Transcript Rueda-Clausen et al. Int J Cardiol 2010,139
LECCIONES APRENDIDAS DE LOS ESTUDIOS INTERHEART, INTERSTROKE Y PURE
PATRICIO LÓPEZ-JARAMILLO MD PhD FACP DIRECTOR DE INVESTIGACION Y DE LA CLINICA DE SINDROMEMETABOLICO, PREDIABETES Y DIABETES. FOSCAL DIRECTOR DE INVESTIGACIONES DE LA FACULTAD DE MEDICINA DE LA UNIVERSIDAD DE SANTANDER UDES BUCARAMANGA-COLOMBIA
DEATHS FROM CVD WORLDWIDE
Over 70% of the global burden of heart attack and stroke is in developing countries 30 25 20 15 10 5 0 6 5 9 19 Established economies and former socialist countries Developing countries 1990 2020 KS Reddy. NEJM 2004; 350:2438
Epidemiological data indicates a continuous relationship between blood pressure level and CAD related mortality
COMPARISON OF THE LA INTERHEART STUDY RISK FACTOR PROFILES WITH THE OVERALL INTERHEART STUDY Lanas, et al. Circulation. 2007;115:1067-1074
ODDS RATIOS OF ACUTE MYOCARDIAL INFARCTION AND CORRESPONDING POPULATION-ATTRIBUTABLE RISKS BY GENDER Lanas, et al. Circulation. 2007;115:1067-1074
EPIDEMIC OF OVERWEIGHT AND OBESITY IN LATIN AMERICA AND THE CARIBBEAN Rueda-Clausen et al. International Journal of Cardiolology. 2008;125:111-112.
LA TRIADA CARDIOMETABOLICA
OBESIDAD ABDOMINAL HIPERINSULINISMO/ RESISTENCIA A LA INSULINA INFLAMACION DE BAJO GRADO DIABETES / ENFERMEDAD CARDIO CEREBRO VASCULAR
RAS EXPRESSION IN HUMAN ADIPOSE TISSUE
.
Karlsson C, et al. J Clin Endocrinol Metab. 1998; 83: 3925-3929
ANGIOTENSIN II ENHANCES ENDOTHELIAL TNF ΑLPHA PROTEIN PRODUCTION
Arenas et al, Am J Physiol. Cell Physiol. 2004 ; 286 : C779-C784
MEAN VALUES OF CONTINUOUS RISK FACTORS FOR HIGH BLOOD PRESSURE BY HYPERTENSION STATUS Risk factor ( Overall mean% n =300) Hypertensive Nonhypertensives mean% ( n =138) ( mean% n =162) P value
____________________________________________________________________________________ Age (years) 59.8
65.2
55.2
<0.001
BMI (kg/m2)
Waist circunf
28.6
103.2
29.6
104.8
27.8
101.9
0.002
0.008
Fasting glicemia
(mg/dL, mean) 100.2
107.0
94.3
<0.001
____________________________________________________________________________________
BMI, body mass index Bautista et al. J Hypertens 2001;19:857-861
CRUDE AND SEX AND AGE ADJUSTED PREVALENCE FOR HYPERTENSION BY C REACTIVE PROTEIN QUARTILES Bautista et al. J Hypertens 2001;19:857-861
TUMOR NECROSIS FACTOR ALPHA AND FLOW MEDIATED VASODILATATION López-Jaramillo et al. Rev Esp Cardiol. 2007;60:168-178
BLOOD PRESSURE AND C REACTIVE PROTEIN IN A HISPANIC PEDIATRIC POPULATION López-Jaramillo et al. Am J Hypertens 2008; 21: 527-532
PLASMA ASYMMETRIC DIMETHYLARGININE AND C-REACTIVE PROTEIN CONCENTRATIONS Garcia et al. Int J Cardiol 2007;127:176-178
INSULIN RESISTANCE: FOCUS ON SIGNALING PATHWAYS
BK NO BK 2 receptor Insulin Insulin receptor + IRS-1 +
NO Akt1 + PI3-K GLUT-4 biosynthesis + Glucose transport + + GLUT-4 trans location GLUT-4 AT 1 receptor Ang II Adapted from Henriksen EJ, Jacob S. J Cell Physiol. 2003;196:171 9
.
