Dislipemias
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Lo mejor del ACC 2015 (San Diego) Miércoles, 18/3/15 De 14:00 a 15:30 Casa del Corazón. Sociedad Española de Cardiología. http://acc15.secardiologia.es/ Dislipemias Dr. Juan Pedro Botet Servicio de Medicina Interna. Hospital del Mar, Barcelona
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Dislipemias
- 1. #PostACC15 Juan Pedro-Botet 18 Marzo a las 14:00h Casa del Corazón, Madrid La Sociedad Española de Cardiología en colaboración con MSD, presentan en directo
- 2. #PostACC15 Lipid Guidelines: Evolution, Revolution or Devolution Lipid Guidelines: Let’s Find Some Common Ground. Salim S. Virani ACC-AHA Cholesterol Guidelines – Where’s the Beef? Neil J. Stone Guidelines for the management of dyslipidaemias. No time for revolution (?) let’s stay the course. Alberico L. Catapano NLA Recommendations for Managing Dyslipidemia: A Patient-centered Approach Peter H. Jones MD CCS Guidelines: Identifying, Targeting and Managing Dyslipidemia: A Clinical Application of the CCS 2012 Dyslipidemia Guidelines. Paul Poirier Impact of New Prevention Guidelines on Care: Insights From PINNACLE Registry. Thomas M. Maddox
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- 12. #PostACC15 Reduction in Total (First and Recurrent) Cardiovascular Events with Ezetimibe/ Simvastatin compared with Simvastatin Alone post ACS in the I MPROVE-I T Trial Sabina A. Murphy, Christopher Cannon, Robert Giugliano, Michael Blazing, Thomas Musliner, Andrew Tershakovec, Jennifer White, Kelly Im, Naveen Deenadayalu, Haral Darius, Witold Ruzyllo, Andrew Tonkin, Uma Kher, Robert Califf, Eugene Braunwald On behalf of the IMPROVE IT Investigators
- 13. #PostACC15 Background: Cholesterol Lowering ➢ Previous statin trials have examined total events for comparing high-intensity vs moderate- intensity statins – PROVE-IT TIMI 22 – IDEAL ➢ Evidence from trials show reduction with high- intensity statins in total as well as first events post ACS ➢ IMPROVE-IT trial evaluated whether ezetimibe added to simvastatin would provide a clinical benefit compared with simvastatin therapy alone Murphy SA, et al. JACC 2009;54:2358–62 Tikkanen, MJ et al. JACC 2009;54:2353–7
- 14. #PostACC15 Number of Primary Endpoint Events 42315314 NFMI NF Stroke UA CVD Revasc NFMI NF Stroke UA CVD RevascTotal N=9545 First Event Additional Events
- 15. #PostACC15 Total Primary Endpoint Events 506 456 972 2297 5314 5th-14th event Fourth event Third event Second event First event Total N=9545
- 16. #PostACC15 Total Primary Endpoint Events 2742 2572 2241 1990 0 1000 2000 3000 4000 5000 #Events Ezetimibe Simvastatin Simvastatin Alone 4562 4983 Total Events RR 0.91 P=0.007 Additional Events RR 0.88 (0.79-0.98) 1st Event HR 0.936 P=0.016 -421 -251 -170
- 17. #PostACC15 Secondary EP: CHD death, MI , urgent revascularization Events 1448 1322 1222 981 0 1000 2000 3000 #Events Ezetimibe Simvastatin Simvastatin Alone 2303 2670 Total Events RR 0.85 P=0.002 Additional Events RR 0.79 (0.69-0.91) 1st Event HR 0.912 P=0.016 -367 -241 -126
- 18. #PostACC15 Total PEP Events by Type of Event 538 537 168 173 2481 2319 354 274 1442 1259 0 1000 2000 3000 4000 5000 NF MI NF Stroke Revascularization UA CV Death #Events Ezetimibe Simvastatin Simvastatin Alone 4562 4983 Total NF MI RR 0.87 p=0.004 Total NF Stroke RR 0.77 p=0.005
- 19. #PostACC15 Conclusions ➢ These data provide further support of the benefit of continuation of intensive combination lipid lowering therapy after a recurrent CV event ➢ Analyses of recurrent events are important as total events have implications: – Patient morbidity – Need for recurrent hospitalizations – Costs ➢ These considerations not always accounted for when analyzing first events only
- 20. #PostACC15 CONCLUSIONES Guías clínicas Nada nuevo. Cada uno sigue en sus 13. PCSK9 (estudios OSLER 1 y 2) La reducción de cLDL con fármacos no estatinas se acompaña de beneficios clínicos. Concentraciones de cLDL muy bajas (< 25 mg/dl) se han mostrado seguras. IMPROVE-IT Disminución no sólo del 1º episodio, sino del nº total de ECVs. Los beneficios clínicos son independientes de la concentración basal de cLDL y de la estrataificación según el REACH score para predecir futuros ECVs.
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