New Cardiac Risk Factors

64 slides
1.46 MB
292 views

Similar Presentations

Presentation Transcript

1

Emerging Cardiac Risk FactorsJon W. Wahrenberger, MD FACCDHMC Cardiology Update Symposium 2003 December 1, 2003

2

Traditional Risk FactorsTobacco Exposure Hypertension Diabetes Mellitus Lipid Disorders Family History

3

Question: Traditional risk factors are present in what percentage of patients with coronary heart disease: A. Less than 50% B. Greater than 50% C. Conflicting dataAudience Response Question 1

4

Total Cholesterol Distribution: CHD vs Non-CHD PopulationCastelli WP. Atherosclerosis. 1996;124(suppl):S1-S9.35% of CHD Occurs in People with TC<200 mg/dL150200Total Cholesterol (mg/dL)250300No CHDCHDFramingham Heart Study—26-Year Follow-up

5

Prevalence of Risk Factors in Patients with Coronary Heart DiseaseKhot, et al. JAMA 2003;290:898-904

6

Prevalence of Risk Factors in CHD01234

7

Emerging Cardiac Risk FactorsC-Reactive Protein Lipoprotein (a) Fibrinogen HomocysteineThe Four Big Ones

8

AtherosclerosisCurrent Understanding

9
10

Atherosclerosis and InflammationRoss R. N Engl J Med 1999;340:115-126.

11

Atherosclerosis and InflammationRoss R. N Engl J Med 1999;340:115-126.

12

Anatomy of the Mature Plaque

13

Matrix Metabolism and Integrity of the Plaque’s Fibrous CapLibby P. Circulation 1995;91:2844-2850.++++++–SynthesisBreakdownLipid coreIL-1 TNF- MCP-1 M-CSFFibrous capIFN-CD-40LCollagen-degrading ProteinasesTissue Factor Procoagulant

14

Plaque Rupture with ThrombosisFrom A Slide Atlas Atherosclerosis Progression and Regression, Parthenon Publishing, 1999

15

Emerging Cardiac Risk FactorsC-Reactive Protein Lipoprotein (a) Fibrinogen HomocysteineThe Four Big Ones

16

Characteristics of an Ideal Screening TestPresence of reliable assay Independence from other risk factors Presence of populations norms to allow interpretation of test Clear statistical association of test and clinical endpoint Ability to improve prediction beyond traditional risk factors Ability to generalize results to other groups Acceptable cost for assayCirculation 2003;107:499-511

17

C-reactive ProteinCirculating acute phase reactant Many-fold increase with injury & infection Synthesized in liver, induced primarily by interleukin-6 (IL-6) Stable levels in circulation, not affected by meals, no circadian levels Level – within normal range – predicts CVD risk

18

Hs-CRP predicts first events

19

hs-CRP and Risk of Future MI in Apparently Healthy MenRidker PM et al. N Engl J Med 1997;336:973-979.1 <0.055Relative Risk of MIP = 0.03Quartile of hs-CRP (range, mg/dL)2 0.056–0.1143 0.115–0.2104 >0.211P < 0.001P < 0.001P Trend <0.001

20

hs-CRP and Risk of Future MI: Analysis Stratified by Smoking StatusRidker PM et al. N Engl J Med 1997;336:973-979.1Relative Risk of Future MIQuartile of CRP234All PatientsNonsmokers

21

CRP and Risk: Overview of 18 StudiesRidker PM. Circulation 2003;107:363-9

22

C-Reactive Protein and CHDDanesh, et al. BMJ. 2000;321:199-204

23

CRP and Cardiovascular RiskMI Stroke Peripheral arterial disease Sudden cardiac death Recurrent ischemia and death in: Unstable Angina Myocardial Infarction Percutaneous intervention CRP will Predict:

24

hs-CRP and Risk of T2DMPradhan, et al. JAMA 2001;286:327-34P value for trend = 0.001

25

hs-CRP and Risk of Metabolic SyndromeRidker, et al. Circulation 2003;107:391-7P value for trend < 0.0001ATP III Definition of the Metabolic Syndrome Three of the following five characteristics: Midline obesity Elevated TG Low HDL Hypertension Glucose Intolerance

26

CRP, Metabolic Syndrome and CV EventsRidker, et al. Circulation 2003;107:391-7

Browse More Presentations

Last Updated: 8th March 2018

Recommended PPTs