Therapeutic Strategies in Cardiovascular Risk

Contents......Page 6
Contributors......Page 8
Introduction......Page 12
REFERENCES......Page 13
BACKGROUND......Page 16
THE RATIONALE FOR THE PREVENTION OF CARDIOVASCULAR DISEASES......Page 17
CRITERIA FOR CAUSALITY......Page 18
TOTAL OR GLOBAL RISK......Page 19
RISK ESTIMATION AT THE EXTREMES OF AGE......Page 21
THE ISSUE OF BLOOD SUGAR AND DIABETES......Page 23
UTILITY – RISK PREDICTION SYSTEMS AND GUIDELINES......Page 24
REFERENCES......Page 25
INTRODUCTION......Page 28
THE PIONEERS......Page 29
RISK ESTIMATION SYSTEMS: THE EARLY DAYS......Page 31
AUTOMATION......Page 32
SIMPLIFICATION......Page 34
THE FIRST EUROPEAN TASK FORCE RISK CHART......Page 35
KEY QUESTIONS IN DEVELOPING A RISK ASSESSMENT SYSTEM......Page 37
Availability of data......Page 38
Clinically appropriate measurements: diabetes and acute CHD......Page 39
More and more risk factors – better and better risk estimation?......Page 40
Single measurements versus clinical practice: regression dilution bias......Page 41
STATISTICAL METHODS......Page 42
Data mining, neural networks and other complex models......Page 44
Sparse data......Page 45
Assessment of goodness of fit......Page 46
RELATIONSHIP WITH THERAPEUTIC GUIDELINES......Page 47
ACKNOWLEDGMENTS......Page 48
REFERENCES......Page 49
INTRODUCTION......Page 52
DEATH AS AN ENDPOINT......Page 53
NON-FATAL ENDPOINTS......Page 54
COMPOSITE ENDPOINTS AND SHIFTING ENDPOINTS IN TRIALS......Page 56
FUTURE CHALLENGES......Page 57
REFERENCES......Page 58
CLASSICAL RISK ASSESSMENT......Page 60
BETTER BIOCHEMICAL MARKERS OF RISK......Page 61
FAMILY HISTORY AND MOLECULAR GENETIC ANALYSIS......Page 62
Genotypic or phenotypic disease definitions?......Page 63
Uses of molecular genetic analysis......Page 65
REFERENCES......Page 66
THE GLOBAL BURDEN OF CARDIOVASCULAR DISEASE......Page 70
LEFT VENTRICULAR HYPERTROPHY......Page 72
AORTIC STIFFNESS......Page 73
HYPERTENSION......Page 74
HYPERCHOLESTEROLAEMIA......Page 75
HYPERHOMOCYSTEINAEMIA......Page 76
UNDER-TREATMENT AND INVESTIGATIONS OF RISK FACTORS IN THE ELDERLY......Page 77
ACUTE CORONARY SYNDROME, STROKE AND HEART FAILURE......Page 78
ATRIAL FIBRILLATION......Page 79
DEMENTIA......Page 80
Neuropathology......Page 81
REFERENCES......Page 82
OVERWEIGHT, OBESITY AND CARDIOVASCULAR DISEASES......Page 88
WEIGHT GAIN AND CARDIOVASCULAR DISEASES......Page 89
PHYSICAL ACTIVITY AND CARDIOVASCULAR DISEASES......Page 91
PHYSICAL ACTIVITY AND CARDIOVASCULAR DISEASE IN PATIENTS WITH TYPE 2 DIABETES......Page 92
INSULIN RESISTANCE AND CORONARY HEART DISEASE OR CARDIOVASCULAR MORTALITY......Page 94
INSULIN RESISTANCE AND STROKE......Page 96
THE METABOLIC SYNDROME AND CARDIOVASCULAR MORTALITY......Page 97
IMPAIRED GLUCOSE TOLERANCE AND CORONARY HEART DISEASE OR CARDIOVASCULAR MORTALITY......Page 98
DIABETES AND CORONARY HEART DISEASE OR CARDIOVASCULAR MORTALITY......Page 99
GENDER DIFFERENCE IN CARDIOVASCULAR MORTALITY RELATED TO DIABETES......Page 101
REFERENCES......Page 102
INTRODUCTION......Page 112
Methodological: LDL cholesterol estimated by Friedewald versus LDL cholesterol measured by ultracentrifugation......Page 113
