Robinson, Jennifer (Arteriosclerosis)

29 Pages·2016·1.19 MB·English

Can W e Cure Arterio sclero sis?
N ew Tho ughts and Co ncepts and
NN eeww GGaamm ee CChhaannggiinngg TTrreeaattmm eennttss
JenniferG.R obinson,M D,M P H
P rofessor,DepartmentsofEpidemiology& M edicine
Director,P reventionInterventionCenter
U niversityofIow a
Iow aCity,Iow a
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Dateofpreparation:Sept2016SAGB.ALI.16.07.0709k ThismeetinghasbeenorganisedandfundedbySanofi.Praluent® ( alirocumab) PrescribingInformationisavailable
atthismeeting
Disclosures
R eceivedinthepastyear:
R esearchgrantstotheinstitution:Am arin,Am gen,Astra-Zeneca,Eli
L illy,Esai,Glaxo-S m ithKline,M erck,P fizer,R egeneron/S anofi,T akeda
Consultant:Akcea/Ionis,Am gen,EliL illy,Esperion,M erck,P fizer,
R egeneron/S anofi
GlobalBM I
trends
Age-standardisedmeanBMIinwomenandmenbycountryin1975and2014;N CDRiskFactorCollaboration.Lancet2016;387:1377-
96
Cardiovascular Prevention
• L ifestyleisfoundationforpopulation-based CVD riskreduction
• L ow adherencetohealthy lifestylehabitsinm odernindustrial
societies
•• HHiigghhrraatteessoobbeessiittyy iinncchhiillddrreenn,,aaddoolleesscceennttss,,aannddaadduullttss
• Medicaltherapy is needed to reduce CVD risk in absence of
healthy lifestyles
KingBA etal.Am JP ubHealth2012;102:e93-100;O gdenCL,etal.JAM A 2014;311:806-814
Lim itations “ late” utilization ofevidence-based
m edications
• Continued riskofCVD eventsontreatm ent
• L argeburdenofatherosclerosis
•• SS uubbooppttiimm aallaaddhheerreenncceettoomm eeddiiccaattiioonnss
• S uboptim aladherencetolifestyle
• S uboptim alcontrolofriskfactors
M yerbergR Jetal.Circulation 2012;125:1043-1052;M oraS,etal.Circulation2012;125:1979-8198;M ozaffarianD,etal.Circulation2008;117:3031-3038;
N ichollsS,etal.N EJM 2011;365:2078-2087;N aderiSH,etal.Am JM ed2012;125:882-887
Start statin earlier to prevent m ore
events
No statin
Startmoderate intensity statin
15 % 10 -yearASCVD risk
ADDITIONALASCVD
Starthigh intensity statin
EVENTS&DEATHS
5 % 10 -yearASCVD risk
PREVENTED
Advancingage
Adaptedfrom RobinsonJG,GiddingSS.CuringAtherosclerosisShouldBetheN extM ajorCardiovascularPreventionGoal.JACC.2014;63(25,PartA):2779-2785
Start statin earlier
Evidence
Greaterrelative risk reduction CVD events
from statins in low errisk than in higherrisk individuals
But,CVD events stilloccurin low risk persons
*1mmol/L (39mg/dl)LDL-C reductionwastheaverageintheprimarypreventionR CTsexcludingJU P ITER
CTT Collaborators.Lancet2012;380:581-590.
Start statin earlier
Evidence
Totalm ortality reduction
in low errisk individuals
CVD death stilloccurin low risk persons
*1mmol/L (39mg/dl)LDL-C reductionwastheaverageintheprimarypreventionR CTsexcludingJU P ITER
CTT Collaborators.Lancet2012;380:581-590.
ECAD - Elim inate Coronary Artery Disease trial
 M en35-50 y& w omen45-59 years
 Canada& M exico
 N =10,000-15,000;
 P rimarypreventionL DL -C >70 mg/dl
 >R iskfactor(smoking,hypertension,truncalobesity,familyhistorypremature
MM II,,SS AAssiiaannaanncceessttrryy
 Atorvastatin20 mgvscontrolX 10 years
 1endpoint:N onfatalM Iorstroke,coronaryrevascularization,non-
cancer/traumadeath
 2endpoints:includenew onsetdiabetes
DomanskiM ,etal.JAm CollCardiol2015;66:1828-1836;N CT02245087clinicaltrials.govAccessedM arch30,2016.
Fam ilialHypercholesterolem ia - Early treatm ent essential
N ordestgaardBG etal.EHJ2013;Dec1;34(45):3478–3490