1 / 26

Campagna Educazionale Regionale ANMCO Toscana “Difendiamo il cuore”

Campagna Educazionale Regionale ANMCO Toscana “Difendiamo il cuore”. Dai grandi trials clinici con statine al razionale del target terapeutico del colesterolo in prevenzione secondaria. Valerio Zacà. Monteriggioni, 9 Febbraio 2008. National Education Cholesterol Panel

nadda
Download Presentation

Campagna Educazionale Regionale ANMCO Toscana “Difendiamo il cuore”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Campagna Educazionale Regionale ANMCO Toscana “Difendiamo il cuore” Dai grandi trials clinici con statine al razionale del target terapeutico del colesterolo in prevenzione secondaria Valerio Zacà Monteriggioni, 9 Febbraio 2008

  2. National Education Cholesterol Panel Adult Treatment Panel: 30 years experience NCEP ATP II Guidelines 1993 NCEP ATP I Guidelines 1988 NCEP ATP III Guidelines 2002 UPDATE2004 1970s Framingham MRFIT LRC-CPPT Coronary Drug Project Helsinki Heart CLAS (angio) Angiographic Trials (FATS, POSCH, SCOR, STARS, Ornish, MARS) Meta-Analyses(Holme, Rossouw) 4S, WOSCOPS, CARE, LIPID, AFCAPS/TexCAPS, VAHIT, others HPS, PROVE-IT, ASCOT, ALLHAT, PROSPER

  3. National Education Cholesterol Program Adult Treatment Panel III Circulation. 2002;106:3413-21.

  4. National Education Cholesterol Program Adult Treatment Panel III Circulation. 2002;106:3413-21.

  5. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins Cholesterol Treatment Trialists’ (CTT) Collaborators. Lancet. 2005;366:1267–78.

  6. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Grundy SM et al. Circulation. 2004;110:227-239.

  7. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines ** When LDL-lowering drug therapy is employed, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels. †† If baseline LDL-C is 100 mg/dL, institution of an LDL-lowering drug is a therapeutic option on the basis of available clinical trial results. Grundy SM et al. Circulation. 2004;110:227-239.

  8. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Grundy SM et al. Circulation. 2004;110:227-239.

  9. Nuovi scenari dal 2004 ad oggi… Prevenzione secondaria di pazienti stabili: TNT IDEAL Prevenzione secondaria dopo sindrome coronarica acuta: A to Z PROVE IT - TIMI 22 Prevenzione secondaria dopo stroke: SPARCL Terapia intensiva vs. moderata

  10. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease LaRosa JC et al. N Engl J Med. 2005;352:1425-35.

  11. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease LaRosa JC et al. N Engl J Med. 2005;352:1425-35.

  12. Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease LaRosa JC et al. N Engl J Med. 2005;352:1425-35.

  13. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes Cannon CP et al. N Engl J Med. 2004;350:1495-504.

  14. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes Cannon CP et al. N Engl J Med. 2004;350:1495-504.

  15. Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl Lower Is Better and Physiologically Normal O’Keefe JH et al. J Am Coll Cardiol. 2004;43:2142-6.

  16. Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl Lower Is Better and Physiologically Normal O’Keefe JH et al. J Am Coll Cardiol. 2004;43:2142-6.

  17. Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy Cannon CP et al. J Am Coll Cardiol. 2006;48:438-45.

  18. Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy Cannon CP et al. J Am Coll Cardiol. 2006;48:438-45.

  19. Meta-Analysis of Cardiovascular Outcomes Trials Comparing Intensive Versus Moderate Statin Therapy Coronary death or myocardial infarction Cannon CP et al. J Am Coll Cardiol. 2006;48:438-45.

  20. High-Dose Atorvastatin after Stroke or Transient Ischemic Attack Amarenco P et al. N Engl J Med. 2006;355:549-59.

  21. High-Dose Atorvastatin after Stroke or Transient Ischemic Attack Amarenco P et al. N Engl J Med. 2006;355:549-59.

  22. Safety of Aggressive Lipid Management High-dose statin therapy or combination therapy will be required for the large majority of very high-risk patients to achieve the optional LDL goal of 70 mg/dl. Rhabdomyolysis was extremely uncommon: highest rate 0.13% with SIMVA 80 mg Vs 0-0.07% with low-to-moderate doses as compared to other statins. Davidson MH et al. J Am Coll Cardiol. 2007;49:1753-62.

  23. Outcomes of Using High- or Low-Dose Atorvastatin in Patients 65 Years of Age or Older with Stable Coronary Heart Disease Wenger NK et al. Ann Intern Med. 2007;147:1-9.

  24. Can Low-Density Lipoprotein Be Too Low? The Safety and Efficacy of Achieving Very Low Low-Density Lipoprotein With Intensive Statin Therapy A PROVE IT-TIMI 22 Substudy Wiviott SD et al. J Am Coll Cardiol. 2005;46:1411-1416.

  25. Conclusioni • Negli ultimi 20 anni in seguito alle evidenze fornite da numerosi RCTs il target terapeutico di colesterolemia LDL in prevenzione secondaria è stato significativamente ridotto. • Un target di LDL <100 mg/dL con una riduzione del 30-40% rispetto al basale è raccomandato nella maggior parte dei pazienti. • In soggetti selezionati ad alto rischio il target terapeutico raccomandato è LDL <70 mg/dl.

  26. Conclusioni • In molti pazienti è necessaria una riduzione di almeno il 50% dei livelli basali per raggiungere LDL<100 mg/dL. • Per raggiungere il valore raccomandato di colesterolemia LDL è spesso necessario ricorrere ad una terapia intensiva con statina, associata ad un miglior impatto prognostico e ad un soddisfacente profilo di sicurezza.

More Related