Presentation is loading. Please wait.

Presentation is loading. Please wait.

18° MEETING OF THE EUROPEAN CHAPTER OF THE INTERNATIONAL UNION OF ANGIOLOGY JOINT WITH THE XIX ANNUAL MEETING OF THE MEDITERRANEAN LEAGUE OF ANGIOLOGY.

Similar presentations


Presentation on theme: "18° MEETING OF THE EUROPEAN CHAPTER OF THE INTERNATIONAL UNION OF ANGIOLOGY JOINT WITH THE XIX ANNUAL MEETING OF THE MEDITERRANEAN LEAGUE OF ANGIOLOGY."— Presentation transcript:

1 18° MEETING OF THE EUROPEAN CHAPTER OF THE INTERNATIONAL UNION OF ANGIOLOGY JOINT WITH THE XIX ANNUAL MEETING OF THE MEDITERRANEAN LEAGUE OF ANGIOLOGY AND VASCULAR SURGERY Park Florio Hotel & Magaggiari Hotel Resort October 24th-27th, 2009

2 University of Palermo Faculty of Medicine and Surgery Department of Internal Medicine and Cardiovascular Diseases Chair of Cardiovascular Diseases, post-graduate School of Cardiology, Master of Vascular Diseases, Master of Echocardiography, Center for the Early Diagnosis of Preclinical and Multifocal Atherosclerosis and for the Secondary Prevention, Division of Cardiology University Hospital “P. Giaccone” of the University of Palermo Director: prof. Salvatore Novo Tuesday, October 27th, 2009 – « A. Strano » Lecture HOW DO PRECLINICAL ATHEROSCLEROSIS AND INFLAMMATION INFLUENCE GLOBAL CV RISK? Salvatore Novo Present: E. Bastounis

3

4 THE CIFTI4-GESCO-MURST PROJECT ON CARDIOVASCULAR AGING National Coordinator: R. Paoletti (Milan) Centre of Palermo: A. Strano, S. Novo From 1986……..

5 THE CONCEPT OF GLOBAL CARDIOVASCULAR RISK AND THE RISK CHARTS

6 INTERATION BETWEEN RISK FACTORS: THE MRFIT Not Smokers Smokers Fatal Coronaric Events/10.000/year Quintiles of Cholesterol mg/dl Quintiles of Cholesterol mg/dl

7 RELATIVE RISK OF CORONARY EVENTS FOR EACH LEVEL OF SBP ACCORDING TO THE ASSOCIATED RISK FACTORS 8 year - probability SBP Tot Chol. Diabetes Smoke LVH (ECG)

8 These mathematical algorithms, built up by using data coming from from large observational epidemiological studies, evaluating the main traditional RF. They aimed at stratifyng the risk to have a major CV event over the time. ALGORITHMS OF RISK

9 FRAMINGHAM RISK CHART FOR NON DIABETIC SUBJECTS MEN WOMEN Risk entity within 10 years Very High High Moderate Mild Low > 40% 20% - 40% 10% - 20% 5% - 10% < 5%

10 FRAMINGHAM RISK CHART FOR DIABETIC SUBJECTS Very High High Moderate Mild Low > 40% 20% - 40% 10% - 20% 5% - 10% < 5% MEN WOMEN Risk entity within 10 years Smokers Not Smokers Cholesterol age

11 ESC RISK CHART EUROSCORE 2003 High risk Low risk Non SmokersSmokersNon smokersSmokers Women Men Systolic Arterial Pressure (mmHg) years years years years years Third Joint Task Force. Eur J of CV Prevention and Rehabilitation. 2003, 10: S1-S10 (mmoll) (mg/dL) <1% 2% 3%-4% 5%-9% 15% and more 1% 10%-14% Non SmokersSmokersNon SmokersSmokers Women Men Total Cholesterol: Percentage levels of risk

12 ITALIAN CHART OF CARDIOVASCULAR RISK: 10 – YEAR RISK IN NON DIABETIC MEN ISS, years years years mmHg mg/dL Not smokers Smokers 20% - 30% Risk of CVD V 10% - 15% Risk of CVD III Less then 5% Risk of CVD I More then 30% Risk of CVD VI 15% - 20% Risk of CVD IV 5% - 10% Risk of CVD II

