El Dr. Juan F. Ascaso, presidente de la Sociedad Española de la Arteriosclerosis (SEA), participa en el acto de presentación de la 'Jornada Galáctica sobre Guías de Lípidos y objetivos a alcanzar en los pacientes de más alto riesgo cardiovascular' (Málaga, 4-5 abril, 2014). Accede a la jornada completa en http://guiaslipidos.secardiologia.es

2. - 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

3. 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

4. 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

5. 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

6. - 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

7. - 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 Hypercholesterolemia
FCH Familial Combined Hyperlipidemia
FHFCH
0,5%
Juan F Ascaso

8. 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

9. - 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

10. - Diabetes
- Markedly elevated single risk factors
- Chronic kidney disease
- Association of risk factors
OB 25%
The Emerging Risk Factors Collaboration. Lancet 2011; 377: 1085–95
OW 50%
Juan F Ascaso

11. 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
Oddsratio(99%CI)
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

12.  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

13. Juan F Ascaso