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Current & New treatment strategies to address CV Risk

Current & New treatment strategies to address CV Risk. Evolution of Atherosclerosis. Genetic. Environmental. Clinical Events. Age (yrs). 0. 20. 40. 60. Atherosclerosis: ‘Investing in your Arteries ’. Early Intervention for Lifetime Risk management.

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Current & New treatment strategies to address CV Risk

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  1. Current & New treatmentstrategies to address CV Risk

  2. Evolution of Atherosclerosis Genetic Environmental Clinical Events Age (yrs) 0 20 40 60

  3. Atherosclerosis:‘Investing in your Arteries’ Early Intervention for Lifetime Risk management

  4. Framingham Heart Study:LifetimeRisk Men Women 0.7 0.7 69% ≥2 Major RFs 1 Major RF ≥ Elevated RF ≥ Not Elevated RF All Optimal RFs 0.6 0.6 50% 50% 0.5 0.5 46% 0.4 0.4 39% Adjusted Cumulative Incidence 36% 0.3 0.3 27% 0.2 0.2 0.1 0.1 8% 5% 0 0 50 70 60 90 50 80 90 70 60 80 Attained Age Lloyd-Jones Circ. 2006; 113: 791-798

  5. Age and CV Risk in Diabetes Women Men 30 30 Women with diabetes Women without diabetes Men with diabetes Men without diabetes 25 25 20 20 15 15 10 10 5 5 0 0 20-30 31-40 41-45 46-50 51-60 56-60 61-65 66-70 71-75 76-80 81-85 20-30 31-40 41-45 46-50 51-60 56-60 61-65 66-70 71-75 76-80 81-85 Age (years) Age (years) Booth Lancet 2006; 368: 29-36

  6. Current GuidelinesBased on Short term Absolute Risk

  7. New Guidelines Individuals with low 10-year but high lifetime risk have a greater subclinical disease burden and greater incidence of atherosclerotic progression compared with individuals with low 10-year and low lifetime risk, even at younger ages

  8. Without Compelling Indications With Compelling Indications Drug(s) for the compelling indications Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed Stage 1 Hypertension(SBP 140-159 or DBP 90-99 mm Hg)Thiazide-type diuretics for mostMay consider ACEI, ARB, BB, CCB, or combination Stage 2 Hypertension (SBP 160 or DBP 100 mm Hg) 2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB) JNC 7 Algorithm for Treatment of Hypertension Lifestyle Modifications Not at Goal BP (<140/90 mm Hg) (<130/80 mm Hg for those with diabetes or chronic kidney disease) Initial Drug Choices Chobanian et al. JAMA. 2003;289:2560-2572.

  9. ESHESC and JNC 7 Guidelines Recommend Target BP Goals of <140/90 mmHg for Uncomplicated Hypertension and <130/80 mmHg for Complicated Hypertension1 *Lower if proteinuria is >1 g/day 1. Task Force of ESH–ESC. J Hypertens 2007;25:110587 2. Chobanian et al. Hypertension 2003;42:1206–52

  10. Blood Pressure Targets Uncomplicated DM CRF US (2003 ) < 140/90 < 130/80 < 130/80 Europe (2007) < 140/90 < 130/80 < 130/80 WHO/ISH (2004) SBP < 140 < 130/80 < 130/80 UK (2004) < 140/85 < 130/80 < 130/80 China (2005) < 140/90 < 130/80 < 130/80

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