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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. - PowerPoint PPT Presentation
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Current & New treatment strategies to address
CV Risk
0 20 40 60 Age (yrs)
Evolution of Atherosclerosis
Clinical Events
Genetic Environmental
Atherosclerosis:‘Investing in your Arteries’
Early Intervention for Lifetime Risk management
Framingham Heart Study:Lifetime RiskAd
just
ed C
umul
ative
Inci
denc
e
50%
39%
27%
Attained Age
0.7
0.6
0.5
0.4
0.3
0.2
0.1
050 60 70 80 90
69%
50%46%
36%
5%
0.7
0.6
0.5
0.4
0.3
0.2
0.1
050 60 70 80 90
8%
≥2 Major RFs1 Major RF≥ Elevated RF≥ Not Elevated RFAll Optimal RFs
Men Women
Lloyd-Jones Circ. 2006; 113: 791-798
Age and CV Risk in Diabetes
Booth Lancet 2006; 368: 29-36
30
25
20
15
10
30
25
20
15
10
5
0
20-3031-40
41-4546-50
51-6056-60
61-6566-70
71-7576-80
81-85
WomenWomen with diabetesWomen without diabetes
Age (years)
5
0
20-3031-40
41-4546-50
51-6056-60
61-6566-70
71-7576-80
81-85
MenMen with diabetesMen without diabetes
Age (years)
Current GuidelinesBased on Short term Absolute Risk
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
New Guidelines
Not at Goal BP (<140/90 mm Hg) (<130/80 mm Hg for those with diabetes or chronic kidney disease)
Initial Drug Choices
Drug(s) for the compelling indications
Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB)
as needed
With Compelling Indications
Lifestyle Modifications
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)
Stage 1 Hypertension(SBP 140-159 or DBP 90-99 mm Hg)
Thiazide-type diuretics for most
May consider ACEI, ARB, BB, CCB,
or combination
Without Compelling Indications
JNC 7 Algorithm for Treatment of Hypertension
Chobanian et al. JAMA. 2003;289:2560-2572.
ESHESC and JNC 7 Guidelines Recommend Target BP Goals of <140/90 mmHg for Uncomplicated Hypertension and <130/80 mmHg for Complicated Hypertension1
Type of hypertension BP goal (mmHg)
Uncomplicated <140/90
Complicated
Diabetes mellitus <130/80
Kidney disease <130/80*
Other high risk (stroke, myocardial infarction)
<130/80
1. Task Force of ESH–ESC. J Hypertens 2007;25:1105872. Chobanian et al. Hypertension 2003;42:1206–52
*Lower if proteinuria is >1 g/day
Blood Pressure Targets UncomplicatedDM 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