13 60-69 years years years mmHg mg/dL Non SmokingSmoking 20% - 30% Risk of CVD V 10% - 15% Risk of CVD III Less then 5% Risk of CVD I More then 30% Risk of CVD VI 15% - 20% Risk of CVD IV 5% - 10% Risk of CVD II ITALIAN CHART OF CARDIOVASCULAR RISK: 10 – YEAR RISK IN NON DIABETIC WOMEN ISS, 2004

14 ITALIAN CHART OF CARDIOVASCULAR RISK: 10 – YEAR RISK IN DIABETCS 20% - 30% Rischio MCV V 10% - 15% Rischio MCV III meno 5% Rischio MCV I oltre 30% Rischio MCV VI 15% - 20% Rischio MCV IV 5% - 10% Rischio MCV II ISS, 2004

15 HIGH GLOBAL CARDIOVASCULAR RISK AND THE ITALIAN NOTE 13 TO WRIGHT STATINS IN CHARGE OF NHS HIGH GLOBAL CARDIOVASCULAR RISK AND THE ITALIAN NOTE 13 TO WRIGHT STATINS IN CHARGE OF NHS  PATIENTS WITH CHD OR PREVIOUS ICTUS/TIA OR PAD OR DIABETES.  Hypercolesterolemia non susceptible to correction with diet in subjects with CV risk ≥ 20% in ten years.

16 Normal Fatty Streak Fibrous Plaque Athero- sclerotic Plaque Plaque Rupture/ Fissure & Thrombosis Myocardial Infarction Infarction Ischemic Stroke Critical Leg Ischemia Clinically Silent Cardiovascular Death Increasing Age Effort Angina Transient Ischemic Attack Claudication ATHEROGENESIS, ATHEROTHROMBOSIS AND MULTIFOCAL ATS: A PROGRESSIVE PROCESS

17 SOME METHODS TO DETECT PRE-CLINICAL ATS: Evaluation of endothelial function IMT IMT ABI < 0.90 ABI < 0.90 Multidetector coronary CT Multidetector coronary CT

18 METHOD FOR THE NON INVASIVE EVALUATION OF ENDOTHELIAL FUNCTION by the evaluation of flow mediated dilatation (FMD)

19 FMD % ENDOTHELIAL FUNCTION, AS DETECTED BY FLOW MEDIATED VASODILATION, IN RELATION TO TRADITIONAL RISK FACTORS p < 0,05 Corrado E, Muratori I, Coppola G, Strano A, Novo S Int Angiol 2005: 24: 52-8

20 IMT AND FMD: RELATIONSHIP WITH EVENTS IN A 2 YEARS FOLLOW-UP IN 84 ASYMPTOMATIC SUBJECTS WITH A CLUSTER OF RF 84 PATIENTS AGE = 60 ± 11 YEARS Corrado E, Rizzo M, Carella M, Muratori I, Novo S, Coronary Artery Dis 2008; 19:

21 ENDOTHELIAL DYSFUNCTION AND CAROTID LESIONS STRONG PREDICTORS OF CLINICAL EVENTS IN PATIENTS WITH EARLY STAGES OF ATS: A 24-MONTHS FOLLOW-UP STUDY Corrado E, Rizzo M, Coppola G, Muratori I,, Novo S. Coronary Artery Disease Corrado E, Rizzo M, Coppola G, Muratori I,, Novo S. Coronary Artery Disease 2008; 19:

22

23 ABI: INVERSE RELATIONSHIP WITH 5- YEAR RISK OF CV EVENTS AND DEATH Dormandy JA, Creager MA. Cerebrovasc Dis 1999; 9 (Suppl 1): 128 (Abstr 4) 10.2% relative risk increase per 0.1 decrease in ABI (p = 0.041) ABI Risk relative to ABI

24 The ABI was a strong predictor of morbidity and mortality during 4 years follow-up even in patients with no clinical symptoms of PAD RESULTS FROM HOPE STUDY Ostergren J et al. Eur Heart J 2004; 25, 17-24

