- Know CVD

- Type 2 diabetes mellitus o Type 1 with microalbuminuria.

- Markedly elevated single risk factors (HF, severe hypertension,…)

- Chronic kidney disease

- Score of high risk

2003 Framingham and ATPIII 10-year risk of CVD event of ≥20%

2012 SCORE (European Societies) 10-year risk of CVD death of ≥5%

2013 IAS Estimation of total CVD morbidity by age 80 ≥45%

2013 ACC/AHA estimated 10-year ASCVD risk ≥7.5%

(40 to 75 years of age with LDL-C ≥70 mg/dL)Juan F Ascaso

0

10

20

30

40

50

60

70

80

90

100

Categoría 1

High

Intermediate

Low

CVR

20,0

60,7

19,3

European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice, aged 50-65 years free of diabetes and not receiving lipid-lowering therapy

EURIKA Eur J Prev Cardiol 2013 Juan F Ascaso

Population

Intermediate Risk

No event Intermediate Risk

Event

High Risk

Death

Death

High Risk

High Risk

Modified. Perman G et al. Cost Eff Resour Alloc. 2011; 9: 4. Juan F Ascaso

No event

Event

High Risk

Death

Death

Europa Risk SCORE 1-4

USA 40-75 y, LDL-C 70-189 mg/dL, Risk 5-7,5

is modulated by

- Family history of premature CVD, which is considered to increase the risk by 1.7-fold in women and by 2.0-fold in men.

- Abdominal obesity- Physical activity pattern, - Low HDL-C and high TG, - hs-CRP, - Lp(a), - Fibrinogen,- Homocysteine, - Apo B,- Social class.Conversely, risk may be lower than indicated in those with very high HDL-C levels or a family history of longevity.

- LDL–C ≥160 mg/dL or other evidence of genetic hyperlipidemias

- Family history of premature ASCVD in a first degree relative, with onset <55 y in male or <65 y in female

- Hs-CRP >2 mg/L - CAC score ≥300 Agatston units or ≥75

percentile for age, sex, and ethnicity, - Ankle-brachial index <0.9, - Elevated lifetime risk of ASCVD. - Additional factors may be identified in the

future.

Juan F Ascaso

- Diabetes

- Markedly elevated single risk factors

- Chronic kidney disease

- Association of risk factors

Huxley, R. et al. BMJ 2006;332:73-78

14%

Juan F Ascaso

- Diabetes

- Markedly elevated single risk factors

- Chronic kidney disease

- Association of risk factors

Versmissen J et al. BMJ 2008;337:a2423.Skoumas et al. Circ J 2013; 77:163-8

2%

HF Familial HypercholesterolemiaFCH Familial Combined Hyperlipidemia

FHFCH

0,5%

Juan F Ascaso

9,8% 56.6% women mean age, 57.1 y

- Diabetes

- Markedly elevated single risk factors

- Chronic kidney disease

- Association of risk factors

IDHOCO. PLoS Med. 2014; 11(1): e1001591

≥160/≥100 mm HgSevere hypertension

Juan F Ascaso

- Diabetes

- Markedly elevated single risk factors

- Chronic kidney disease

- Association of risk factors

7,0% eGFR <60

Di Angelantonio et al. BMJ 2010;341:c4986

0,2%,eGFR <45

>45 y

Juan F Ascaso

- Diabetes

- Markedly elevated single risk factors

- Chronic kidney disease

- Association of risk factorsOB 25%

The Emerging Risk Factors Collaboration. Lancet 2011; 377: 1085–95

OW 50%

Juan F Ascaso

Modified. INTERHEART Study. Lancet 2004; 364: 937-972

51

225

612

864

32

16

8

4

2

1

(1) (2) (3) (4)Smk DM HTN ApoB/A 1+2+3 All4 +Obes +PS AllRFs

Od

ds

rati

o (

99

%C

I)

2.9(2.6-3.2) 2.4

(2.1-2.7)1.9

(1.7-2.1)

3.3(2.8-3.8)

13.0(10.7-15.8)

42.3(33.2-54.0)

68.5(53.0-88.6)

182.9(132-252)

333.7(230-483)

In 27 000 participants from 52 countries in INTERHEART

Juan F Ascaso

ECV aterosclerosa, especialmente EC, es la primera causa de

muerte prematura en todo el mundo.

ECV afecta a hombres y mujeres.

En europeos <75 años la ECV representa:

- El 42% de todas las causas de muerte en mujeres

- El 38% de todas las causas de muerte en hombres

Eur Heart J 2012

La reducción de la mortalidad por ECV se relaciona con una

intervención adecuada con

- cambios en el estilo de vida

- tratamiento farmacológico

Juan F Ascaso

Juan F Ascaso