欧洲和中国心脏调查预后和潜在的治疗意义-英文课件.ppt
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1、,10th South China International Congress of Cardiology ACE trial symposium Prognostic and potential therapeutic implications of the European and China Heart surveys,Lars Rydn Karolinska Institutet Stockholm, Sweden,Implications of the European and China Heart Surveys,European Guidelines on Diabetes,
2、 prediabetes and Cardiovascular Disease may be downloaded from http:/www.escardio.org http:/www.easd.org,Implications of the European and China Heart Surveys,Diabetes and prediabetes is more common among patients with coronary artery disease than imagined,GAMI1 n=164,34%,35%,31%,(1. Norhammar et al.
3、 Lancet. 2002;359:21404),Dysglycemia and coronary artery disease Glucometabolic category by OGTT in patients without known perturbations,DM,IGT,IFG,Normal,OGTT,OGTT,FPGWHO,FPGADA,0,20,40,60,80,100,%,WHO 1999 criterion (FPG 6.1 mmol/l),ADA 2003 criterion (FPG 5.6 mmol/l),% of all with OGTT,(Bartnik,
4、Rydn et al Heart 2007; 93:72),Dysglycemia and coronary artery disease Classification according to FPG or OGTT,Mortality in CVD Relation to fasting and postprandial glycemia in patients without diabetes,0,0.5,1,1.5,2,2.5,6.1,6.1- 6.9,7.0- 7.7,7.8,7.8,7.8-11.0,11.1,Fasting glucose (mmol/L),OGTT (mmol/
5、L),Relative risk,Adjusted for age, gender and area,(The DECODE study group Lancet 1999; 354:617),Guideline recommendations,Diabetes and prediabetes is more common among patients with coronary artery disease than imagined Newly detected dysglycemia relates to impaired prognosis,Implications of the Eu
6、ropean and China Heart Surveys,RR 1995-1998 =1.42 RR 1999-2002 =1.31,1995 1996 1997 1998 1999 2000 2001 2002,Year,Mortality (%),30 20 10 0,No,Yes,The Swedish CCU registry 1995 - 2002,Time trends in 1-year mortality in patients with AMI ),Patients with (n= 14 873) and without (n=50 009) diabetes From
7、 the Swedish National Registry for MI,Diabetes,(Norhammar et al Heart J 2007; 93:1577 ),OGTT at discharge (n= 168),Abnormal 67%,Follow-up time (months),0,Normal,Abnormal,Probability of event free survival,two-sided p = 0.002,10,20,30,40,50,Time to Major Cardiovascular Event,0.0,0.8,0.7,1.0,0.9,GAMI
8、- major cardiovascular events,(Bartnik et al Europ Heart J 2004; 25:1990),Glucometabolic state,Euro Heart Survey diabetes and the heart Survival in relation to glucometabolic state,(Lentzen et al Europ Heart J 2006; 27:2969),Known DM,New DM,1.00,0.94,0.96,0.98,0,100,200,400,300,Follow up time (days)
9、,0.92,Normal,IGT,Log rank test p 0.001,Survival probability,Glucometabolic state,Guideline recommendations,Implications of the European and China Heart Surveys,Diabetes and prediabetes is more common among patients with coronary artery disease than imagined Newly detected dysglycemia relates to impa
10、ired prognosis A multifactorial risk factor management important,Dysglycemia and cardiovascular risk a continuum,80,60,40,30,10,5,80,60,40,30,10,5,Systolic blood pressure (mm Hg),Serum cholesterol (mmol/L),No diabetes,Diabetes,110,120,130,140,150,160,4,5,6,7,Ten-year CHD mortality (per 1000),(Stamle
11、r et al Diabetes Care 1993; 16:434),Multifactorial intervention in type 2 diabetes The Steno 2 study - 8 year follow up,(Gaede et al New Engl Med 2003; 348:383),Study protocol,Project team every 3 months Strict therapeutic targets Behavioural modification fat 30% (satur 10%) exercise 30 min x3-5/wee
12、k smoking cess courses Vitamin supplementation Stepwise introduced drugs Hypoglycemic regimen according to strict rules,By their GP Guidelines by Danish Med Ass 1998 & 2000 Referral if needed n = 53 (average 3 times/pat),Intensive treatment,Conventional treatment,Multifactorial intervention in type
13、2 diabetes The Steno 2 study 8 year follow up,(Gaede et al New Engl Med 2003; 348:383),Management principles,Multifactorial intervention in type 2 diabetes The Steno 2 study 8 years of follow up,Composite endpoint CV-death, MI or stroke, CABG or PCI, limb amputation or vascular surgery,(Gaede et al
14、New Engl Med 2003; 348:383),Microvascular,Mortality,4 years,13 years,n=80,n=80,n=160,Microvascular,Mortality,4 years,13 years,Macrovascular,8 years,Macrovascular,8 years,Primary endpoint,1993,1997,2001,2006,Multifactorial intervention in type 2 diabetes The Steno 2 study 13 years follow up,Conventio
15、nal,Intensive,Extendend study protocol,(Gaede et al New Engl J Med 2008; 358: 580 ),Impact of intensive therapy on OR 95% CI ARR p-value All-cause mortality 0.54 0.32-0.89 20% 0.015 Cardiovascular mortality 0.43 0.19-0.94 13% 0.036 Major cardiovascular events 0.41 0.25-0.63 29% 0.001,Multifactorial
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- 欧洲 中国 心脏 调查 预后 潜在 治疗 意义 英文 课件
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