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• New Frontiers in CVD Risk Management: Optimizing Outcomes in Patients with Multiple Cardiovascular Risks


 

New Frontiers in CVD Risk Management: Optimizing Outcomes in Patients with Multiple Cardiovascular Risks

Download VBWG06-CoreMR-S01.ppt (125 slides - 6.0MB)


New Frontiers in CVD Risk Management:Optimizing Outcomes in Patients with Multiple Cardiovascular Risks US population at high risk Development and progression of CVD Genetics augment effects of environmental risk factors Cardiovascular risk factors, adults 55–64 years Synergistic interaction of traditional multiple risk factors on CVD risk Obesity decreases life expectancy regardless of smoking Decline in smoking vs rise in obesity: A trade-off? Development and progression of CVDTraditional CVD risk factorsSelected emerging biomarkers LDL infiltration triggers inflammatory response Role of ox-LDL in macrophage recruitment Hypertension increases atherogenic lipoprotein content of arterial vessel walls AT1 and LOX-1 receptor cross-talk promotes adhesion molecule expression Lipoprotein-associated phospholipase A2 (Lp-PLA2) Studies demonstrating association of Lp-PLA2 with incident CHD EPC number/function correlates with endothelial function EPC number has prognostic importance Arterial stiffness: Cause and consequence of atherosclerosis Correlation between number of risk factors and arterial distensibility Peripheral arterial stiffness is associated with subclinical atherosclerosis Pleiotropic effects of statins High-dose statin treatment reduces Ox-LDL markers Statin treatment reduces Lp-PLA2 Statins increase circulating EPCs Intensive lipid lowering improves arterial compliance Comparative effects of statin and ezetimibe on EPCs and endogenous antioxidant system Neuroprotection with statins in stroke model Pleiotropic effects of BP-lowering agents Statin metabolite and CCB show additive antioxidant effect Additive effects of statin + CCB on fibrinolytic balance Beneficial effect of statin + ACEI on endothelial function Approaches to CVD prevention Lifestyle changes reduce need for drug therapy New lifestyle guidelines: More exercise, fruits and vegetables Exercise reduces CV and all-cause mortality Diet reduces mortality in primary prevention trials Potential cardioprotective mechanisms of dietary components Non-pharmacologic interventions and BP reduction Benefit of multifactorial interventions Key findings from recent lipid-lowering trials PROVE IT-TIMI 22: Assessment of intensive lipid lowering in ACS PROVE IT-TIMI 22: Early benefit with intensive lipid lowering PROVE IT-TIMI 22: Benefit at 30 days PROVE IT-TIMI 22: Evidence for rapid reduction in markers of inflammation PROVE IT-TIMI 22: Clinical implications A to Z: Early initiation of intensive regimen vs delayed initiation of less-intensive regimenA to Z: Treatment effect on LDL-C A to Z: Treatment effect on CRP A to Z: Treatment effect on primary outcomeA to Z: Treatment effect on primary outcome at different time periods A to Z: Clinical implications TNT: Assessment of intensive lipid lowering on clinical outcomes TNT: Treatment effects on LDL-C TNT: Treatment effects on primary outcome TNT: Incidence of elevated liver or muscle enzymes TNT: Clinical implications Potential factors contributing to early statin benefit HPS and CARDS: Benefits of lowering LDL-C in diabetes CARDS: Adverse events 4D Trial: Neutral effect of statin in hemodialysis patients with diabetes Statins reduce all-cause death: Meta-analysis of 14 trials Statin benefit independent of baseline lipids: Meta-analysis of 14 trials HPS: Assessing relation of statin benefit to baseline LDL-C HPS: Effects on specific major vascular events HPS: Vascular events by baseline LDL-C levels HPS: Statin beneficial irrespective of baseline lipid level and diabetes status HPS: Incidence of elevated liver or muscle enzymes Improving time to benefit in clinical outcomes studies Key findings from recent BP-lowering trials Increased stroke risk for -blockers shown in meta-analysis Comparison of active treatments on stroke Comparison of active treatments on CHD VALUE: Comparison of CCB and ARB VALUE: Similar treatment effectson primary outcome at study end VALUE: SBP and outcome differencesduring consecutive time periods VALUE: Clinical implications CAMELOT: Trial of BP reduction with ACEI or CCB in CAD patients without HF CAMELOT: Reduction in primary outcome with amlodipine and enalapril CAMELOT: Clinical implications CV pharmacotherapy: Impact on newly diagnosed diabetes Improving time to benefit in clinical outcomes studies PROactive: Study design PROactive: Reduction in primary outcome PROactive: Reduction in secondary outcome PROactive: Clinical implications Multifactorial approaches in CVD prevention Potential benefits of multifactorial approachesABCs of CVD prevention Steno-2 supports aggressive multifactorial intervention in type 2 diabetes Steno-2: Effects of multifactorial intervention on macrovascular outcomes Majority of Americans do not follow a healthy lifestyle Only 1 in 3 patients adherent to preventive therapy after 6 months Combination drugs for treatment of hypertension, dyslipidemia, and diabetes Gemini: More than 55% of patients achieved both BP and LDL-C goals More patients at BP goal with fixed-dose combination vs conventional strategy New paradigm of multiple risk factormanagement ALLHAT: Design ALLHAT: Primary outcome— Fatal coronary disease or nonfatal MI ALLHAT-LLT: Effects of statin or usual care on outcomes ALLHAT: Clinical implications New paradigms in clinical data supporting aggressive therapy INVEST: Assessment of combination regimens in hypertension + CAD INVEST: Comparable effects of treatments on BP INVEST: Comparable effects of treatments on primary outcome INVEST: Clinical implications ASCOT: Rationale ASCOT: Design ASCOT: Patient population risk factor profile ASCOT-BPLA: Study designASCOT-BPLA: Reductions in BP over time ASCOT-BPLA: Reduction in primary outcome (nonfatal MI and fatal CHD) ASCOT-BPLA: Reduction in fatal and nonfatal strokeASCOT-BPLA: Additional reductions with amlodipine-based regimen ASCOT-BPLA: New-onset diabetes ASCOT-LLA: Assessing lipid lowering in hypertensive patients ASCOT-LLA: Atorvastatin reduces primary outcome in hypertensive patients ASCOT-LLA: Time to benefit post hoc analysis—Cardiac events ASCOT-LLA subanalysis: Atorvastatin reduces CV events in patients with diabetes and hypertension ASCOT: Differing effect of statin added to -blocker–based or CCB-based therapy ASCOT: Differing effect of statin added to -blocker–based or CCB-based therapy ASCOT: Differing effect of statin added to -blocker–based or CCB-based therapy ASCOT: Clinical implications Summary: Optimizing outcomes in patients with multiple CVD risks
 

Physician tools

Download VBWG06-CoreMR-S02.ppt (4 slides - 0.1MB)

Physician tools 3-minute lifestyle interview: Nutrition 3-Minute lifestyle interview: Physical activity Effective smoking cessation strategies
VBWG06-CoreMR.pdf (4.2MB)VBWG06-CoreMR.pdf (4.2MB)
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