Aging and Cardiovascular Disease - Case by gyvwpgjmtx

VIEWS: 7 PAGES: 13

									      Aging and
Cardiovascular Disease

 Marek Smieja, MD PhD FRCPC
Atherosclerosis and Cardiovascular Disease
   Cardiovascular Disease
• Heart attack (myocardial infarction)
   – Death, bypass surgery or coronary angioplasty
   – Heart failure, recurrent angina
• Stroke
   – Death
   – Disability: weakness, sensory, speech
• Renal: dialysis or transplant
• Peripheral vascular disease
   – Gangrene, infections
   – Impotence
     Heart Attacks increase with Age

            25
                  Adjusted* relative rate:
            20    1.32 (32%) / 5 years =
                     1.06 (6%) / year
            15

            10

            5

            0
Age group

Events            0     2      2    15    55    80   80    75    53   34     25     24    445
PYFU             275   2322   7408 18012 32551 30991 18600 12209 7583 4024   1916   1413 137310


                                               D:A:D study: Friis-Møller et al, NEJM, 2007
    Predicting Risk of Heart Disease
• Age
• Male

•   Smoking
•   Cholesterol
•   Blood pressure
•   Diabetes
                                      Observed and Predicted Heart Attack Rates


                                  8
Rates per thousand person years




                                  7
                                                                                                               Observed
                                  6                                                                              rates

                                  5                                                                                Best
                                                                                                                estimate of
                                  4                                                                              predicted
                                                                                                                  rates*
                                  3

                                  2

                                  1

                                  0
                                        None         <1            1-2         2-3        3-4             4+

                                                          Duration of cART exposure (years)

                                  *Framingham equation
                                                                                              Law et al, HIV Medicine, 2006
                                  Copenhagen Risk Score underpredicted by 40%
      …and now for the good news

• “Age as a modifiable risk factor”
  – Allen Sniderman
  – Years of risk factor acting, not age per se
  – Smoking, cholesterol, blood pressure
    damage arteries
  – Almost NO progression of disease in
    absence of risk factors
           Smoking and Heart Attacks
• Cui Qu (poster): 60% smokers vs. 20% Ontario

• Continue smoking: 3.0 X (90% lifelong!)
• Former smoking: 1.8 X             -DAD study

• Heavy smoking (>40 cig/day): 9.0 X
• Second-hand smoking:
   – 1-3 hours/day: 1.24 X
   – >3 hours/day: 1.62 X            -InterHeart

• Scotland smoking ban (NEJM 2008):
   – 17% decrease in MI (versus 3% in England)
   – 21% never smokers, 19% former smokers
        Cholesterol and Heart Attacks
• Total cholesterol, LDL (“bad”) cholesterol
  – Mediterranean Diet
  – Statins slow atherosclerosis, prevent heart attacks

• HDL (“good”) cholesterol protective
  – Lifestyle: smoking cessation, exercise
  – Drugs not very effective or even harmful

• Statin drugs most effective
  – No effect of Vitamin C, E, beta-carotene,
    B6/B12/folate, fish oils?
    Developing Canadian
Evidence-Based Guidelines on
  Cardiovascular Risk in HIV
       Marek Smieja
      Astha Ramaiya
        Greg Bondy
 Unrestricted educational grants from:
     Abbott, Astra-Zeneca, BI, BMS,
Gilead, GSK, Merck, Pfizer, Tibotec, CIHR
           Participants

• Marek Smieja      •   Jean-Guy Baril
• Astha Ramaiya     •   Julian Falutz
• Greg Bondy        •   Marianne Harris
                    •   Sean Hosein
• Jacques Genest    •   Mona Loutfy
• Allan Sniderman   •   Anita Rachlis
                    •   Linda Robinson
      Canadian Guidelines Summary
              Smieja et al, CAHR 2008
•  1. HIV is a weak cardiac risk factor (B-II)
•  2. Smoking main cause (A-II)
•  3. HAART: PI (B-II) > NRTI (C-II) > NNRTI
  – Starting & stopping HAART (B-II)
• 4. Screening-Framingham (B-II) + time on
      HAART (C-II)
• 5. Treatment-statins (A-I), switching (B-I)
      smoking cessation meds (A-I)
Solutions to Aging & Heart Disease: S&M
• Stop Smoking
   – Avoid all smoking including passive smoking
• Start Statins
   – Best data on large benefit, low risks
• Switch HIV therapies
   – Maximize viral load suppression,
   – Minimize lipid abnormalities
• Stress management
• Slim
• Sweat: (s)exercise
      &
• Mediterranean diet

								
To top