things we knew, things we did… things we have learnt, things we should do lipid management in...
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Things we knew, things we did… Things we have learnt, things we should do
LIPID MANAGEMENT IN PRIMARY CARE: HOW WELL DO WE DO?
Dr. Carlos BrotonsResearch Unit
Sardenya Primary Health Care CenterBarcelona- Spain
International Congress of Medicine for Everyday Practice
Things we knew, things we did… Things we have learnt, things we should do
Things we knew, things we did… Things we have learnt, things we should do
50%
SBPSBP >115 mm >115 mm
HgHg
31%
Cholesterol>4.5 mmol/L
World Health Report 2002; available at: http://www.who.int/whr/2002/en/
Joint effects of risk factors on CVD risk burden worldwide
CVD = cardiovascular disease
Tobacco 14%
Things we knew, things we did… Things we have learnt, things we should do
Things we knew, things we did… Things we have learnt, things we should do
• 45% OF MI IN WESTERN EUROPE AND 35% OF MI IN CENTRAL AND EASTERN EUROPE ARE DUE TO ABNORMAL LIPIDS
• PATIENTS WITH ABNORMAL LIPIDS ARE AT OVER THREE TIMES THE RISK OF MI COMPARED TO THOSE WITH NORMAL LIPIDS
Things we knew, things we did… Things we have learnt, things we should do
Things we knew, things we did… Things we have learnt, things we should do
Efficacy and safety of cholesterol-lowering treatment:prospective meta-analysis of data from 90056 participantsin 14 randomised trials of statins
Cholesterol Treatment Trialists’ (CTT) Collaborators*Lancet 2005; 366;1267-78
Things we knew, things we did… Things we have learnt, things we should do
Things we knew, things we did… Things we have learnt, things we should do Shalev V, et al. Arch Intern Med 2009;169:260–8
229,918 patients enrolled in a HMO in Israel Initiated statins for primary and secondary prevention of CVD
in 1998 through 2006PDC with statin was recordedFollow-up means 4–5 yrsPrimary outcome: total mortality
PDC = proportion of days covered
Things we knew, things we did… Things we have learnt, things we should do
Primary prevention: mortality reduction versus PDC With statin1.6
1.2
1.0
0.8
0
Haz
ard
Rat
io
Any follow-upFollow-up >1 yearFollow-up >5 year
<10[Ref]
1.4
0.6
0.4
0.210–19
19–29
30–39
40–49
50–59
60–69
70–79
80–89
≥90
Shalev V, et al. Arch Intern Med. 2009;169:260–8
PDC with statins (%)
Things we knew, things we did… Things we have learnt, things we should do
Mortality reduction with statins in the ‘real world’
When comparing statin PDC >90% versus PDC <10%, there was a 40–50% reduction in mortality in primary and secondary prevention groups
Benefits in ‘real world’ clinical practice exceed those seen in clinical trials
Emphasises the importance of promoting statin therapy to a wider group of at risk people and the need to continued therapy
Shalev V, et al. Arch Intern Med. 2009;169:260–8
Things we knew, things we did… Things we have learnt, things we should do
Cardioprotective drug treatment across the EUROASPIRE surveys
Patients with CHD EUROASPIRE I (%) EUROASPIRE II (%)
EUROASPIRE III (%)
Antiplatelet therapies 80.8 83.6 93.2
Beta blockers 56.0 69.0 85.5 BPlowering drugs 84.5 90.6 96.8 All lipid-lowering drugs 32.2 62.7 88.8 Kotseva K, Lancet 2009; 373: 929-940.
Things we knew, things we did… Things we have learnt, things we should do
Things we knew, things we did… Things we have learnt, things we should do
Proportion of patients attaining LDL-C target levels in each country.
Waters DD, et al Circulation 2009;120:28-34
Things we knew, things we did… Things we have learnt, things we should do
Proportion of patients attaining LDL-C target levels in each country according to risk group.
Waters DD, et al Circulation 2009;120:28-34
Things we knew, things we did… Things we have learnt, things we should do
Prevalence of ATP III Risk Categories and Lipid lowering treatment in the United Sates
(NHANES, 1999-2006)
0
10
20
30
40
50
60
70
1999-2000 2001-2002 2003-2004 2005-2006
High Risk
IntermediateRisk
Low Risk
Using lipid-lowering drug
Kuklina, E. V. et al. JAMA 2009;302:2104-2110
Things we knew, things we did… Things we have learnt, things we should do
Trends in High Levels of LDL-C in the United States(NHANES, 1999-2006)
0
5
10
15
20
25
30
35
1999-2000 2001-2002 2003-2004 2005-2006
Total
Eligible forTLC
Eligible fordrug(receiving)
Eligible fordrug (Notreceiving)
Kuklina, E. V. et al. JAMA 2009;302:2104-2110
Things we knew, things we did… Things we have learnt, things we should do
Trends in Mean Levels of LDL-C levels in the United Sates
(NHANES, 1999-2006)
108
110
112
114
116
118
120
122
124
126
128
1999-2000 2001-2002 2003-2004 2005-2006
Mean levels
Kuklina, E. V. et al. JAMA 2009;302:2104-2110
Things we knew, things we did… Things we have learnt, things we should do
CONCLUSIONS
65% of CV risk can be attributed to the joint effects of high blood pressure, dislipidemia and tobacco.
About 40% of MI in Europe are due to abnormal blood lipids
Statins use is associated with large reductions in the risk of major CV events
Lipid lowering therapy is being applied now much successfully although there is room for improvement
Mean LDL-c levels is decreasing at population level
S
Things we knew, things we did… Things we have learnt, things we should do
Questions? ~ Answers!
International Congress of Medicine for Everyday Practice
Things we knew, things we did… Things we have learnt, things we should do
¿Cuestiones? ~ ¡Respuestas!
International Congress of Medicine for Everyday Practice