Post on 09-Jun-2015
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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
Col·labora:
Organitza:
e-actualització
o Introducción (3)
o Factores de riesgo (8)
o Dieta (2)
o Diabetes (4)
o Tratamiento (6)
Actualització 2013 en risc cardiovascular i dislipèmies
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
Lifetime Risk and Years Lived Free of Total Cardiovascular Disease
Wilkins JT et al. JAMA. 2012;308(17):1795-1801
14 años
Ideal Cardiovascular Health Is Inversely Associated With Incident Cancer The Atherosclerosis Risk in Communities Study
Rasmussen-Torvik LJ. Circulation. 2013;127:1270-1275.
3 ------- 25 % riesgo menor 6-7 ---- > 50 % riesgo menor
Factores de riesgo
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.
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
Dupre ME. Arch Intern Med. 2012;172(22):1731-1737.
The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction
Dupre ME. Arch Intern Med. 2012;172(22):1731-1737.
The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction
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
Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health:
theWhitehall II prospective cohort study
European Heart Journal June 26,2013. doi:10.1093/eurheartj/eht216
Riesgo 1,49 mayor (p0.004)
Richardson S et al. Am J Cardiol 2012;110:1711–1716
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
Relation Between Optimism and Lipids in Midlife
Boehm JK et al. Am J Cardiol 2013http://dx.doi.org/10.1016/j.amjcard.2013.01.292
Ajustado por demográficos Ajustado por demog/s.salud
Residential Proximity to Major Roadway and 10-Year All-Cause Mortality After Myocardial Infarction
Rosenbloom JI et al. Circulation. 2012;125:2197-2203
27 %
dieta
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
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
PREDIMED Study
Struch R et al. N Engl J Med 2013.DOI: 10.1056/NEJMoa1200303
30 %
diabetes
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
Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes
Gregg EW. JAMA. 2012;308(23):2489-2496
Mayor remisión en : 1. DM tipo 2 de corta duración 2. Niveles de HbA1c bajos 3. No han requerido insulina
Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy
Results of the ADVANCE study
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
Third 1 (1.1 mmol/L) Third 2 (1.1–1.34 mmol/L) Third 3 (1.34 mmol/L)
Cardiovascular Event Reduction Versus New-Onset Diabetes During Atorvastatin Therapy
Effect of Baseline Risk Factors for Diabetes
Waters DD et al. J Am Coll Cardiol 2013;61:148–52
4 factores independientes predictores de nuevos casos de DM: • glucemia > 100 mg/dl • TGs > 150 mg/dl • IMC > 30 kg/m2 • historia de HTA
tratamiento
CHADS2 Score, Statin Therapy, and Risks of Atrial Fibrillation
Hung CY et al. The American Journal of Medicine (2013) 126, 133-140
19 %
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
PCSK9: proproteína convertasa subtilisina/kexina tipo 9
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.
Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study
Kokkinos PF et al. Lancet 2013; 381: 394–99
*todas con diferencias significativas en relación con el grupo de referencia
Brighton TA et al. N Engl J Med 2012;367:1979-87. DOI: 10.1056/NEJMoa1210384
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
Low-Dose Aspirin for Preventing Recurrent Venous Thromboembolism
34%
Aspirin for Dual Prevention of Venous and Arterial Thrombosis
WarkentinTE. N Engl J Med 2012;367:2039-2041
Statin treatment and the risk of recurrent pulmonary embolism
Biere-Rafi S et al. European Heart Journal (2013) 34, 1800–1806.