycemia: Concept and Clinical Significance John MF. Adam*, Daniel Josten** ABSTRACT The American Diabetes Association has strongly recommended that fasting

More information

Frequently asked questions in response to ABC Catalyst report about cholesterol and medications

Frequently asked questions in response to ABC Catalyst report about cholesterol and medications Frequently asked questions in response to ABC Catalyst report about cholesterol and medications Quick links to the evidence available: The Heart Foundation s guideline for the management of primary prevention

More information

MULTIFACTORIAL ANALYSIS OF CARDIOVASCULAR RISK FACTORS IN A GROUP OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

MULTIFACTORIAL ANALYSIS OF CARDIOVASCULAR RISK FACTORS IN A GROUP OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION 2014 ILEX PUBLISHING HOUSE, Bucharest, Roumania http://www.jrdiabet.ro Rom J Diabetes Nutr Metab Dis. 21(4):327-333 doi: 10.2478/rjdnmd-2014-0040 MULTIFACTORIAL ANALYSIS OF CARDIOVASCULAR RISK FACTORS

More information

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study DOI 10.1007/s00394-017-1408-0 ORIGINAL CONTRIBUTION Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study Elly Mertens 1,2

More information

SECONDARY HYPERTENSION

SECONDARY HYPERTENSION HYPERTENSION Hypertension is the clinical term used to describe a high blood pressure of 140/90 mmhg or higher (National Institute of Health 1997). It is such a health risk the World Health Organisation

More information

THE METABOLIC SYNDROME

THE METABOLIC SYNDROME Nutrition Fact Sheet THE METABOLIC SYNDROME This answer is brought to you by many of the Australian nutrition professionals who regularly contribute to the Nutritionists Network ( Nut-Net'), a nutrition

More information

The IDF consensus worldwide definition of the metabolic syndrome

The IDF consensus worldwide definition of the metabolic syndrome International Diabetes Federation Avenue Emile De Mot 19 B-1000 Brussels, Belgium Telephone +32-2-5385511 Telefax +32-2-5385114 info@idf.org www.idf.org VAT BE433.674.528 The IDF consensus worldwide definition

More information

Obesity: from epidemiology to treatment Entwicklung der Adipositas und Epidemiology, definition and des Diabetes in Europa diagnosis of obesities

Obesity: from epidemiology to treatment Entwicklung der Adipositas und Epidemiology, definition and des Diabetes in Europa diagnosis of obesities Obesity: from epidemiology to treatment Entwicklung der Adipositas und Epidemiology, definition and des Diabetes in Europa diagnosis of obesities Hermann Toplak, Präsident ÖDG &EASO Hermann Toplak, President

More information

Epicardial adipose tissue in children is associated with an unfavorable cardiometabolic risk profile, but is not a stronger indicator than BMI

Epicardial adipose tissue in children is associated with an unfavorable cardiometabolic risk profile, but is not a stronger indicator than BMI Epicardial adipose tissue in children is associated with an unfavorable cardiometabolic risk profile, but is not a stronger indicator than BMI Schusterova I., Joppova E., Stromplova D., Fatulova N., Tohatyova

More information

Cardiovascular Diseases and Diabetes

Cardiovascular Diseases and Diabetes Cardiovascular Diseases and Diabetes LEARNING OBJECTIVES Ø Identify the components of the cardiovascular system and the various types of cardiovascular disease Ø Discuss ways of promoting cardiovascular

More information

The investigation of serum lipids and prevalence of dyslipidemia in urban adult population of Warangal district, Andhra Pradesh, India

The investigation of serum lipids and prevalence of dyslipidemia in urban adult population of Warangal district, Andhra Pradesh, India eissn: 09748369, www.biolmedonline.com The investigation of serum lipids and prevalence of dyslipidemia in urban adult population of Warangal district, Andhra Pradesh, India M Estari, AS Reddy, T Bikshapathi,

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

2/11/2017. Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox. Disclosures. Carl J. Lavie, MD, FACC, FACP, FCCP

2/11/2017. Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox. Disclosures. Carl J. Lavie, MD, FACC, FACP, FCCP Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox Carl J. Lavie, MD, FACC, FACP, FCCP Professor of Medicine Medical Director, Cardiac Rehabilitation and Preventive Cardiology

More information

High Blood Cholesterol What you need to know

High Blood Cholesterol What you need to know National Cholesterol Education Program High Blood Cholesterol What you need to know Why Is Cholesterol Important? Your blood cholesterol level has a lot to do with your chances of getting heart disease.