25 HOT LINES AND CLINICAL TRIAL UPDATES - ESC CONGRESS EXCESS CARDIOVASCULAR MORTALITY IN 6880 OLD PATIENTS WITH PAD IN PRIMARY CARE: 5- YEAR RESULTS OF THE GETABI STUDY BY K. DIEHM. 12.1% of patients presented an ABI < 0.90, without symptoms, and 8.7% a symptomatic PAD. At the end of the follow-up the incidence of all cause of mortality was 24.1% in patients with symptomatic PAD, 19.2% in patients with ABI < 0.90 and 9.5% in Controls

26 ABI COMBINED WITH FRAMINGHAM RISK SCORE TO PREDICT CV EVENTS AND MORTALITY JAMA 2008; 300:

27 CAROTID B-MODE ULTRASONOGRAPHY non invasive less expensive no radiation cost-effective and easily applied technique to screen for atherosclerosis it is well-established as an indicator of cardiovascular event risk from epidemiologic studies

28 Kablak-Ziembicka et al., Heart Poredoš et al., Int Angiol 2002

29

30 Am J Cardiol 2007; 99:

31 NORMAL (n= 212) IMT (n= 162) ACP (n= 294) p= Transient Ischemic Attack Ischemic stroke Effort or unstable angina232.9 Acute Myocardial Infarction Peripheral arterial disease Cardiovascular or cerebrovascular death Total events % Patients with any event % CLINICAL EVENTS REGISTERED DURING THE FOLLOW- UP IN 668 HIGH RISK ASYMPTOMATIC PATIENTS AS RELATED WITH THE ULTRASONOGRAPHIC FINDINGS Corrado E, Muratori I, Bonura F, Novo S, Stroke 2006; 37: 482-6

32 PLOTS OF HAZARD RATIOS FOR CV EVENTS AGAINST CCA-IMT (ADJUSTED FOR AGE AND SEX) Myocardial infarctionStroke Red ARIC blue line, CHS5; green line, MDCS10,11l "R ; purple line, CAPS.12510,11l "R

33 Matthias W et al. Circulation 2007:115: A meta-analysis of 8 popolation studies (Kuopio IHD-RF Study, ARIC Study, Rotterdam Study, CVH Study, Malmo Diet and Cancer Study, Longitudinal Investigation for the Longevity and Aging in Hokkaido Country, CAPS and Kitamura Study) analysing the association between carotid IMT and cerebro and CV events in a total of subjects with a mean follow-up of 5,5 years.

34 Circulation 2007: 115: Matthias W et al. - Circulation 2007: 115: AN IMT INCREASE OF 0.1 mm WAS ASSOCIATED WITH AN ENHANCED RISK OF 15% FOR AMI AND OF 18% FOR STROKE, SO SHOWING THAT PRECOCIOUS ATS LESIONS OF CAROTID ARTERIES ARE AN INDEPENDENT MARKER OF CEREBRO- AND CV EVENTS

35 CLINICAL CASE n. 1 - Male 57 years old, with elevated DBP, TC/TG, homocysteine and low HDL-C, IFG and smoker. Fibroadipose, echolucent, heterogeneous plaque of 2.4 mm at the carotid bulb and 50% stenosis at the superficial femoral artery

36 ITALIAN CHART OF CARDIOVASCULAR RISK: 10 – YEAR RISK IN NON DIABETIC MEN ISS, anni anni anni PAS mmHg CT mg/dL Non fumatoriFumatori 20% - 30% Rischio MCV V 10% - 15% Rischio MCV III meno 5% Rischio MCV I oltre 30% Rischio MCV VI 15% - 20% Rischio MCV IV 5% - 10% Rischio MCV II

37

38

39

40 43 e 56% Non fatal events 3% e 7% Fatal events PRECLINICAL ATHEROSCLEROSIS AND GLOBAL CV RISK: ROLE OF ASYMPTOMATIC CAROTID LESIONS IN THE RISK ASSESSMENT ESTIMATED ACCORDING TO THE ITALIAN ALGORHYTM “PROGETTO CUORE” IN TEN YEARS FOLLOW-UP IN 558 PATIENTS No vo S, Visconti C, Amoroso GR, Corrado E, Muratori I, Fazio G, Novo G Eur J Cardiovasc Prev & Rehabiltation 2009; 16 (Suppl. 1): S48/P221