GLYCEMIA & CV EVENTS: META REGRESSION
3 3 2.5
2-hour glucose Fasting glucose 2.5
2 2 1.5
1.5
1 1 4 6 8 10 11 4 5 6 7 8 9 72 108 144 180 198 72 90 108 126 144 162 @ 2 hr G = 7.8 mM (140 mg%)… @ Fasting G = 6.1 mM (110 mg%)… RR=1.58 (1.19-2.10) RR=1.33 (1.06-1.67) After removal of any DM: p=0.0006 for 2 h G p=0.06 for FPG Coutinho M, Gerstein HC, et al. Diabetes Care. 1999;22:233-240.
DYSGLYCEMIA >> NORMOGLYCEMIA IN ACUTE AND STABLE CV DISEASE
• Consecutive pts: 2107 in-pts; 2854 out-pt elective CV consults in Europe (71% men; mean age 66) 100 % • OGTT/old DM in 1587 (75%) acute & 1857 (66%) elective pts before discharge or within 2 mo. 80 60 40 20
31% 15% 22% 3% 29% 30% 10% 22% 3% 35%
Known DM New DM IGT IFG NGT 0
Euro Heart Survey Bartnik et al; Eur Ht J 2004;1880 Acute Elective
DISGLICEMIA >> A NORMOGLICEMIA EN PACIENTES CON PRIMER INFARTO
• Grupo de estudio: 458 pacientes admitidos con un primer infarto agudo de miocardio en diferentes centros nacionales y 1 centro internacional (27.2 % mujeres, 72.8 hombres) 100 % 80 60 40 20
15,8% 17.7 % 11.3 % 15.1 % 9.49 % 30,4 % Leyendas
Antedecente DM DM de novo Glicemia Alterada en ayunas e intolerancia OG Intolerancia OG Glicemia alterada en ayunas Glicemia Normal 0
Pacientes IAM Lopez-Jaramillo et al. Journal of Diabetes 2011; 3 (Suppl 1): 73
HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011; 145:85-90
HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011;145:85-90
HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011; 145: 85-90
HYPERINSULINEMIA IS A PREDICTOR OF NEW CARDIOVASCULAR EVENTS Garcia et al. Int J Cardiol. 2011: 145: 85-90
REACTIVIDAD VASCULAR
Anillos de Arteria mamaria interna (2 a 3 mm) Curvas Dosis – Respuesta: •Cloruro Potásico (KCl) •Acetilcolina (ACh) •Fenilefrina (PE) •Nitropusiato Sódico (SNP) •Angiotensina II (AII)
Rueda-Clausen et al. Int J Cardiol 2010,139: 32-41
REACTIVIDAD VASCULAR
Rueda-Clausen et al. Int J Cardiol 2010,139: 32-41
PLASMA LEVELS OF LEPTIN AND ADIPONECTIN IN RELATION TO WAIST CIRCUNFERENCE Rueda-Clausen et al. Int J Cardiol 2010,139: 32-41
Epigenetic and Epigenomic
Published online: 17 May 2006 http://www.springerlink.com/content/j3tj16543664/
OBESITY AND METABOLIC SYNDROME ARE A NORMAL BIOLOGICAL RESPONSE TO AN ABNORMAL DEVELOPMENT OF SOCIETY
MECHANISMS POSSIBLY PARTICIPATING IN THE GENESIS OF METABOLIC SYNDROME AND CARDIOVASCULAR MORTALITY IN DEVELOPING COUNTRIES López-Jaramillo et al. Rev Esp Cardiol. 2007;60:168-178
MATERNAL MALNUTRITION AND FETAL PROGRAMMING ASSOCIATED WITH GREATER CV RISK IN ADULT LIFE López-Jaramillo P. Rev Esp Cardiol. 2009; 62: 670-676
POPULATION URBAN AND RURAL EPIDEMIOLOGY (PURE STUDY)
70 60 50 40 30 20 10 0 PURE: Prevalence of HTN by countries within economic regions and by urban vs. rural Urban Rural HIC UMIC LMIC LIC
HTN control amongst all PURE participants with HTN urban vs. rural
Country
All HIC All UMIC All LMIC All LIC
ALL countries
Urban
21.9
17.8
16.3
22.4
19.4
Rural
19.8
15.4
8.7
18.8
15.0
Overall
20.8
16.5
12.0
20.5
17.1
The Polypill Concept – A Strategy to Reduce CV Risk by More than 80%
•
For all people with established CVD
•
For people > 55 years independent of cholesterol and BP levels Wald NJ, Law MR. BMJ 2003;326:1419 Statin Thiazide BB ACEI/ARA II Metformin ?