Biological variance between LDL cholesterol and apoB......Page 115
Time and ROC curves......Page 117
Stop relying on LDL cholesterol: start using apoB......Page 118
REFERENCES......Page 119
CVD BIOMARKERS – A DEFINITION......Page 122
DEFINING REFERENCE VALUES FOR NEW CVD BIOMARKERS......Page 123
OVERVIEW OF NEWER CVD BIOMARKERS......Page 124
Inflammatory markers......Page 125
Oxidative stress......Page 128
Structural markers of arterial vulnerability......Page 129
MARKERS OF BLOOD VULNERABILITY......Page 130
MARKERS OF MYOCARDIAL VULNERABILITY......Page 131
Structural markers of myocardial vulnerability......Page 132
ILLUSTRATING THE USE OF NEW CVD BIOMARKERS......Page 133
REFERENCES......Page 135
INTRODUCTION......Page 148
FACTORS ASSOCIATED WITH THE INDEX INFARCTION THAT DETERMINE SUBSEQUENT PROGNOSIS......Page 149
Endothelial dysfunction......Page 150
Tobacco smoking......Page 151
MULTIVARIATE ANALYSES OF FACTORS COLLECTED BEFORE MYOCARDIAL INFARCTION......Page 152
RISK FACTORS AMONG MEN WITH ‘NON-SPECIFIC’ CHEST PAIN......Page 153
Hypertension......Page 154
MANAGEMENT OF RISK FACTORS......Page 155
REFERENCES......Page 156
REGIONAL DIFFERENCES IN MORTALITY FROM CORONARY HEART DISEASE......Page 162
HOW WELL CAN THESE REGIONAL DIFFERENCES BE EXPLAINED?......Page 164
SOCIOECONOMIC DIFFERENCES IN CHD......Page 165
PSYCHOSOCIAL FACTORS AND CORONARY RISK ESTIMATION......Page 166
REFERENCES......Page 167
RISK ESTIMATION SYSTEMS......Page 170
PROSPECTIVE CARDIOVASCULAR MÜNSTER (PROCAM) STUDY......Page 171
SCORE AND HEARTSCORE......Page 172
THE FRAMINGHAM STUDY......Page 176
ASSIGN AND QRISK......Page 178
REFERENCES......Page 180
CONTRIBUTIONS TO PREVENTIVE CARDIOLOGY......Page 184
Multivariable assessment......Page 185
DELINEATION OF THE FULL CVD CLINICAL SPECTRUM......Page 186
LIFETIME RISK......Page 187
Hypertension......Page 188
Dyslipidaemia......Page 192
Diabetes......Page 193
Proteinuria......Page 194
Menopause......Page 195
SUMMARY......Page 196
REFERENCES......Page 197
THE FIRST GENERATION......Page 202
THE SECOND GENERATION......Page 203
THE EFFECT OF INTERVENTION......Page 204
THE SYSTEMIC CORONARY RISK EVALUATION (SCORE) RISK ESTIMATION SYSTEM......Page 205
THE HEARTSCORE® PROGRAMME......Page 206
OTHER METHODS......Page 208
STRENGTHS AND LIMITATIONS IN ELECTRONIC RISK ESTIMATION......Page 209
REFERENCES......Page 210
INTRODUCTION......Page 212
EXERCISE......Page 213
OBESITY......Page 214
The importance of weight loss vs. health behaviour change......Page 215
Bupropion......Page 216
Conclusion......Page 217
Assessing motivation......Page 218
Summary guidelines for clinical communication......Page 219
REFERENCES......Page 220
15: Management of specific risk factors – lipids......Page 224
PRIMARY AND SECONDARY DYSLIPIDAEMIAS......Page 225
HYPERCHOLESTEROLAEMIA......Page 226
LABORATORY DIAGNOSIS......Page 227
HIGH TRIGLYCERIDES, LOW HDL CHOLESTEROL: ATHEROGENIC DYSLIPIDAEMIA......Page 228
METABOLIC SYNDROME......Page 229
HIGH TRIGLYCERIDES, HIGH HDL CHOLESTEROL......Page 230
FAMILIAL HYPERTRIGLYCERIDAEMIA......Page 231