41 PRECLINICAL ATHEROSCLEROSIS INCREASE THE GLOBAL CV RISK BEYOND THAT DETERMINED BY CHART OF RISK.

42 TRANSATLANTIC INTERSOCIETY CONSENSUS FOR THE MANAGEMENT OF PAD (TASC II) Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG and TASC II Working Group; Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J. Eur J Vasc Endovasc Surg. 2007; 33 (Suppl 1): S1- 75 & J Vasc Surg 2007; 45 (1 Suppl): S5-S67& Int Angiol 2007; 26: Recommendation 2 – Control of lipid pattern in PAD All patients with Symptomatic PAD should have reduced their LDL-C < 100 mg/dL. In patients with PAD and History of Multifocal Disease is suggested to reduce LDL-C < 70 mg/dL All patients with Asymptomatic PAD, without other clinical evidence of CV disease, shoul have reduced their LDL-C < 100 mg/dL

43 *Therapeutic option in very high-risk patients and in patients with high TG, non-HDL-C<100 mg/dL; **Therapeutic option; 70 mg/dL =1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L High Risk CHD or CHD risk equivalents Preclinical ATS ? (10-yr risk >20%) LDL-C level Lower Risk < 2 risk factors Moderately High Risk ≥ 2 risk factors (10-yr risk %) Target 160 mg/dL Target 130 mg/dL 70 - Target 100 mg/dL or optional 70 mg/dL* Moderate Risk ≥ 2 risk factors (10-yr risk <10%) Target 130 mg/dL or optional 100 mg/dL** Grundy SM et al. Circulation 2004; 110: NCEP ATP III: LDL-C GOALS (2004 PROPOSED MODIFICATIONS)

44 HIGH GLOBAL CARDIOVASCULAR RISK AND THE ITALIAN NOTE 13 TO WRIGHT STATINS IN CHARGE OF NHS  PATIENTS WITH CHD OR PREVIOUS ICTUS/TIA OR PAD OR DIABETES.  HYPERCOLESTEROLEMIA NON SUSCEPTIBLE TO CORRECTION WITH DIET IN SUBJECTS WITH A TEN-YEAR CV RISK ≥ 20%  PRECLINICAL ATS?

45

46 THROMBOSIS OF A DISRUPTED ATHEROMA, THE CAUSE OF MOST ACUTE CORONARY SYNDROMES, RESULTS FROM: Weakening of the fibrous cap Thrombogenicity of the lipid core Thrombogenicity of the lipid core Illustration courtesy of Michael J. Davies

47 MATRIX METABOLISM AND INTEGRITY OF THE PLAQUE’S FIBROUS CAP Libby P. Circulation. 1995; 91: – Synthesis Breakdown Lipid core IL-1 TNF- MCP-1 M-CSF Fibrous cap IFN-  CD-40L Collagen-degradingProteinases Tissue Factor Procoagulant

48 INFLAMMATION CAN PROMOTE THROMBOSIS PlateletCRP? Tissue Factor Fibrinogen Via gp llb/llla Fibrin CD40L Platelet- Fibrin Thrombus Fibrinopeptides Platelet

49 PCR AND CAROTID PLAQUE IN THE FRAMINGHAM HEART STUDY Methods: PCR measurement. The presence of a stenosis > 25% has been reported in 24% of men and 14% of women. In the patients of the upper quartile was registered a prevalence of carotid stenosis higher than in those of the lower quartile (after adjustment for the main traditional FR). Methods: 3173 subjects underwent the echocolour Doppler study of carotid arteries and the PCR measurement. The presence of a stenosis > 25% has been reported in 24% of men and 14% of women. In the patients of the upper quartile was registered a prevalence of carotid stenosis higher than in those of the lower quartile (after adjustment for the main traditional FR). P< 0,001 OR for Carotid stenosis (>25%) Quartili PCR Arterioscler Thromb Vasc Biol 2002: 22:

