1. HEALTH TIPS
Living longer
OC and stronger
kkm
Using drugs like
2 aspirin, statins and
ace inhibitors
By Dr. K. K. Mahajan
2. Continuum of Patients at Risk for a
CHD Event
L003
Post MI/Angina
Secondary
Prevention
Other Atherosclerotic
Manifestations
Subclinical Atherosclerosis
Primary
Preventio
Multiple Risk Factors
n
PRIMORDIAL Low Risk
PREVENTION
Courtesy of CD Furberg.
3. Living longer and stronger
L004
SECONDARY PREVENTION measures
taken to reduce death and disability after an
event like stroke or heart attack.
OC Primary prevention is to prevent the
kkm adverse events from happening in high risk
patients. Like statins , aspirin in high risk for
heart attack patients.
Primordial prevention is to adopt healthy
life style per se before you are labeled high
risk.
4. Living longer and stronger
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Following medicines have been shown TO
REDUCE RISK OF C.V.EVENTS IN HIGH RISK
PATIENTS.
ASPIRIN
OC
ACE INHIBITORS LIKE LISINOPRIL, RAMIPRIL
STATINS LIKE LIPITOR
kkm
Ask your doctor as to your risk status and need
for such medicines. Don't start them on your own.
WE FOCUS ON PREVENTIVE MEDICINE .
Wellness visits for Medicare patients are designed
to assess these and other preventive screening and
interventions. There is no copay for such annual
visits.
5. Aspirin in
Primary Prevention of IHD
L006 oc
kkm
Physician Health Study*
ASA reduced 1st MI by 44%
(absolute risk 0.2 vs 0.4 %/yr)
benefit only for those age 50
increased risk of hemorrhagic stoke and GI bleed
*NEJM 1989; 321:129-135. ** BMJ 198824;296:313-316. *** Lancet 1998;351:233-241.
6. ACE INHIBITORS-HIGH RISK CVD PATIENTS -
HOPE Trial – PRIMARY PREVENTION
– L007
Ramipril 10 mg / day
Risk reduction
CVD Death 26 %
Non fatal MI 20%
Stroke 32%
CABG/PTCA 15%
New onset D.M. 34%
Can cause cough, angioedema etc as
adverse events
7. AFCAP/TEXCAP - STATINS REDUCE CHD RISK –
PRIMARY PREV. – L008
180 12 Placebo
37% Lovastatin
10.9
# Per 100 Patients
160 10
156 25% ** **P < .001
mg/dL
8
140 ** 6.8
6
120
115 4
100 2
n=3301 n=3304 n=3301 n=3304
80 0
LDL-C at 1 Year Incidence of Major
CHD Event
Downs JR et al. JAMA. 1998;279:1615-1622.
8. SECONDARY PREVENTION WITH
STATINS
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The 4S, LIPID and CARE trials
demonstrated that long-term intervention with statins
therapy reduces mortality and recurrent ischemic
cardiovascular events in patients with stable coronary heart
disease.
The duration of follow-up of these studies was
5.4 years for 4S,
6.1 years for LIPID and
5.0 years for CARE.
References
8. Scandinavian Simvastatin Survival Study Group. Lancet 1994;344:1383–1389.
9. Sacks FM et al. N Engl J Med 1996;335:1001–1009.
10. The long-term intervention with pravastatin in ischaemic disease (LIPID) study group. N
Engl J Med 1998;339:1349–1357.
14. Schwartz GG et al. Am J Cardiol 1998;81:578–581.
