Dyspidemia

DyspidemiaCRE/006/FEB14-FEB15/BR1CVD is a leading cause of death worldwideAccording to the WHO,1 An estimated 17.3 million people died from CVDs in 2008.By 2030, almost 23.6 million people will die from CVDs.CVD: Cardiovascular disease1. http://www.who.int/cardiovascular_diseases/en/2. De Backer GG. Medicographia. 2009;31:343348.CHD remains the main cause of global mortality and a major cause of morbidity and loss of quality of life.2Globally, chronic noncommunicable diseases are an important cause for mortality with cardiovascular diseases (CVDs) emerging as the main culprit.1 The WHO estimated CVD deaths were about 17.3 million in 2008 (30% of all global deaths). Of these, 7.3 million were due to coronary heart disease (CHD) and 6.2 million due to stroke. Also, more than 80% of such deaths were reported from the developing countries.2 As per WHO, the CVD associated mortality will further increase to 23.3 million by 2030.2

References 1. Backer GGD. The global burden of coronary heart disease. Medicographia. 2009;31:343348. Available at: http://www.medicographia.com/2010/07/the-global-burden-of-coronary-heart-disease/2. Available at: http://www.who.int/cardiovascular_diseases/en/2Multiple independentrisk factors (silo approach)Integrated identification and management of risk factors contributing to CVD risk(global approach)HTNHypercholesterolemiaDiabetesTraditional CVD perspective New CVD risk perspectiveAgeGenderDMHyper-cholesterol-emiaHTN New targets andgoals for therapyReduction oftotal CVD risk is the primary goalSmokingOrgandamageNew Paradigm: Multi-Risk Factor ApproachCVD: Cardiovascular disease; DM: Diabetes mellitus; HTN: HypertensionVolpe M, et al. J Human Hypertens. 2008;22:154157. 3The ultimate goal of treating hypercholesterolemia is to prevent the cardiovascular disease (CVD) and related mortality. Several risk factors have been identified that predispose a patient to CVD. According to the earlier belief, hypertension, hypercholesterolemia and diabetes were considered as independent single risk factors for CVD. With better understanding of the pathology of the disorder and its behavior across various epidemiological studies, these risk factors are now considered to be integrated, where one risk factor predisposes to another. Further, it is understood that reducing LDL-C levels is known to reduce CHD mortality (as explained in the next slide). Thus, reduction of CVD risk is the current primary goal of treatment of hypercholesterolemia.

The figure on the slide suggests that physicians need to realize the importance of determining the total CVD risk in driving their diagnostic and therapeutic choices for each patient. This suggests moving from considering hypertension, hypercholesterolemia and diabetes as separate/independent entities to interdependent conditions, where one condition may predispose other condition.

Reference Volpe M, Erhardt LRW, Williams W. Managing cardiovascular risk: The need for change. J Hum Hypertens. 2008;22:154157. 19881993200120042013History of U.S. Dyslipidemia Guideline Development *ASCVD, Atherosclerotic Cardiovascular Disease1. NCEP. Arch Intern Med .1988;148:36-69. 2. NCEP ATP II. Circulation .1994;89:1333-445. 3. NCEP ATP III. Circulation. 2002;106:3143.4. Grundy SM, et al. Circulation. 2004;110:227-239.. 5. Stone NJ, et al. J Am Coll Cardiol. 2013: doi:10.1016/j.jacc.2013.11.002. Available at: http://content.onlinejacc.org/article.aspx?articleid=1770217. Accessed November 13, 2013.

Risk CategoryLDL-C0-1< 160 mg/dl 2 (10-year risk 10%) the LDL-C goal is < 70 mg/dl and or > 50% reduction when target level cannot be reachedIAHIGH CV risk (markedly elevated single risk factor, a SCORE level > 5 to < 10%), an LDL-C goal < 100 mg/dlII aAMODERATE risk (SCORE level >1 to< 5), an LDL-C goal < 115 mg/dlII a C6ASCVD Statin Benefit GroupsHeart healthy lifestyle habits are the foundation of ASCVD prevention2013 ACC/AHA Guideline Recommendations for Statin TherapyASCVD prevention benefit of statin therapy may be less clear in other groups . Consider additional factors influencing ASCVD risk , potential ASCVD risk benefits and adverse effects, drug-drug interactions, and patient preferences for statin treatment.

* With LDL-C of 70-189 mg/dL Estimated using the Pooled Cohort Risk Assessment Equations

Stone NJ, et al. J Am Coll Cardiol. 2013: doi:10.1016/j.jacc.2013.11.002. Available at: http://content.onlinejacc.org/article.aspx?articleid=1770217. Accessed November 13, 2013.High-Intensity Statin TherapyModerate-Intensity Stain TherapyLow-Intensity Statin TherapyLDLC 50% LDLC 30% to