50 INDEPENDENT RELATIONSHIP BETWEEN hsCRP AND BOTH IMT AND ABI AS MEASURES OF SUBCLINICAL ATHEROSCLEROSIS

51 ASSOCIATIONS OF INFLAMMATORY MARKERS AND CORONARY ARTERY CALCIFICATION (CAC): THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) Jenny NS, Brown ER, Detrano R, Folsom AR, Saad MF, Shea S, Szklo M, Herrington DM, Jacobs DR Jr. - Atherosclerosis Aug 28. [Epub ahead of print] AIM: to evaluate the association of CRP, IL-6 and fibrinogen with CAC presence (Agatston score>0) in MESA participants. AIM: to evaluate the association of CRP, IL-6 and fibrinogen with CAC presence (Agatston score>0) in 6783 MESA participants. RESULTS: all participants in the highest quartile of CRP had a RR of 1.13 for CAC than those in lowest quartile. For highest versus lowest quartiles, RR were 1.22 for IL-6 and 1.18 for fibrinogen. RR for CAC were 1.05 for CRP, 1.12 for IL-6 and 1.09 for fibrinogen in multivariate adjusted models. CONCLUSION: CONCLUSION: Inflammatory markers were weakly associated with CAC presence.

52 Rizzo M, Corrado E, Coppola G, Muratori I, Novo G, Novo S - Coronary Artery Dis 2009; 20: Methods: Our research group recently investigated 127 asymptomatic women in post- menopausal periodechographic preclinical atherosclerosis. All women underwent a five-years follow-up Methods: Our research group recently investigated 127 asymptomatic women in post- menopausal period with echographic preclinical atherosclerosis. All women underwent a five-years follow-up

53 MULTIVARIATE ANALYSIS OF RFs INDEPENDENTLY ASSOCIATED TO THE PRESENCE OF PRECLINICAL ATHEROSCLEROSIS OR (95% CI); p value Age 1.1 ( ), 0.01 Obesity 1.5 ( ), 0.5 Smoke 2.1 (0.1-16),0.6 Family history of CVD 0.5 ( ), 0.3 Diabetes 2.2 ( ), 0.2 Dyslipidemia 1.3 ( ), 0.7 High values of CPR (> 3mg/L) 3.2 (1.1–11.8), High values of fibrinogen (> 350mg%) 6.2 (1.2–12.3), Rizzo M, Corrado E, Coppola G, Muratori I, Novo G, Novo S, Coronary Artery Dis 2009; 20: 15-20

54 Hs-PCR [4.4 (1.4 – 13.7),.0096] Fibrinogen [ 6.0( ),.0014] ASSOCIATION OF ELEVATED FIBRINOGEN AND hsCRP LEVELS WITH CAROTID LESIONS IN PATIENTS WITH NEWLY DIAGNOSED HYPERTENSION OR TYPE II DIABETES Corrado E, Rizzo M, Muratori I, Coppola G, Novo S. Arch Med Research 2006; 37:1004-9

55 AGING, INFLAMMATION AND ASYMPTOMATIC CAROTID ATS ARE STRONG PREDICTORS OF CLINICAL EVENTS IN POSTMENOPAUSAL WOMEN Corrado E, Rizzo M, Muratori I, Coppola G, Novo S. Menopause 2008; 15: Methods: 250 asymptomatic postmenopausal women. A 5 years follow-up A 5 years follow-up Age [1.7( ), <.0001] Hs-PCR quintils [1.3( ),.0175] Fibrinogen quintils [ 1.6( ),.001] Carotid ATS [2.0( ),.0002] Logistc regression analysis – Variables predittive of CV events ( OR (95% IC); P-value

56 Control subjects Patients with MS * P < No. of components of MS % P < Localisation of vascular disease IMT or ACP 62%74% CHD 2%10% CVD 4%11% PREVALENCE OF VASCULAR DISEASE IN THE WHOLE SAMPLE AND IN RELATION WITH THE NUMBER OF COMPONENTS OF THE M.S. (n=163 on 568 high risk pts) Novo G, Corrado E, Novo S. et al. Int. Angiol 2007; 26: Novo G, Corrado E, Novo S. et al. Int. Angiol 2007; 26: *Metabolic syndrome (M.S.) based on the ATP III criteria.

