C. Guijarro 3

CAUSAS DE MUERTE
EN ESPAÑA 2011
INE 2013
Gracias por su atención
From: Effect of Long-Term Exposure to Lower Low-Density Lipoprotein Cholesterol Beginning Early in Life on
the Risk of Coronary Heart Disease: A Mendelian Randomization Analysis
24%
54%
J Am Coll Cardiol. 2012;():. doi:10.1016/j.jacc.2012.09.017
Figure Legend:
Comparative CHD Risk Reduction of Earlier and Later LDL-C Lowering Boxes represent the summary point estimate of the OR for
the association between each unit lower LDL-C and the risk of CHD, for both meta-analyses combining data from Mendelian
randomization studies adjusted per unit lower LDL-C and meta-analyses of statin trials adjusted per unit lower LDL-C. Bars
represent 95% CI. See Online Appendix for details.
Statins for the primary prevention of cardiovascular disease
(Review)
Authors’ conclusions
Reductions in all-cause mortality, major vascular events and
revascularisations were found with no excess of cancers or muscle pain
among people without evidence of cardiovascular disease treated with
statins.
Taylor F, et al. Cochrane Database Syst Rev. 2013;1:CD004816.
Efficacy and safety of more intensive lowering of LDL
cholesterol: a meta-analysis of data from 170 000 participants
in 26 randomised trials
Cholesterol Treatment Trialists’ (CTT) Collaborators*
CGH 2010
The Lancet 2010 Nov
DOI: 10.1016/S0140-6736(10)61350-5
Efficacy and safety of more intensive lowering of LDL
cholesterol: a meta-analysis of data from 170 000 participants
in 26 randomised trials
Cholesterol Treatment Trialists’ (CTT) Collaborators*
CGH 2010
The Lancet 2010 Nov
DOI: 10.1016/S0140-6736(10)61350-5
+20
Meta-regression analysis CHD (nonfatal AMI + CHD
death). Relationship Between % cholesterol reduction
and Event Rates
Non-statin Trials
Statin Trials
VA-HIT Veterans Affairs High-Density Lipoprotein Intervention Trial; LRC-CPPT, Lipids Research Clinics Coronary Primary Prevention Trial;
A to Z, Aggrastat to Zocor; CDP, Coronary Drug Project; HHS, Health and Human Services; CARE, Cholesterol and Recurrent Events;
POSCH, Program on the Surgical Control of the Hyperlipidemias; ASCOT-LLA, Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm;
LIPS, Lescol Intervention Prevention Study; 4S, Scandinavian Simvastatin Survival Study.
Davidson: Circulation, Volume 111(18).May 10, 2005.2280-2281.
Association between change in high density lipoprotein
cholesterol and cardiovascular disease morbidity and
mortality: systematic review and meta-regression analysis
• 108 ensayos clínicos aleatorizados
• 299 310 pacientes
• Tratamientos modificadores de lípidos
–
–
–
–
–
–
–
Estatinas (62)
Fibratos (9)
Acidos grasos omega 3 (9)
Hormonas (9)
Combinaciones con niacina (6)
Dieta / cirugía (5)
Otros (glitazonas, probucol, inhibidores de la ACAT,
resinas, probucol, torcetrapib)
BMJ 2009;338:b92
Association between change in high density lipoprotein
cholesterol and cardiovascular disease morbidity and
mortality: systematic review and meta-regression analysis
20
Univariado
Bivariado
Multivariado
Cambio en riesgo coronario (%)
15
10
5
0
-5
LDL
HDL
-10
-15
ENF CORONARIA
-20
∆ 10% cLDL
BMJ 2009;338:b92
∆ 10% cHDL
Association between change in high density lipoprotein
cholesterol and cardiovascular disease morbidity and
mortality: systematic review and meta-regression analysis
BMJ 2009;338:b92
HTA y enfermedad Coronaria
cuanto más alto peor
256
Age at Risk (Y)
80-89
128
70-79
64
60-69
32
50-59
16
40-49
8
4
2
1
0
120 140 160 180
Usual Systolic BP (mm Hg)
Ischemic Heart Disease Mortality
Ischemic Heart Disease Mortality
Ischemic Heart Disease Mortality
256
Age at Risk (Y)
80-89
128
70-79
64
60-69
32
50-59
16
40-49
8
4
2
1
0
70 80 90 100 110
Usual Diastolic BP (mm Hg)
BP=Blood pressure
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913
HTA y mortalidad por ictus
BP=Blood pressure
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913
HTA y mortalidad
cardiovascular
Stroke
80-89
256
128
70-79
128
64
60-69
64
32
50-59
256
16
40-49
8
4
Stroke Mortality
Ischemic Heart Disease Mortality
CHD
4
1
0
0
180
Usual Systolic BP (mm Hg)
50-59
8
1
160
60-69
16
2
140
70-79
32
2
120
80-89
120
140
160
180
Usual Systolic BP (mm Hg)
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913
The J-curve phenomenon and the treatment of
hypertension.
Farnett L, JAMA 1991;265:489–495.
OBJETIVOS DE PRESIÓN ARTERIAL PARA EL
TRATAMIENTO DE LA HIPERTENSIÓN
BP < 135/85 vs BP < 140-160/90-100, Outcome 8 Major
CV events.
The Cochrane Library, 2009 Issue 3 Art no. CD004349
OBJETIVOS DE PRESIÓN ARTERIAL PARA EL
TRATAMIENTO DE LA HIPERTENSIÓN
BP < 135/85 vs BP < 140-160/90-100,.
CV
mortality
AMI
Stroke
The Cochrane Library, 2009 Issue 3 Art no. CD004349
Reappraisal of European guidelines on hypertension
management: a ESHTask Force document
Journal of Hypertension 2009, 27:2121–2158
CV Mortality
CV Events
HOT Outcomes by
Target Blood Pressure Group*
138.5
82.6
 85
86.5
 80
138.8
Hansson L, et al. Lancet. 1998;351:1755–1762.
Atorvastatin increases expression of NPC1L1 & PCSK9
in hyperlipidemic men
Journal of Lipid ResearchMarch 2011 vol. 52 no. 3 558-565
Statin Use and Reduced Cancer-Related Mortality
N Engl J Med 2012; 367:1792-1802
Effect of ERN/LRPT on MAJOR VASCULAR EVENTS
Patients suffering events (%)
20
Risk ratio 0.96 (95% CI 0.90 – 1.03)
Logrank P=0.29
15
15.0%
14.5%
10
Placebo
ERN/LRPT
5
0
0
1
2
Years of follow-up
3
4