risc cardiovascular i dislipèmies

MANEIG INTEGRAL DEL PACIENT AMB PATOLOGIA CRÒNICA

Actualització 2013 en risc cardiovascular i

dislipèmies

Dr. Cèsar Asenjo

ABS Martí Julià- Cornellà 1 Grup de Lípids CAMFiC

9 octubre 2013 Matí: 14.00 hores Tarda: 20:30 hores

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www.camfic.cat Sol·licitada acreditació al Consell Català de la Formació Continuada de les Professions Sanitàries

Col·labora:

Organitza:

e-actualització

o Introducción (3)

o Factores de riesgo (8)

o Dieta (2)

o Diabetes (4)

o Tratamiento (6)

Actualització 2013 en risc cardiovascular i dislipèmies

Tendencias en mortalidad por infarto de miocardio. Estudio comparativo entre España y Estados Unidos: 1990-2006

Orozco et al. Rev Esp Cardiol. 2012;65(12):1079–1085

Lifetime Risk and Years Lived Free of Total Cardiovascular Disease

Wilkins JT et al. JAMA. 2012;308(17):1795-1801

14 años

Ideal Cardiovascular Health Is Inversely Associated With Incident Cancer The Atherosclerosis Risk in Communities Study

Rasmussen-Torvik LJ. Circulation. 2013;127:1270-1275.

3 ------- 25 % riesgo menor 6-7 ---- > 50 % riesgo menor

Factores de riesgo

Long-Term Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drug Use According to Time Passed After First-Time Myocardial Infarction

A Nationwide Cohort Study

Schjerning Olsen AM et al. Circulation. 2012;126:1955-1963.

Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual

participant data from randomised trials

Coxib and traditional NSAID Trialists’ (CNT) Collaboration*. Lancet 2013; 382: 769–79

Dupre ME. Arch Intern Med. 2012;172(22):1731-1737.

The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction

Dupre ME. Arch Intern Med. 2012;172(22):1731-1737.

The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction

Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data

Kivimäki M et al. Lancet 2012; 380: 1491–97

Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health:

theWhitehall II prospective cohort study

European Heart Journal June 26,2013. doi:10.1093/eurheartj/eht216

Riesgo 1,49 mayor (p0.004)

Richardson S et al. Am J Cardiol 2012;110:1711–1716

Meta-Analysis of Perceived Stress and Its Association With Incident Coronary Heart Disease

27 %

LDL 50 mg/dl TAS/TAD 2,7/1,4 mmHg Fumar 5 cig/día

Relation Between Optimism and Lipids in Midlife

Boehm JK et al. Am J Cardiol 2013http://dx.doi.org/10.1016/j.amjcard.2013.01.292

Ajustado por demográficos Ajustado por demog/s.salud

Residential Proximity to Major Roadway and 10-Year All-Cause Mortality After Myocardial Infarction

Rosenbloom JI et al. Circulation. 2012;125:2197-2203

27 %

dieta

Egg consumption and risk of coronary heart disease and stroke: dose-response meta-analysis of

prospective cohort studies

Rong Y et al. BMJ 2013;346:e8539 doi: 10.1136/bmj.e8539

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

PREDIMED Study

Struch R et al. N Engl J Med 2013.DOI: 10.1056/NEJMoa1200303

30 %

diabetes

Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes

The Look AHEAD Research Group*. N Engl J Med 2013;369:145-54. DOI: 10.1056/NEJMoa1212914

Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes

Gregg EW. JAMA. 2012;308(23):2489-2496

Mayor remisión en : 1. DM tipo 2 de corta duración 2. Niveles de HbA1c bajos 3. No han requerido insulina

Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy

Results of the ADVANCE study

T1 vs T3 p T2 vs T3 p

Total eventos microvasculares

1,17 (1,06-1,28) 0,001 1,11 (1,02-1,20) 0,02

Total eventos renales 1,19 (1,08-1,32) 0,0005 1,13 (1,04-1,24) 0,006

Nuevos casos de microalbuminuria

1,14 (1.03-1,27) 0,01 1,10 (1,01-1,21) 0,04

Total eventos retina 1,01 (0,82-1,25) 0,9 0,98 (0,82-1,18) 0,9

Morton J et al. Diabetes Care 35:2201–2206, 2012

Third 1 (1.1 mmol/L) Third 2 (1.1–1.34 mmol/L) Third 3 (1.34 mmol/L)

Cardiovascular Event Reduction Versus New-Onset Diabetes During Atorvastatin Therapy

Effect of Baseline Risk Factors for Diabetes

Waters DD et al. J Am Coll Cardiol 2013;61:148–52

4 factores independientes predictores de nuevos casos de DM: • glucemia > 100 mg/dl • TGs > 150 mg/dl • IMC > 30 kg/m2 • historia de HTA

tratamiento

CHADS2 Score, Statin Therapy, and Risks of Atrial Fibrillation

Hung CY et al. The American Journal of Medicine (2013) 126, 133-140

19 %

CHADS2 Score, Statin Therapy, and Risks of Atrial Fibrillation

31 % , p <.001

Hung CY et al. The American Journal of Medicine (2013) 126, 133-140

PCSK9: proproteína convertasa subtilisina/kexina tipo 9

Low-Density Lipoprotein Cholesterol–Lowering Effects of AMG 145, a Monoclonal Antibody to Proprotein Convertase

Subtilisin/Kexin Type 9 Serine Protease (PCSK9) in Patients With Heterozygous Familial Hypercholesterolemia

Aal F et al. Circulation. 2012;126:2408-2417.

Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study

Kokkinos PF et al. Lancet 2013; 381: 394–99

*todas con diferencias significativas en relación con el grupo de referencia

Brighton TA et al. N Engl J Med 2012;367:1979-87. DOI: 10.1056/NEJMoa1210384

Low-Dose Aspirin for Preventing Recurrent Venous Thromboembolism

26%

Brighton TA et al. N Engl J Med 2012;367:1979-87. DOI: 10.1056/NEJMoa1210384

Low-Dose Aspirin for Preventing Recurrent Venous Thromboembolism

34%

Aspirin for Dual Prevention of Venous and Arterial Thrombosis

WarkentinTE. N Engl J Med 2012;367:2039-2041

Statin treatment and the risk of recurrent pulmonary embolism

Biere-Rafi S et al. European Heart Journal (2013) 34, 1800–1806.