57 Fibrinogen (mg%) Cluster of risk factors of the Metabolic Syndrome hs CRP (mg%) 5 components vs 0, 1, 2, 3, 4, p< 0,005 p < 0,05 p < 0,002 PLASMATIC LEVELS OF hsCRP AND FIBRINOGEN: RELATIONSHIP WITH THE CLUSTER OF RISK FACTORS OF THE MS Novo G, Corrado E, Bellia A, Muratori I, Novo S, Int Angiol 2007: 26: 312-7

58 INCREASED LEVELS OF hsCRP AND FIBRINOGEN INFLUENCE THE RISK OF VASCULAR EVENTS IN A FIVE YEARS FOLLOW-UP OF 156 PATIENTS WITH NIDDM r = p< Associated to non fatal events. Fibrinogen Fibrinogen Preclinical atherosclerosis Preclinical atherosclerosis ObesityObesity hsCRP > 0.3 mg% hsCRP > 0.3 mg% Associated to fatal events Fibrinogen > 350 mg% Fibrinogen > 350 mg% Age Age hsCRP > 0.3 mg% hsCRP > 0.3 mg% Coppola G, Corrado E, Muratori I, Lo Coco L, Novo S. Int J Cardiol 2006; 106: 16-20

59 Quintiles of hs-PCR (in mg/dL) Clinical Events (in percent) 0.22      0.05 p < % 10% 20% 30% 40% THE PREDICTIVE ROLE OF C-REACTIVE PROTEIN IN 472 SUBJECTS WITH HYPERTENSION AND SUBCLINICAL ATHEROSCLEROSIS Rizzo M, Corrado E, Coppola G, Muratori I, Novo G, Novo S. Internal Med J 2009; 39: 539–45

60 Patients without events p= Patients with events Logistic Regression Analysis OR (95% IC); P-value High Fibrinogen (>350 mg/dL)9< ( ), <.0001 High hs-CRP (>3 mg/L) ( ),.014 HP IgG+ (%) ( );.4 HP CTX+ (%) ( ),.001 CMP IgG+ (%) ( ),.026 CMV IgG+ (%) ( );.4 Total burden of infection (%)4< ( ), <.0001 Presence of baseline carotid lesions (%) 65< ( ), <.0001 BASELINE CLINICAL CHARACTERISTICS AND BIOCHEMISTERY PLASMA VALUES IN RELATION TO THE OCCURRENCE OF THE CLINICAL EVENTS AFTER 5-YEARS OF FOLLOW-UP Corrado E, Rizzo M, Muratori I, Bonura F, Vitale G, Novo S. Stroke, 2006;37: 482-6

61 .02 PREDICTION OF CARDIO- AND CEREBRO-VASCULAR EVENTS IN PATIENTS WITH SUBCLINICAL CAROTID ATHEROSCLEROSIS AND LOW HDL-CHOLESTEROL Rizzo M, Corrado E, Coppola G, Muratori I, Novo G, Novo S. Atherosclerosis. 2008; 200: SmokeFamily history of CVD smoke Fibrinogen > Without eventsWith events

62 From the original population of 5888 subjects, without baseline CVD, of the CHS (an observational study of adults aged 65 years), 5020 subjects were sampled. They were followed up for as long as 12 years for incidence of CVD and all-cause mortality after baseline ultrasound and CRP measurement Methods: From the original population of 5888 subjects, without baseline CVD, of the CHS (an observational study of adults aged 65 years), 5020 subjects were sampled. They were followed up for as long as 12 years for incidence of CVD and all-cause mortality after baseline ultrasound and CRP measurement

63 KAPLAN-MEIER PLOTS OF CUMULATIVE CV EVENTS (A) AND ALL CAUSE OF MORTALITY (B) OVER 12-YEAR FOLLOW-UP STRATIFIED BY CAROTID ATS AND CRP LEVEL (LOW LEVEL ≤ 3 MG/L VS HIGH LEVEL > 3 MG/L) A B High CRP, high athero High CRP, low athero Low CRP, High athero Low CRP, low athero years years Cao JJ et al - Circulation 2007; 116: 32-8