More information

Jared Moore, MD, FACP

Jared Moore, MD, FACP Hypertension 101 Jared Moore, MD, FACP Assistant Program Director, Internal Medicine Residency Clinical Assistant Professor of Internal Medicine Division of General Medicine The Ohio State University Wexner

More information

Obesity and the Metabolic Syndrome in Developing Countries: Focus on South Asians

Obesity and the Metabolic Syndrome in Developing Countries: Focus on South Asians Obesity and the Metabolic Syndrome in Developing Countries: Focus on South Asians Anoop Misra Developing countries, particularly South Asian countries, are witnessing a rapid increase in type 2 diabetes

More information

Country report Serbia April 2017

Country report Serbia April 2017 Country report Serbia April 2017 Report by Vojislav Giga, MD, PhD, Cardiologist et al. National CVD Prevention Coordinator for Serbia Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia Prepared

More information

Traitements associés chez l hypertendu: Statines, Aspirine

Traitements associés chez l hypertendu: Statines, Aspirine 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 Global Mortality 2000: Impact

More information

Evi Seferidi PhD student Imperial College London

Evi Seferidi PhD student Imperial College London Associations of sweetened beverage intake with energy, sugar and cardiometabolic markers in UK children: a cross-sectional analysis of the National Diet and Nutrition Survey Rolling Programme Evi Seferidi

More information

Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease

Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease (2002) 16, 837 841 & 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Low fractional diastolic pressure in the ascending aorta increased the risk

More information

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE

More information

Metabolic syn and CVD. Dr : dehestani Imam reza hospital

Metabolic syn and CVD. Dr : dehestani Imam reza hospital Metabolic syn and CVD { Dr : dehestani Imam reza hospital Global Distribution of CVDs as Causes of Death, WHO 2011 Worldwide Mortality from Ischemic Heart Disease and Cerebrovascular Disease 2011 Ischemic

More information

Clinical Practice Guidelines for Diabetes Management

Clinical Practice Guidelines for Diabetes Management Clinical Practice Guidelines for Diabetes Management Diabetes is a disease in which blood glucose levels are above normal. Over the years, high blood glucose damages nerves and blood vessels, which can

More information

Cleveland Clinic Heart Health Survey

Cleveland Clinic Heart Health Survey Cleveland Clinic Heart Health Survey Table of Contents Section Slide # Survey Objectives and Methodology 3 Key Findings Part 1: Perceived Heart Health Knowledge 4 Key Findings Part 2: Heart Health Related

More information

Coronary Artery Calcium Score

Coronary Artery Calcium Score Coronary Artery Calcium Score August 19, 2014 by Axel F. Sigurdsson MD 174 Comments essential for living organisms. Calcium is a chemical element that is Most of the calcium within the human body is found

More information

A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes

A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Hypotheses: Among individuals with type 2 diabetes, the risks of major microvascular

More information

REVEAL: Randomized placebo-controlled trial of anacetrapib in 30,449 patients with atherosclerotic vascular disease

REVEAL: Randomized placebo-controlled trial of anacetrapib in 30,449 patients with atherosclerotic vascular disease REVEAL: Randomized placebo-controlled trial of anacetrapib in 30,449 patients with atherosclerotic vascular disease Martin Landray and Louise Bowman on behalf of the HPS 3 / TIMI 55 - REVEAL Collaborative

More information

Manifestations and Survival in Coronary Heart Disease

Manifestations and Survival in Coronary Heart Disease From the Department of Emergency and Cardiovascular Medicine, Sahlgrenska University Hospital/Östra, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Manifestations

More information

Diabetes and Heart Disease

Diabetes and Heart Disease Diabetes and Heart Disease Sarah Alexander, MD Assistant Professor of Medicine Division of Cardiology Rush University Medical Center 2/8/2017 Rush is a not-for-profit health care, education and research

More information

Diabetes Mellitus Case Study

Diabetes Mellitus Case Study COLORADO STATE UNIVERSITY Diabetes Mellitus Case Study Medical Nutrition Therapy By: Emily Lancaster 9/28/2012 [Type the abstract of the document here. The abstract is typically a short summary of the

More information

Coronary heart disease prevention and age inequalities:

Coronary heart disease prevention and age inequalities: Coronary heart disease prevention and age inequalities: the first year of the National Service Framework for CHD Julia Hippisley-Cox, Michael Pringle, Ruth Cater, Carol Coupland and Andy Meal ABSTRACT

More information

Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia. Richard Peto University of Oxford, UK

Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia. Richard Peto University of Oxford, UK Alcohol is the main cause of the high rates and rapid fluctuations of premature adult mortality in Russia Richard Peto University of Oxford, UK Belgrade, April 2016 ACST-2 collaborators 25 most populous

More information

The Best Lipid Fraction for the Prediction of the Population at Risk of Atherothrombotic Disease. William E. Feeman, Jr., M.D.

