Μοντέλα καρδιαγγειακού κινδύνου Μοντέλα καρδιαγγειακού κινδύνου Υπάρχουν διαφορές μεταξύ των Υπάρχουν διαφορές μεταξύ των

φύλων?φύλων?

Χριστίνα ΧρυσοχόουΧριστίνα Χρυσοχόου Επιμ ΒΕπιμ Β

Α Πανεπιστημιακή Καρδιολογική ΚλινικήΑ Πανεπιστημιακή Καρδιολογική Κλινική

Οι «κλασσικοί» παράγοντες Οι «κλασσικοί» παράγοντες κινδύνουκινδύνου

18αι 19αι 20αι 21αι

Η διαχρονική εξέλιξη της Προληπτικής Καρδιολογίας

Η ηλικία και το άρρεν φύλο

Αρτηριακή πίεση, δυσλιπιδαιμία, διαβήτης, κάπνισμα, ψυχολογικοί παράγοντες

Η εκτίμηση του Η εκτίμηση του καρδιαγγειακού κινδύνουκαρδιαγγειακού κινδύνου

Τα πιο γνωστά μοντέλα Τα πιο γνωστά μοντέλα κινδύνουκινδύνου

Framingham Score Sheet (1980s)Framingham Score Sheet (1980s)TheThe “Dundee risk function” “Dundee risk function” (1991)(1991)TThe Italian RIFLE pooling Projecthe Italian RIFLE pooling Project (1994) (1994)The Bogalusa Heart StudyThe Bogalusa Heart Study (1995) (1995)The The PROCAMPROCAM - - Prospective Cardiovascular Munster (1998)Prospective Cardiovascular Munster (1998)The British Regional Heart Study - BRHSThe British Regional Heart Study - BRHS (2000)(2000)The The CCardiovascular ardiovascular EEvent vent RReduction eduction TToolool––CERTCERT (2000) (2000) The Greek CARDIO2000 (2002)The Greek CARDIO2000 (2002)The INTERHEART Study model (2003) The INTERHEART Study model (2003) The The ESC SCOREESC SCORE project (2003) project (2003)The Italian The Italian RISKARD 2005 RISKARD 2005 (2006)(2006)Reynolds scoreReynolds score

Women and CHD

The age-adjusted death rate resulting from coronary heart disease in females, which accounts for about half of all CVD deaths in women, was 95.7 per 100 000 females in 2007, One third of what it was in 1980. Approximately 50% of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies

N Engl J Med. 2007;356:2388 –2398.JAMA. 2002;288:321–333.

Effectiveness-Based Guidelines for the Prevention of

Cardiovascular Disease in Women—2011 Update

A Guideline From the American Heart Association

CVD Risk Assessment

“at high risk,” based on the presence of documented CVD, diabetes mellitus, end-stage or chronic kidney disease, or 10-year predicted risk for CHD >20%; “at risk,” given the presence of 1 major CVD risk factors, metabolic syndrome, evidence of subclinical vascular disease (eg, coronary calcification), or poor exercise tolerance on treadmill testing;“at optimal risk” in the setting of a Framingham risk score <10%, absence of major CVD risk factors, and engagement in a healthy lifestyle.

Hsia et al, directly evaluated the algorithm in 161808 women 50 to 79 years of age who were enrolled in the Women’s Health Initiative and followed up for a mean of 7.8 years. When the 2007 update categories were applied, 11% of women were found to be at high risk, 72% were at risk, and 4% were at optimal risk.Among high-risk, at-risk, optimal risk, and unclassified women, the rates of MI, CHD death, or stroke were 19.0%, 5.5%, 2.2%, and 2.6% per 10 years, respectively (P for trend 0.0001).

Circ Cardiovasc Qual Outcomes. 2010;3:128 –134.

Circulation. 2011;123:1243-1262

WomenWomen MenMenAge, yAge, y 10-y vascular 10-y vascular

risk (%)risk (%)Aspirin Aspirin recommended recommended

10-y vascular risk 10-y vascular risk (%)(%)

Aspirin Aspirin recommended recommended

40–49 40–49 Average risk Average risk 11 No No 44 NoNo2x average risk 2x average risk 33 NoNo 77 NoNo5x average risk 5x average risk 77 NoNo 1818 NoNo

50–59 50–59 Average risk Average risk 33 No No 88 NoNo2x average risk 2x average risk 66 No No 1515 NoNo5x average risk 5x average risk 1515 No No 3434 YesYes

60–69 60–69 Average risk Average risk 88 No No 1414 No No 2x average risk 2x average risk 1515 No No 2626 Yes Yes 5x average risk 5x average risk 3434 YesYes 5353 YesYes

70—79 70—79 Average risk Average risk 1616 NoNo 2020 YesYes2x average risk 2x average risk 3030 Yes Yes 3535 Yes Yes 5x average risk 5x average risk 6060 Yes Yes 6666 YesYes

Risk of vascular disease and aspirin recommendations for Risk of vascular disease and aspirin recommendations for

aspirin use in men and women of different agesaspirin use in men and women of different ages

Algra A and Greving JP. Lancet 2009; 373

•Recent data suggests that those at highest risk (e.g., CHD risk of 20% or greater) may benefit most in terms of absolute risk reduction with aspirin as their absolute risk is high, although they are also at higher risk of bleeding

Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials Lancet. 2009;373:1849-1860

ASPIRIN USE IN PRIMARY PREVENTION

ACC 2007

Specific Dietary Intake Recommendations for Women

Patient and Public Education

In 2000, it was estimated that only 7% of people with CHD adhered to prescribed treatments for CVD lifestyle risk factors.Thirty percent to 70% of all hospital admissions for medication-related illness are attributed to poor adherence, resulting in billions of dollars in additional healthcare costs annually.