The Renin-Angiotensin- Aldosterone System: Linking New Data and Mechanisms for Cardiovascular Risk Reduction VBWG.

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Presentation transcript:

The Renin-Angiotensin- Aldosterone System: Linking New Data and Mechanisms for Cardiovascular Risk Reduction VBWG

I.Scope of the problem II.Physiology of RAAS: Focus on angiotensin III.Role of RAAS modulation: Recent clinical trials CAD Diabetes ACEIs and ARBs IV.Management strategies for post-intervention in patients with CAD V.Appendix: Clinical guidelines Contents VBWG

Scope of the Problem VBWG

Coronary artery disease: Leading cause of hospitalization in the US Primary diagnosis Coronary atherosclerosis1$38.4 Acute MI2$27.8 Congestive HF (nonhypertensive) 4$21.8 Cardiac dysrhythmias8$14.3 Acute cerebrovascular disease9$13.9 AHA. Heart Disease and Stroke Statistics–2005 Update. $66.2 National bill (billions) Rank VBWG

Lifetime risk for CAD Lloyd-Jones D et al. Lancet. 1999;353: Women Men Age (years) Cumulative risk of CAD 0 Framingham Heart Study Lifetime risk at age 40 1 in 3 1 in 2 0 VBWG

Yusuf S et al. Lancet. 2004;364: Odds ratio for 1st MI (99% CI) Smk (1) DM (2) HTN (3) ApoB/A1 (4) –4All 4+ obesity All 4+ Psycho- social All Multiple risk factors raise the risk for MI INTERHEART Smk = smoking; DM = diabetes mellitus; HTN = hypertension; Apo = apolopoprotein VBWG

Lifetime risk of diabetes for individuals born in WhiteBlackHispanicOther races/ ethnicities Total* Narayan KMV et al. JAMA. 2003;290: Estimates based on National Health Interview Survey (1984–2000) Lifetime risk (%) Men Women *Weighted race/ethnic-specific values by proportion of nondiabetic US population in 2000 VBWG

Whiteley L et al. Diabetes Care. 2005;28: Diabetes as a CHD risk equivalent: Impact on mortality in women and men Years Women Men Diabetes/CHD Diabetes CHD No Diabetes/CHD Survival rate N = 7052 men, 8354 women; age 45–64 yrs, follow-up 25 years VBWG

Worldwide prevalence of diabetes expected to increase Diabetes prevalence >171 million in 2000 ~366 million in 2030 World Health Organization, 2000 vs July AfricaAmericasE MeditEuropeSE Asia W Pacific Diabetes prevalence (in millions) % +160% +181% +44% +155% +99% VBWG

–4445–64≥65 New and recurrent MIs (in thousands) Age (years) Men Women AHA. Heart Disease and Stroke Statistics–2005 Update. Over 1 million Americans will have an MI this year VBWG

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