64

65 HS-CRP ADDS PROGNOSTIC INFORMATION AT ALL LEVELS OF LDL-C AND AT ALL LEVELS OF THE FRAMINGHAM RISK SCORE Relative risk Multivariable relative risk <130>160 Framingham estimate of 10-year risk (%) LDL cholesterol (mg/dL) C-Reactive Protein (mg/L) < >3.0 Ridker et al, N Engl J Med. 2002; 347: < >3.0

66 Elevated CRP levels and coronary microvascular dysfunction in patients with coronary artery disease. Tomai et al. Eur Heart J 2009; /eurheartj/ehi356 CRP regulates the expression and activity of TF as well as TFPI via NF-kappaB and ERK 1/2 MAPK pathway. Chen Y et al. FEBS (Letter) 2009; 583: CRP enhances TF expression by vascular smooth muscle cells: mechanisms and in vivo significance. Wu J et al. Arterioscler Thromb Vasc Biol. 2008; 28:

67  Release of CRP as well as activity of MMP-9 from unstable atherosclerotic plaques during PCI. Robertson L et a. J Intern Med. 2007; 262:  Lp-APA2: an independent predictor of CV risk and a novel target for immunomodulation therapy. Khakpour H et al. Cardiol Rev. 2009; 17:  CRP stimulates superoxide anion release and TF activity in vivo. Devaraj S et al. Atherosclerosis 2009; 203:  Atherothrombosis: role of TF: link between diabetes, obesity and inflammation. Meerarani P et al. Indian J Exp Biol. 2007; 45:

68 Placebo Rosuvastatin 20 mg JUPITER - PRIMARY ENDPOINT Time to first occurrence of a CV death, non-fatal stroke, non-fatal MI, UA or revascularization Hazard Ratio 0.56 (95% CI ) P < Ridker P et al. N Eng J Med 2008;359: NNT for 2y = 95 5y* = Cumulative Incidence Follow-up (years) Number at Risk Rosuvastatin Placebo 8,9018,6318,4126,5403,8931,9581, ,9018,6218,3536,5083,8721,9631,

69 Placebo Rosuvastatin 20mg JUPITER - TOTAL MORTALITY Death from any cause Hazard Ratio 0.80 (95% CI ) p=0.02 Ridker P et al. N Eng J Med 2008;359: Cumulative Incidence Number at Risk Follow-up (years) Rosuvastatin Placebo 8,9018,8478,7876,9994,3122,2681,6021, ,9018,8528,7756,9874,3192,2951,6141,

70

71 INFLAMMATION PARTICIPATES IN ALL PHASES OF ATHEROTHROMBOTIC DISEASE Lesion initiation Lesion progression Thrombotic complications Libby P. Circulation. 1995; 91:

72 The inflammation has an important role in the determinism of atherosclerotic process. The CRP is able to guide the clinical practice and is currently an important field of research. Possible clinical implications: Primary prevention: the CRP is an independent marker of CVD and its evaluation could provide further informations for the assessment of GCVR in patients with dyslipidemia and MS. Primary prevention: the CRP is an independent marker of CVD and its evaluation could provide further informations for the assessment of GCVR in patients with dyslipidemia and MS. Secondary prevention: nevertheless the possible CRP usefulness is uncertain, a more aggressive pharmacological treatments should be warrented. Secondary prevention: nevertheless the possible CRP usefulness is uncertain, a more aggressive pharmacological treatments should be warrented. INFLAMMATION IN THE FUTURE

73

74 StudyRR (95% CI)Weight (%) Trichopoulou et al Knoops et al Lagiou et al Mitrou et al (males) Mitrou et al (females) (0.92–1.00) 0.88 (0.81–0.96) Total (95% CI) ( ) Increased risk Fung et al (0.91–0.97) (0.82–1.01) (0.77–1.03) (0.90–1.00) Decreased risk ADHERENCE TO MD AND CARDIOVASCULAR INCIDENCE AND/OR MORTALITY % Sofi et al., BMJ 2008


Download ppt "18° MEETING OF THE EUROPEAN CHAPTER OF THE INTERNATIONAL UNION OF ANGIOLOGY JOINT WITH THE XIX ANNUAL MEETING OF THE MEDITERRANEAN LEAGUE OF ANGIOLOGY."

Similar presentations


Ads by Google