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1、CVD Prevention,Charlie Shaeffer, MD, FACC,Cardiovascular Deaths by Region in 1990:Global Burdon of Disease Study, 1990,PredictedDue to CHDDue to StrokeIncrease by 2002No. (x 106)(%)(%)(%) Established market economies3.2532515 Former socialist economies2.1503126 India2.35220111 China2.6305077 Other A

2、sia and Islands1.33429106 Sub-Saharan Africa0.82647114 Latin America and Caribbean0.84432120 Middle Eastern Crescent1.34716129,Cardiovascular Deaths, 1990,,,“Cardiovascular death and incidence in China and India more than doubled between 1990 and 2000.”,Yusuf: WCC May 2002,Urbanization, Child Deaths

3、 and Infection Tobacco Use Physical Activity Fat Consumption Stress,Yusuf: WCC May 2002,“Can prevent 5/6 myocardial infarctions by smoking cessation and blood pressure and lipid control.”,Yusuf: WCC May 2002,,,Worldwide Tobacco Mortality,1998 4,000,000 deaths/year 2030 10,000,000 deaths/year 1/3 of

4、all deaths Half of these deaths will be in the 35-65 age group, with an average loss of 20-25 years of life,,,,,,,,,,,,,Non Cigarette Smokers,All Cigarette Smokers,10 0,79,114,,64,122,44,135,Angina Pectoris,Myocardial Infarction,Sudden Death,OBS. EXP.,,,,,,Summary of NCEP ATP III* Guidelines LDL-C G

5、oals,*National Cholesterol Education Program Adult Treatment Panel III. Therapeutic lifestyle changes include: (1) dietary changes: reduced intake of saturated fats and cholesterol and enhanced LDL lowering with plant stanols/sterols and increased soluble fiber; (2) weight reduction; and (3) increas

6、ed physical activity. Coronary heart disease. CHD risk equivalents comprise: diabetes, multiple risk factors that confer a 10-year risk for CHD 20%, and other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease). M

7、ajor risk factors (exclusive of LDL-C) that modify LDL-C goals include cigarette smoking, hypertension (BP 140/90 mmHg or on antihypertensive medication), low HDL cholesterol (<40 mg/dL), family history of premature CHD (CHD in male first-degree relative <55 years; CHD in female first-degree relativ

8、e <65 years), age (men 45 years; women 55 years). HDL cholesterol 60 mg/dL counts as a “negative” risk factor; its presence removes 1 risk factor from the total count.,,,,Age* (years) Male (%) White (%) Body mass index* (kg/m3) Current smoker (%) Diabetes (%) Hypertension (%) TC* (mg/dLmmol/L) LDL-C

9、* (mg/dLmmol/L) TG* (mg/dLmmol/L) HDL-C* (mg/dLmmol/L),55.89.8 71 90 30.56.5 26 20 68 231.834.2 6.00.9 150.227.9 3.90.7 197.295.7 2.21.2 42.39.9 1.10.3,Characteristic,Atorvastatin 80 mg (n=253),REVERSAL: Baseline Characteristics,56.69.2 73 87 30.55.6 27 18 70 232.634.1 6.00.9 150.225.9 3.90.7 197.71

10、05.6 2.21.1 42.911.4 1.10.3,Pravastatin 40 mg (n=249),*MeanSD,,*P<0.001 vs pravastatin,Data are mean percent change from baseline to 18-month follow-up.,,,,,,,,-40,-30,-20,-10,0,10,Atorvastatin,,Change From Baselinein Lipid Parameters,,-50,Change from baseline (%),Total cholesterol,LDL-cholesterol,,

11、-25.2,,-18.4,,5.6,,-6.8,,-46.3*,,-34.1*,,2.9,,-20.0*,Triglycerides,HDL-cholesterol,,Pravastatin,,,4,162 patients with an Acute Coronary Syndrome < 10 days,ASA + Standard Medical Therapy,,,“Standard Therapy” Pravastatin 40 mg,“Intensive Therapy” Atorvastatin 80 mg,,,Duration: Mean 2 year follow-up (9

12、25 events),,Primary Endpoint: Death, MI, Documented UA requiring hospitalization, revascularization ( 30 days after randomization), or Stroke,PROVE IT - TIMI 22: Study Design,2x2 Factorial: Gatifloxacin vs. placebo,,,Double-blind,Patient population: CHD LDL-C: 130-250 mg/dL (3.4-6.5 mmol/L) Triglyce

13、rides 600 mg/dL (6.8 mmol/L),Study Design,Primary efficacy outcome measure: Time to occurrence of a major CV event: CHD death Nonfatal, non-procedure-related MI Resuscitated cardiac arrest Fatal or nonfatal stroke,Atorvastatin 10 mg,Open-label run-in n=15,464,8 weeks,,,Atorvastatin 10 mg LDL-C targe

14、t: 100 mg/dL (2.6 mmol/L),Median follow-up = 4.9 years,Atorvastatin 80 mg LDL-C target: 75 mg/dL (1.9 mmol/L),Double-blind periodn=10,001LDL-C <130 mg/dL (<3.4 mmol/L),,n=4995,n=5006,,Baseline,Baseline Patient Characteristics,No single cause of death (by body system, or pathological process) and no single cancer type drove the non-significant difference in all-cause mortality between groups No statistically significant differences were observed between treatment groups for any cause of death,Mortality,