C

Global cardiometabolic risk*Gelfand EV et al, 2006; Vasudevan AR et al, 2005

Know your riskWorld heart day 2008-9-281.2.3.4.

12 34

Know your risk---1.2.483.4.

12 34

Know your risk1. 150mmHg2.260mg/dl3.103

----------------------- +--------------- ------------ ------------------ --------------

RR reduction 2-year event rateNone-----8.0%Aspirin25%6.0% B B25%4.5%Statin30%3.0%ACEI25%2.3%

10 yr CV riskRR reduction 20% 40% 55%

RAAS

/

2010

20101-3556527.8-11.0 mmol/L/ 6.1-6.9 mmol/LTC5.7mmol/L220mg/dLLDL-C> 3.3mmol/L 130mg/dLHDL-C

2010124 h

2010ARB & ACEI

2010

A. ACEIB. -C. D. E.

ACC/AHA STEMI2007 ,

ACC/AHA STEMI2007-- (ACEI):,LVEF40%STEMIACEI(/A);,(LVEF)ACEI(/B);ACEI(a/B)(ARB)LVEF40%ACEIARB(/A);ACEIARB(/B);ACEIARB(b/B):40%,ACEI,,(/A)

ACC/AHA STEMI2007 ,(ACS),(/A)

(/B)

---

Original Dean Ornish PlanFats (

The Traditional Healthy Mediterranean Diet PyramidCP1059685-222000 Oldways Preservation & Exchange Trust

Benowitz NL Prog Cardiovasc Dis 2003;46:91-111

-LDL/-ACEI/ARB

()

2007:ACEI10

2007ARB 5ARBLIFEARB13%25%SCOPEARB28% MOSESARB JIKEI HEARTARB139/81 mmHg131/77 mmHgARB40% VALUEARB

2007ARB1. ARB2. ARB22ARBACEI : ARB

2007ARB3. /ARBACEIARBACEI 4. /TIAACEIARB

2007ARB5. -ACEIARB6. 2~5ARBARBACEI7. MSARBACEI

ACCOMPLISHKaplan Meier for Primary EndpointCumulative event rateHR (95% CI): 0.80 (0.72, 0.90)Time to 1st CV morbidity/mortality (days)p = 0650526.0002INTERIM RESULTS Mar 08

1984-199977%Critchley J. Circulation, 2004;110:1236-1244250077%

1.61.620002000600023.59

TNTLDL-C77mg/dL*CHD LaRosa JC, et al. N Engl J Med. 2005,352()10mg LDL-C101mg/dL(2.6mmol/L)80mg LDL-C77mg/dL(2.0mmol/L)P

TNTLDL-C77mg/dLLaRosa JC, et al. N Engl J Med. 2005,35200.020.01P=0.0210mg LDL-C101mg/dL(2.6mmol/L)80mg LDL-C77mg/dL(2.0mmol/L)RR25%0.030.04()0123456

TNT5

AE = ; AST = ; ALT = ; ULN =

LaRosa JC, et al. N Engl J Med. 2005,352

TNTLDL-C

2008ACC/ADACVDLDL-C50mg/dL LDL-CLDL-CCVD LDL-C50mg/dLCVDJACC 2008;51(15):1512-1524

*(CHD)+ 1)2)

30%30% International Journal of Cardiology 2007;114:78-8232.5% Circulation 2003;108:2473-247831% Circulation 2004;110:928-93722% J Am Coll Cardiol 2002;40:904-910

Int J Cardiol. 2005 Jul 10;102(2):201-6

ESTABLISH20mgEarly statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: theESTABLISHStudy.Circulation. 2004;110:1061-1068n=24-13.1P0.0001n=24P=0.02768.7p0.00011050-5-10-15-20%

TNT- TNT

Dr. John La Rosa (Downstate)

John LaRosa, 2008 ESC Congress2345RRR (%)P95%CI1921

2004LDL-C

8.00.61.20.5

-----

2007ESC NSTE-ACSI IIa IIb III 160-325 mg () 75100 mg

A2007AHA/ACC NSTE-ACSI IIa IIb IIIA 75-162mg/

2007NSTE ACSClopidogrel: recommendations (ESC 2002) - ACS , Clopidogrel 9-12 ( I- B )

Clopidogrel: recommendations (ESC 2007) - 300mg75mg , Clopidogrel 12 ( I A ) .

ACS: +CURE: MI, Stroke, or CV Death*18%Relative Risk Reduction (P=0.015)20%Relative Risk Reduction (P=0.0025)

2007ESC NSTE-ACSI IIa IIb III 300mg75mg/ 12PCI600mg BAA2007AHA/ACC NSTE-ACS I IIa IIb IIIBAA300600mg75mg/ 300600mg75mg/GP IIb/IIIa300600mg75mg/11

Summary of Trials of Beta-Blocker TherapyPhase of TreatmentAcute treatmentSecondarypreventionOverallTotal No.Patients28,97024,29853,2680.512Relative risk (RR) of deathBeta blockerbetterRR (95% CI)Placebobetter0.87 (0.77-0.98)0.77 (0.70-0.84)0.81 (0.75-0.87)Antman E, Braunwald E. Acute Myocardial Infarction. In: Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A textbook of Cardiovascular Medicine, 6th ed., Philadelphia, PA: W.B. Sanders, 2001, 1168.

PCI & CABGSTEMI 12hNSTE-ACS

ACC/AHA Guidelines for Revascularization with PCI and CABG in Patients with Stable Angina (class I)1. CABG for patients with significant left main coronary disease (A)2. CABG for patients with triple-vessel disease. The survival benefit is greater in patients with abnormal LV function (ejection fraction

ACC/AHA Guidelines for Revascularization with PCI and CABG in Patients with Stable Angina (class I)5. PCI or CABG for patients with single- or double-vessel CAD without significant proximal LAD CAD but with a large area of viable myocardium and high-risk criteria on noninvasive testing (B) 6. CABG for patients with single- or double-vessel CAD without significant proximal LAD CAD who have survived sudden cardiac death or sustained ventricular tachycardia (C)7. In patients with prior PCI, CABG or PCI for recurrent stenosis associated with a large area of viable myocardium or high-risk criteria on noninvasive testing (C)8. PCI or CABG for patients who have not been successfully treated by medical therapy and can undergo revascularization with acceptable risk (B)

Stiell (2005) N Engl J Med