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1、CVD PreventionCharlieCharlie Shaeffer Shaeffer, MD, FACC , MD, FACC Cardiovascular Deaths by Region in 1990: Global Burdon of Disease Study, 1990Predicted Due to CHDDue to StrokeIncrease by 2002 No. (x 106)(%)(%)(%)Established market economies3.2532515Former socialist economies2.1503126India2.352201
2、11China2.6305077Other Asia and Islands1.33429106Sub-Saharan Africa0.82647114Latin America and Caribbean0.84432120Middle Eastern Crescent1.34716129Cardiovascular Deaths, 1990“Cardiovascular death and incidence in China and India more than doubled between 1990 and 2000.” YusufYusuf: WCC May 2002: WCC
3、May 2002Urbanization Child Deaths and InfectionChild Deaths and Infection Tobacco Use Tobacco Use Physical Activity Physical Activity Fat Consumption Fat Consumption Stress StressYusuf: WCC May 2002“Can prevent 5/6 myocardial infarctions by smoking cessation and blood pressure and lipid control.”Yus
4、uf: WCC May 2002Worldwide Tobacco Mortality 1998 4,000,000 1998 4,000,000 deaths/yeardeaths/year 2030 10,000,000 deaths/year2030 10,000,000 deaths/year 1/3 of all deaths1/3 of all deaths Half of these deaths will be in the Half of these deaths will be in the 35-65 age group, with an average 35-65 ag
5、e group, with an average loss of 20-25 years of lifeloss of 20-25 years of lifeNon Cigarette SmokersNon Cigarette SmokersAll Cigarette SmokersAll Cigarette Smokers10 010 0 797911411464641221224444135135AnginaAngina PectorisPectorisMyocardialMyocardial InfarctionInfarctionSuddenSudden DeathDeathOBS.O
6、BS.EXP.EXP.Summary of NCEP ATP III* Guidelines LDL-C Goals*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
7、 soluble fiber; (2) weight reduction; and (3) increased 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 a
8、neurysm, and symptomatic carotid artery disease).Major 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 (20%)925 events)Duration: Mean 2 year follow-up (925 events)Primary Endpoin
9、t: Death, MI, Documented UA requiring hospitalization, Primary Endpoint: Death, MI, Documented UA requiring hospitalization, revascularization ( 30 days after randomization), or Stroke revascularization ( 30 days after randomization), or Stroke PROVE IT - TIMI 22: Study Design2 2x2 Factorial: Gatifl
10、oxacin vs. placebox2 Factorial: Gatifloxacin vs. placeboDouble-blindDouble-blindPatient population: CHD LDL-C: 130-250 mg/dL (3.4-6.5 mmol/L) Triglycerides 600 mg/dL (6.8 mmol/L)Study DesignPrimary efficacy outcome measure: Time to occurrence of a major CV event: CHD death Nonfatal, non-procedure-re
11、lated MI Resuscitated cardiac arrest Fatal or nonfatal strokeAtorvastatin 10 mgOpen-label run-in n=15,464 8 weeks1-8 weeksScreening and wash-out n=18,469Atorvastatin 10 mg LDL-C target: 100 mg/dL (2.6 mmol/L)Median follow-up = 4.9 yearsAtorvastatin 80 mg LDL-C target: 75 mg/dL (1.9 mmol/L)Double-bli
12、nd period n=10,001 LDL-C 130 mg/dL (3.4 mmol/L)n=4995n=5006BaselineAtorvastatin 10 mg (n=5006)Atorvastatin 80 mg (n=4995)Age (mean SD), years Men (%) White (%)61 8.8 81 9461 8.8 81 94Cardiovascular risk factors (%) Current smoker Hypertension Diabetes mellitus13 54 1513 54 15Cardiovascular history (
13、%) Angina MI Coronary angioplasty Coronary bypass Cerebrovascular accident81 58 54 47 582 59 54 47 5Baseline Patient CharacteristicsNo. of patients (%)Atorvastatin 10 mg (n=5006)Atorvastatin 80 mg (n=4995)All-cause mortality282 (5.6)284 (5.7)Cardiovascular CHD death Stroke death Hemorrhagic stroke d
14、eath155 (3.1) 127 (2.5) 8 (0.2) 2 (0.0)126 (2.5) 101 (2.0) 7 (0.1) 3 (0.1)Noncardiovascular Cancer Trauma Other127 (2.5) 75 (1.5) 9 (0.2) 43 (0.9)158 (3.2) 85 (1.7) 15 (0.3) 58 (1.2) 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 deathMortality
