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VBWG. The Renin-Angiotensin-Aldosterone System:. Linking New Data and Mechanisms for Cardiovascular Risk Reduction. VBWG. Contents. Scope of the problem Physiology of RAAS: Focus on angiotensin Role of RAAS modulation: Recent clinical trials CAD Diabetes ACEIs and ARBs
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VBWG The Renin-Angiotensin-Aldosterone System: Linking New Data and Mechanisms for Cardiovascular Risk Reduction
VBWG Contents Scope of the problem Physiology of RAAS: Focus on angiotensin Role of RAAS modulation: Recent clinical trials CAD Diabetes ACEIs and ARBs Management strategies for post-intervention in patients with CAD Appendix: Clinical guidelines
VBWG Scope of the Problem
VBWG Coronary artery disease: Leading cause of hospitalization in the US National bill (billions) Rank $66.2 AHA. Heart Disease and Stroke Statistics–2005 Update.
VBWG Lifetime risk for CAD Framingham Heart Study Lifetime risk at age 40 Men Women 1 in 2 0.5 0.5 1 in 3 0.4 0.4 Cumulative risk of CAD 0.3 0.3 0.2 0.2 0.1 0.1 0 0 40 50 60 70 80 90 94 40 50 60 70 80 90 94 Age (years) Age (years) Lloyd-Jones D et al. Lancet. 1999;353:89-92.
VBWG Multiple risk factors raise the risk for MI INTERHEART 333.7 512 182.9 256 128 68.5 42.3 Odds ratio for1st MI (99% CI) 64 32 13.0 16 8 3.3 2.9 4 2.4 1.9 2 1 Smk(1) DM(2) HTN(3) ApoB/A1(4) 1+2+3 1–4 All 4+obesity All 4+Psycho- social All Smk = smoking; DM = diabetes mellitus; HTN = hypertension; Apo = apolopoprotein Yusuf S et al. Lancet. 2004;364:937-52.
VBWG Lifetime risk of diabetes for individuals born in 2000 Estimates based on National Health Interview Survey (1984–2000) 60 53 49 50 45 43 40 39 Lifetimerisk (%) 40 37 33 31 30 27 20 10 0 White Black Hispanic Other races/ethnicities Total* Men Women *Weighted race/ethnic-specific values by proportion of nondiabetic US population in 2000 Narayan KMV et al. JAMA. 2003;290:1884-90.
VBWG Diabetes as a CHD risk equivalent: Impact on mortality in women and men N = 7052 men, 8354 women; age 45–64 yrs, follow-up 25 years Men Women 1.0 1.0 0.8 0.8 0.6 0.6 Survival rate 0.4 0.4 0.2 0.2 0.0 0.0 0 5 11 16 22 27 0 5 11 16 22 27 Years Years CHD Diabetes/CHD No Diabetes/CHD Diabetes Whiteley L et al. Diabetes Care. 2005;28:1588-93.
VBWG Worldwide prevalence of diabetes expected to increase World Health Organization, 2000 vs 2030 Diabetes prevalence >171 million in 2000 ~366 million in 2030 140 +155% 120 120 100 +99% +102% Diabetes prevalence (in millions) 80 71 67 +44% +181% 60 48 47 42 40 36 +160% 33 33 18 20 15 7 0 W Pacific Africa Americas E Medit Europe SE Asia 2000 2030 www.who.int/diabetes/. July 2005.
Over 1 million Americans will have an MI this year VBWG 500 410 400 372 New andrecurrentMIs(in thousands) 300 250 200 88 100 34 10 0 29–44 45–64 ≥65 Age (years) Men Women AHA. Heart Disease and Stroke Statistics–2005 Update.