E-actulització en risc cardiovascular i dislipèmies

1. e-actualització
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
Ja us podeu inscriure a la nostra pagina web
www.camfic.cat
Sol·licitada acreditació al Consell Català de la Formació Continuada de les Professions Sanitàries
Organitza:
Col·labora:

2. Actualització 2013 en risc cardiovascular i dislipèmies
o Introducción (3)
o Factores de riesgo (8)
o Dieta (2)
o Diabetes (4)
o Tratamiento (6)

3. 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

4. Lifetime Risk and Years Lived Free
of Total Cardiovascular Disease
14 años
Wilkins JT et al. JAMA. 2012;308(17):1795-1801

5. Ideal Cardiovascular Health Is Inversely Associated With Incident Cancer
The Atherosclerosis Risk in Communities Study
3 ------- 25 % riesgo menor
6-7 ---- > 50 % riesgo menor
Rasmussen-Torvik LJ. Circulation. 2013;127:1270-1275.

6. Factores de riesgo

7. 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.

8. 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

10. The Cumulative Effect of Unemployment
on Risks for Acute Myocardial Infarction
Dupre ME. Arch Intern Med. 2012;172(22):1731-1737.

11. The Cumulative Effect of Unemployment
on Risks for Acute Myocardial Infarction
Dupre ME. Arch Intern Med. 2012;172(22):1731-1737.

12. 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

13. Increased risk of coronary heart disease among individuals reporting adverse
impact of stress on their health:
theWhitehall II prospective cohort study
Riesgo 1,49 mayor (p0.004)
European Heart Journal June 26,2013. doi:10.1093/eurheartj/eht216

14. 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
Richardson S et al. Am J Cardiol 2012;110:1711–1716

15. Relation Between Optimism and Lipids in Midlife
Ajustado por demográficos
Ajustado por demog/s.salud
Boehm JK et al. Am J Cardiol 2013http://dx.doi.org/10.1016/j.amjcard.2013.01.292

16. Residential Proximity to Major Roadway and 10-Year
All-Cause Mortality After Myocardial Infarction
27 %
Rosenbloom JI et al. Circulation. 2012;125:2197-2203

17. dieta

18. 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

19. Primary Prevention of Cardiovascular Disease
with a Mediterranean Diet
PREDIMED Study
 30 %
Struch R et al. N Engl J Med 2013.DOI: 10.1056/NEJMoa1200303

20. diabetes

21. 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

22. Association of an Intensive Lifestyle Intervention
With Remission of Type 2 Diabetes
Mayor remisión en :
1. DM tipo 2 de corta duración
2. Niveles de HbA1c bajos
3. No han requerido insulina
Gregg EW. JAMA. 2012;308(23):2489-2496

23. Low HDL Cholesterol and the Risk of Diabetic Nephropathy and
Retinopathy
Results of the ADVANCE study
Third 1 (1.1 mmol/L)
Third 2 (1.1–1.34 mmol/L)
Third 3 (1.34 mmol/L)
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

24. Cardiovascular Event Reduction Versus
New-Onset Diabetes During Atorvastatin Therapy
Effect of Baseline Risk Factors for Diabetes
4 factores
independientes
predictores de nuevos
casos de DM:
• glucemia > 100 mg/dl
• TGs > 150 mg/dl
• IMC > 30 kg/m2
• historia de HTA
Waters DD et al. J Am Coll Cardiol 2013;61:148–52

25. tratamiento

26. CHADS2 Score, Statin Therapy, and Risks of Atrial
Fibrillation
19 %
Hung CY et al. The American Journal of Medicine (2013) 126, 133-140

27. 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

28. PCSK9: proproteína convertasa subtilisina/kexina tipo 9

29. 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.

30. Interactive effects of fitness and statin treatment on mortality
risk in veterans with dyslipidaemia: a cohort study
*todas con diferencias significativas en relación con el grupo de referencia
Kokkinos PF et al. Lancet 2013; 381: 394–99

31. 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

32. Low-Dose Aspirin for Preventing Recurrent
Venous Thromboembolism
34%
Brighton TA et al. N Engl J Med 2012;367:1979-87. DOI: 10.1056/NEJMoa1210384

33. Aspirin for Dual Prevention of Venous and Arterial Thrombosis
WarkentinTE. N Engl J Med 2012;367:2039-2041

34. Statin treatment and the risk of recurrent
pulmonary embolism
Biere-Rafi S et al. European Heart Journal (2013) 34, 1800–1806.