The Best Lipid Fraction for the Prediction of the Population at Risk of Atherothrombotic Disease. William E. Feeman, Jr., M.D. The Best Lipid Fraction for the Prediction of the Population at Risk of Atherothrombotic Disease William E. Feeman, Jr., M.D. 640 South Wintergarden Road Bowling Green, Ohio 43402 Phone 419-352-4665 Fax

More information

Mafauzy Mohamed, Than Winn, GR Lekhraj Rampal*, Abdul Rashid AR, Mustaffa BE

Mafauzy Mohamed, Than Winn, GR Lekhraj Rampal*, Abdul Rashid AR, Mustaffa BE Malaysian Journal of Medical Sciences, Vol. 12, No. 1, January 2005 (20-25) ORIGINAL ARTICLE A PRELIMENARY RESULT OF THE CARDIOVASCULAR RISK FACTORS INTERVENTION STUDY (PIKOM STUDY): DIABETES MELLITUS,

More information

Figure 1 Modelling of diseases in PRIMEtime (after Barendregt et al. [7])

Figure 1 Modelling of diseases in PRIMEtime (after Barendregt et al. [7]) PRIMEtime PRIMEtime is a new model that combines elements of the PRIME model [1], which estimates the effect of population-level changes in diet, physical activity, and alcohol and tobacco consumption

More information

THE DEVELOPMENT AND IMPLEMENTATION OF SECONDARY PREVENTION MEASURES FOR CORONARY ARTERY DISEASE ROBERT F. RILEY, MD

THE DEVELOPMENT AND IMPLEMENTATION OF SECONDARY PREVENTION MEASURES FOR CORONARY ARTERY DISEASE ROBERT F. RILEY, MD THE DEVELOPMENT AND IMPLEMENTATION OF SECONDARY PREVENTION MEASURES FOR CORONARY ARTERY DISEASE BY ROBERT F. RILEY, MD A Thesis Submitted to the Graduate Faculty of WAKE FOREST UNIVERSITY GRADUATE SCHOOL

More information

NEW GUIDELINES FOR CHOLESTEROL

NEW GUIDELINES FOR CHOLESTEROL NEW GUIDELINES FOR CHOLESTEROL NEW CHOLESTEROL GUIDELINES 2013 Recently updated guidelines for the treatment of high blood cholesterol levels is a major update since 2002. The news media have trumpeted

More information

Original Scientific Paper

Original Scientific Paper Original Scientific Paper EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries Kornelia Kotseva a, David Wood

More information

A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects

A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects Original Article# A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects V Mohan*, R Deepa*, M Deepa*, S Somannavar*, M Datta** Abstract Aim : The aim of this study was

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

Summary HTA. HTA-Report Summary

Summary HTA. HTA-Report Summary Summary HTA HTA-Report Summary Prognostic value, clinical effectiveness and cost-effectiveness of high sensitivity C-reactive protein as a marker in primary prevention of major cardiac events Schnell-Inderst

More information

Clinical cases with Coversyl 10 mg

Clinical cases with Coversyl 10 mg Clinical cases Coversyl 10 mg For upgraded benefits in hypertension A Editorial This brochure, Clinical cases Coversyl 10 mg for upgraded benefits in hypertension, illustrates a variety of hypertensive

More information

ESAM Scientific Meeting at AsMA Wednesday 16 May 2012

ESAM Scientific Meeting at AsMA Wednesday 16 May 2012 ESAM Scientific Meeting at AsMA 2012 Wednesday 16 May 2012 Human factor FLIGHT SAFETY Technical Factor State of health, low professional fitness, low professional motivation, social vulnerability Aviation

More information

KEY COMPONENTS. Metabolic Risk Cardiovascular Risk Vascular Inflammation Markers

KEY COMPONENTS. Metabolic Risk Cardiovascular Risk Vascular Inflammation Markers CardioMetabolic Risk Poor blood sugar regulation and unhealthy triglyceride and lipoprotein levels often present long before the diagnosis of type 2 Diabetes. SpectraCell s CardioMetabolic and Pre-Diabetes

More information

WHO Secretariat Dr Timothy Armstrong Coordinator, Surveillance and Population-based Prevention Department of Chronic Diseases and Health Promotion

WHO Secretariat Dr Timothy Armstrong Coordinator, Surveillance and Population-based Prevention Department of Chronic Diseases and Health Promotion WHO Secretariat Dr Timothy Armstrong Coordinator, Surveillance and Population-based Prevention Department of Chronic Diseases and Health Promotion Overview: Revised WHO Discussion Paper (A/NCD/INF./1)

More information

Coronary Artery Disease (CAD) Clinician Guide SEPTEMBER 2017

Coronary Artery Disease (CAD) Clinician Guide SEPTEMBER 2017 Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Coronary Artery Disease (CAD) Clinician Guide SEPTEMBER 2017 Introduction This Clinician Guide is based on the 2017 KP National Coronary Artery Disease

More information