Atherosclerosis......Page 232
LOW HDL CHOLESTEROL IN AFFLUENT COUNTRIES......Page 233
INTERNATIONAL RECOMMENDATIONS ASSESSING RISK AND SETTING GOALS OF THERAPY......Page 234
DIET......Page 235
Diets to lower risk of atherosclerotic disease by reducing body weight or LDL cholesterol: fat modification......Page 236
STATINS (HMG-COA REDUCTASE INHIBITORS)......Page 237
FIBRATES......Page 238
NIACIN (NICOTINIC ACID)......Page 239
DRUG COMBINATIONS......Page 240
Surgery......Page 241
REFERENCES......Page 242
16: Management of specific risk factors – hypertension......Page 244
BLOOD PRESSURE AS A RISK FACTOR FOR CVD......Page 245
DIAGNOSTIC EVALUATION......Page 246
Ambulatory BP monitoring......Page 247
Home BP measurement......Page 248
Masked hypertension or isolated ambulatory hypertension or ‘reversed white-coat’ condition......Page 249
Routine tests......Page 250
Optional tests......Page 252
Extended evaluation......Page 253
TOTAL CARDIOVASCULAR RISK......Page 254
GOALS OF TREATMENT......Page 257
DRUG TREATMENT......Page 258
LIPID-LOWERING THERAPY......Page 262
REFERENCES......Page 263
ANIMAL STUDIES......Page 272
EPIDEMIOLOGICAL STUDIES......Page 274
THE EFFECT OF INCREASING HEART RATE ON CARDIOVASCULAR MORTALITY IN MEN FROM THE GENERAL POPULATION......Page 278
THE EFFECT OF ELEVATED HEART RATE ON CARDIOVASCULAR MORTALITY IN WOMEN IN THE GENERAL POPULATION......Page 279
PREDICTIVE ABILITY OF ELEVATED HEART RATE IN THE ELDERLY......Page 280
EPIDEMIOLOGICAL STUDIES INVESTIGATING THE EFFECT OF ELEVATED HEART RATE IN CAD PATIENTS......Page 281
POSSIBLE MECHANISMS FOR THE ASSOCIATION OF ELEVATED HEART RATE AND INCREASED RISK OF CARDIOVASCULAR MORTALITY......Page 285
ASSOCIATIONS OF ELEVATED HEART RATE INCLUDING THE METABOLIC SYNDROME......Page 286
EVIDENCE THAT HEART RATE REDUCTION IS A MECHANISM OF BENEFIT IN beta-BLOCKADE......Page 287
IS THE RELATIONSHIP BETWEEN HEART RATE AND CVD AND TOTAL MORTALITY ONE OF CAUSE AND EFFECT?......Page 290
SHOULD RESTING HEART RATE BE INCLUDED IN RISK ESTIMATION SYSTEMS?......Page 291
REFERENCES......Page 292
CHAPTER 1 – CARDIOVASCULAR EPIDEMIOLOGY: BACKGROUND AND PRINCIPLES OF CARDIOVASCULAR DISEASE PREVENTION......Page 294
CHAPTER 3 – ENDPOINTS, MORTALITY AND MORBIDITY......Page 295
CHAPTER 5 – MANAGEMENT OF CARDIOVASCULAR RISK IN THE OLDER PERSON......Page 296
CHAPTER 8 – NEW BIOMARKERS OF CARDIOVASCULAR DISEASE......Page 297
Socioeconomic aspects at population level......Page 298
CHAPTER 11 – RISK ESTIMATION SYSTEMS IN CLINICAL USE: SCORE, HEARTSCORE AND THE FRAMINGHAM SYSTEM......Page 299
CHAPTER 12 – EPIDEMIOLOGICAL RESEARCH AND PREVENTIVE CARDIOLOGY: LESSONS FROM FRAMINGHAM......Page 300
CHAPTER 14 – MANAGEMENT OF SPECIFIC BEHAVIOURAL RISK FACTORS–\rEXERCISE, OBESITY AND SMOKING......Page 301
CHAPTER 16 – MANAGEMENT OF SPECIFIC RISK FACTORS – HYPERTENSION......Page 302
CHAPTER 17 – HEART RATE AS A RISK FACTOR......Page 303
Abbreviations......Page 304
A......Page 308
C......Page 309
E......Page 311
F......Page 312
H......Page 313
L......Page 314
M......Page 315
P......Page 316
R......Page 317
S......Page 318
V......Page 319
Y......Page 320