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Effects of Mediterranean Diet���on AMI, Stroke, and CV Death
Estruch R et al: NEJM 2013 (PREDIMED)
Age: 67 y BMI: 30 DM: 48% HT: 82%
n–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction
Alpha Omega Trial
Kromhout D et al: NEJM 2010
Dietary linoleic acid for secondary prevention of CAD ���Sydney Diet Heart Study
Ramsden CE et al: BMJ 2013
PUFAs for secondary prevention of CV death ���Metaanalysis
Ramsden CE et al: BMJ 2013
7
Chocolate Consumption and Nobel Prizes
Messerli F: NEJM 2012
Dal Moro F: Maturitas 2013
Coffee Consumption and Nobel Prizes
1 mmol/L LDL-Reduction is associated with…..
CTT Collaborators. Lancet 2005
LDL-Reduction with statins and vascular events
50
40
30
20
10
0 0.5 1.0 1.5 2.0
-10 LDL-Reduction in mmol/L
50
40
30
20
10
-10
0 0.5 1.0 1.5 2.0
LDL-Reduction in mmol/L
Prospective metaanalysis of 90,056 patients from 14 studies1
…. 23% Reduction of coronary events
…. 21% Reduction of vascular events
Pro
prtio
nal r
educ
tion
of
eve
nts
(%±S
E)
Pro
porti
onal
redu
ctio
n
of e
vent
s (%
±SE
)
Adapted from Rosensen RS. Exp Opin Emerg Drugs 2004;9(2):269-279
LDL-C achieved mg/dL (mmol/L)
WOSCOPS – Placebo AFCAPS - Placebo
ASCOT - Placebo AFCAPS - Rx WOSCOPS - Rx
ASCOT - Rx
4S - Rx
HPS - Placebo
LIPID - Rx
4S - Placebo
CARE - Rx
LIPID - Placebo
CARE - Placebo
HPS - Rx
0
5
10
15
20
25
30
40 (1.0)
60 (1.6)
80 (2.1)
100 (2.6)
120 (3.1)
140 (3.6)
160 (4.1)
180 (4.7)
Eve
nt ra
te (%
)
6
Secondary Prevention
Primary Prevention
Rx - Statin therapy PRA – pravastatin ATV - atorvastatin
200 (5.2)
PROVE-IT - PRA
PROVE-IT – ATV
TNT – ATV10 TNT – ATV80
The lower the better!
JUPITER - Pl
JUPITER - Rx
POSCH
POSCH
Works in everybody except heart failure
EMPFEHLUNGEN NACH IAS 2003 modifiziert und aktualisiert für die Schweiz 2012
EAS/ESC EMPFEHLUNGEN 2011
EAS/ESC EMPFEHLUNGEN 2011
EMPFEHLUNGEN NACH IAS 2003 modifiziert und aktualisiert für die Schweiz 2012
Medikamentöse Behandlung der Dyslipidämie
Effects of PCSK9 Antibody on LDL
Lancet 2012
Effects of PCSK9 Antibody on top of Statins on LDL
Lancet 2012
Effects of a monoclonal antibody to PCSK9, REGN727 on LDL in familial hypercholesterolaemia on statin dose +/- ezetimibe
Stein EA et al: Lancet 2012
(n=15) (n=15) (n=16)
(n=16) (n=15)
LDL 3.6 - 4.4 mmol/l
71% on ezetimibe, 42% CAD
(≥4.9 mmol/l)
AHA Guideline on the Treatment of Blood Cholesterol���to Reduce Atherosclerotic Cardiovascular Risk
Stone NJ et al: Circulation 2013
(1.8-4.9 mmol/l)
LDL <4.9 mmol/l
Stone NJ et al: Circulation 2013
Intensity of Statin Therapy
Stone NJ et al: Circulation 2013
Statins an New Onset of Diabetes
Sattar N et al: Lancet 2010
CV Benefit > Risk of diabetes (9:1)
9 CV events prevented vs
1 case of diabetes
By treating for 4 years 255 patients with a
standard dose of statins
Adapté de Sattar et al. Lancet 2010; 375: 735-42. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.
Hohe Triglyzeride (>2.3 mmol/l) Tiefes HDL (<0.9 mmol/l)
Normale Triglyzeride Normales HDL (<0.9 mmol/l)
Studien mit Fibraten - Odds Ratio für ein koronares Ereignis ist abhängig von den Ausgangs-Lipidwerten
Sacks et al: NEJM 2010
Therapie der arteriellen Hypertonie
RAS-Blocker
Effects of intensive Blood Pressure Control in Diabetics ACCORD
NEJM 2010
Goal <140 mmHg
Goal <120 mmHg
BP: 139 -> 134
BP: 139 -> 119
Effects of Intensive vs Standard BP Control on Stroke MI, and CV Death in Type II Diabetes (ACCORD)
NEJM 2010
Messerli, F. H. et al. J Am Coll Cardiol 2009;54:1827-1834
Incidence of MI and Stroke Stratified by Diastolic Blood Pressure in the INVEST Study
Aged under 55 years
Aged over 55 years or black person of African or
Caribbean origin of any age
A C
A + C
A + C + D
Resistant hypertension consider further diuretic
alpha or betablocker consider seeking expert advise
Step 1
Step 2
Step 3
Step 4
A=ACEI or ARB C=CCB D=Thiazide diuretic
NICE 2011
ESH: Zielwert für alle <140/90 mmg ausser Diabetiker <140/85 mmHg
Long-term Effect of Renal nerve Denervation on Blood Pressure in Resistant Hypertension
p <0,01 für Δ gegenüber der Baseline für alle Zeitpunkte
Effects of Renal Denervation on Office BP (Zurich Experience, N= 36)
Effects of Renal Denervation on ABPM (Zurich Experience, N= 36)
Take home messages
• Diät wirkt v.a. primärpräventiv
• Cholesterin ist ein behandelbarer Risikofaktor
• Hochrisikopatienten aggressiv behandeln (Zielwerte?)
• Grenzen der Statine: Herzinsuffizienz.
• Zur Senkung der Triglyzeride: Fibrat
• Blutdruckzielwert bei Hypertonie: <140/90 mmHg ausser: Betagte: <150/90 mmHg Diabetiker: <140/85 mmHg
• Bei resistenter Hypertonie renale Denervation erwägen
