- Know CVD
- Type 2 diabetes mellitus o Type 1 with microalbuminuria.
- Markedly elevated single risk factors (HF, severe hypertension,…)
- Chronic kidney disease
- Score of high risk
2003 Framingham and ATPIII 10-year risk of CVD event of ≥20%
2012 SCORE (European Societies) 10-year risk of CVD death of ≥5%
2013 IAS Estimation of total CVD morbidity by age 80 ≥45%
2013 ACC/AHA estimated 10-year ASCVD risk ≥7.5%
(40 to 75 years of age with LDL-C ≥70 mg/dL)Juan F Ascaso
0
10
20
30
40
50
60
70
80
90
100
Categoría 1
High
Intermediate
Low
CVR
20,0
60,7
19,3
European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice, aged 50-65 years free of diabetes and not receiving lipid-lowering therapy
EURIKA Eur J Prev Cardiol 2013 Juan F Ascaso
Population
Intermediate Risk
No event Intermediate Risk
Event
High Risk
Death
Death
High Risk
High Risk
Modified. Perman G et al. Cost Eff Resour Alloc. 2011; 9: 4. Juan F Ascaso
No event
Event
High Risk
Death
Death
Europa Risk SCORE 1-4
USA 40-75 y, LDL-C 70-189 mg/dL, Risk 5-7,5
is modulated by
- Family history of premature CVD, which is considered to increase the risk by 1.7-fold in women and by 2.0-fold in men.
- Abdominal obesity- Physical activity pattern, - Low HDL-C and high TG, - hs-CRP, - Lp(a), - Fibrinogen,- Homocysteine, - Apo B,- Social class.Conversely, risk may be lower than indicated in those with very high HDL-C levels or a family history of longevity.
- LDL–C ≥160 mg/dL or other evidence of genetic hyperlipidemias
- Family history of premature ASCVD in a first degree relative, with onset <55 y in male or <65 y in female
- Hs-CRP >2 mg/L - CAC score ≥300 Agatston units or ≥75
percentile for age, sex, and ethnicity, - Ankle-brachial index <0.9, - Elevated lifetime risk of ASCVD. - Additional factors may be identified in the
future.
Juan F Ascaso
- Diabetes
- Markedly elevated single risk factors
- Chronic kidney disease
- Association of risk factors
Huxley, R. et al. BMJ 2006;332:73-78
14%
Juan F Ascaso
- Diabetes
- Markedly elevated single risk factors
- Chronic kidney disease
- Association of risk factors
Versmissen J et al. BMJ 2008;337:a2423.Skoumas et al. Circ J 2013; 77:163-8
2%
HF Familial HypercholesterolemiaFCH Familial Combined Hyperlipidemia
FHFCH
0,5%
Juan F Ascaso
9,8% 56.6% women mean age, 57.1 y
- Diabetes
- Markedly elevated single risk factors
- Chronic kidney disease
- Association of risk factors
IDHOCO. PLoS Med. 2014; 11(1): e1001591
≥160/≥100 mm HgSevere hypertension
Juan F Ascaso
- Diabetes
- Markedly elevated single risk factors
- Chronic kidney disease
- Association of risk factors
7,0% eGFR <60
Di Angelantonio et al. BMJ 2010;341:c4986
0,2%,eGFR <45
>45 y
Juan F Ascaso
- Diabetes
- Markedly elevated single risk factors
- Chronic kidney disease
- Association of risk factorsOB 25%
The Emerging Risk Factors Collaboration. Lancet 2011; 377: 1085–95
OW 50%
Juan F Ascaso
Modified. INTERHEART Study. Lancet 2004; 364: 937-972
51
225
612
864
32
16
8
4
2
1
(1) (2) (3) (4)Smk DM HTN ApoB/A 1+2+3 All4 +Obes +PS AllRFs
Od
ds
rati
o (
99
%C
I)
2.9(2.6-3.2) 2.4
(2.1-2.7)1.9
(1.7-2.1)
3.3(2.8-3.8)
13.0(10.7-15.8)
42.3(33.2-54.0)
68.5(53.0-88.6)
182.9(132-252)
333.7(230-483)
In 27 000 participants from 52 countries in INTERHEART
Juan F Ascaso
ECV aterosclerosa, especialmente EC, es la primera causa de
muerte prematura en todo el mundo.
ECV afecta a hombres y mujeres.
En europeos <75 años la ECV representa:
- El 42% de todas las causas de muerte en mujeres
- El 38% de todas las causas de muerte en hombres
Eur Heart J 2012
La reducción de la mortalidad por ECV se relaciona con una
intervención adecuada con
- cambios en el estilo de vida
- tratamiento farmacológico
Juan F Ascaso
Juan F Ascaso
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