guia aha/acc stroke 2014
TRANSCRIPT
DR. ROBERTO MEDINA R3 MEDICINA INTERNA
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
TIA / STROKE
• Mas de 690 mil casos anuales de ICTUS EE.UU
• Mas de 240 mil casos anuales de TIA EE.UU
• Riesgo de ICTUS después de un TIA o ICTUS previo es 3-4% anual
historica %
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Definiciones
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Ictus
Isquemico
Aterosclerosis de grandes
vasos
cardioembólica
Causas secundarias e
indeterminadas
Enfermedad de pequeños vasos
• TIA
• vs
• ICTUS
Objetivos
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Novedades
• Nuevos factores de riesgo: Apnea del sueño, aterosclerosis arco aórtico, nutrición, pre-diabetes.
• Revisión FA, estenosis carotidea, válvulas protésicas cardiacas con relación a AHA y ACC
• Consideración del ¨infarto cerebral silente¨
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack, Stroke AHA ,May 1, 2014
Secciones• Hipertensión
• Dislipidemia
• Diabetes mellitus
• Obesidad
• Inactividad física
• Nutrición
• Apnea del sueño
• Tabaco
• Alcohol
• Enfermedad carotidea
• Embarazo
• Aterosclerosis intracraneal
• Fibrilación auricular
• Miocardiopatía
• Enfermedad valvular
• PFO
• Homocisteinemia
• Antiagregantes plaquetarios
• Hipercoagulación
• Anticuerpos antifosfolipidos
• Falcemia
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Hipertensión Arterial
78 millones de estadounidenses sufren de HTA
Objetivo preventivo mas importante
Prevalencia HTA/ICTUS reciente 70%
Walter N. Kernan et, al Guidelines for the Prevention of Strokein Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Placebo vs perindopril+indapamida
Capp Trial
Lennart Hansson, Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality inhypertension: the Captopril Prevention Project (CAPPP), THE LANCET • Vol 353 • February 20, 1999
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Dislipidemia
La “ACC/AHA Guideline on the Treatment of Blood
Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in
Adults” fue lanzada en el 2013
Reemplaza la ATP III
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Trastornos del metabolismo de la glucosa
• Notable aumento
tanto en países
desarrollados como
en vía de desarrollo
• 11.3% de adultos EEUU
Actualmente Dx.
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke
AHA ,May 1, 2014
Px. con ictus isquémico reciente uso del activo RR 45% con relacion a placebo
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
ObesidadIMC mayor 30kg/m2
Factor de riesgo asociado
a dislipidemia, SM, DM y HTA
Relacion lineal:
IMC/ACV= 1kg/m2=5% ACV
Obesidad central/ACV
Px. ACV o AIT=Dx. 18-44% obesos
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,StrokeAHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Inactividad física
2013 AHA/ACC Guideline on Lifestyle Management to ReduceCardiovascular Risk
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Nutrición
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Enfoque: Desnutrición/equilibrio de micronutrientes/dieta óptima
Prevalencia 8-13% niveles de vit D/K Pescado/hortalizas/mediterranea
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack, Stroke AHA ,May 1, 2014
• Apnea del sueño
¾ de Px. con Ictus
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Enfermedad carotidea
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Figure
Data from the North American Symptomatic Carotid Artery Trial (NASCET)
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Aterosclerosis intracraneal
Causa mas importante de AIT/ICTUSSin diferencias significativas
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke
AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Fibrilación auricular• Afecta mas de 2.7 millones en EE.UU
• A mayor edad mayor prevalencia/ arritmia mas frecuente en los ancianos
• Responsable de mas de 70 mil ictus isquémico por año en EE.UU (10%)
• Estimación riesgo
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Eficacia de la anticoagulaciónWarfarina:
EAFT
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
ACTIVE-W TRIAL
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
NUEVOS ANTICOAGULANTES?
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke
AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014
Walter N. Kernan et, al Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack,Stroke AHA ,May 1, 2014