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VBWG. The Renin-Angiotensin-Aldosterone System:. Linking New Data and Mechanisms for Cardiovascular Risk Reduction. VBWG. Contents. Scope of the problem Physiology of RAAS: Focus on angiotensin Role of RAAS modulation: Recent clinical trials CAD Diabetes ACEIs and ARBs - PowerPoint PPT Presentation
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The Renin-Angiotensin-The Renin-Angiotensin-Aldosterone System:Aldosterone System:
Linking New Data and Mechanisms Linking New Data and Mechanisms for Cardiovascular Risk Reductionfor 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
ContentsVBWG
Scope of the Problem
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Coronary artery disease: Leading cause of hospitalization in the US
Primary diagnosis
Coronary atherosclerosis 1 $38.4
Acute MI 2 $27.8
Congestive HF (nonhypertensive)
4 $21.8
Cardiac dysrhythmias 8 $14.3
Acute cerebrovascular disease 9 $13.9
AHA. Heart Disease and Stroke Statistics–2005 Update.
$66.2
National bill(billions)Rank
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Lifetime risk for CAD
Lloyd-Jones D et al. Lancet. 1999;353:89-92.
0.5
0.4
0.3
0.2
0.1
40 50 60 70 80 90 94
0.5
0.4
0.3
0.2
0.1
40 50 60 70 80 90 94
WomenMen
Age (years) Age (years)
Cumulativerisk of CAD
0
Framingham Heart Study
Lifetime risk at age 40
1 in 3
1 in 2
0
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Yusuf S et al. Lancet. 2004;364:937-52.
Odds ratio for
1st MI (99% CI)
64
512
16
1
2
256
128
32
8
4
Smk(1)
DM(2)
HTN(3)
ApoB/A1(4)
1+2+3 1–4 All 4+obesity
All 4+Psycho-social
All
2.9 2.41.9
3.3
13.0
42.3
68.5
182.9
333.7
Multiple risk factors raise the risk for MIINTERHEART
Smk = smoking; DM = diabetes mellitus; HTN = hypertension; Apo = apolopoprotein
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Lifetime risk of diabetes for individuals born in 2000
27
4045
373331
4953
4339
0
10
20
30
40
50
60
White Black Hispanic Other races/ethnicities
Total*
Narayan KMV et al. JAMA. 2003;290:1884-90.
Estimates based on National Health Interview Survey (1984–2000)
Lifetimerisk (%)
Men Women
*Weighted race/ethnic-specific values by proportion of nondiabetic US population in 2000
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Whiteley L et al. Diabetes Care. 2005;28:1588-93.
Diabetes as a CHD risk equivalent: Impact on mortality in women and men
Years Years
Women Men
0.0
0.2
0.4
0.6
0.8
Diabetes/CHD
1.0
0 5 11 16 22 27 0 5 11 16 22 270.0
0.2
0.4
0.6
0.8
1.0
DiabetesCHD No Diabetes/CHD
Survivalrate
N = 7052 men, 8354 women; age 45–64 yrs, follow-up 25 years
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Worldwide prevalence of diabetes expected to increase
Diabetes prevalence >171 million in 2000 ~366 million in 2030
World Health Organization, 2000 vs 2030
www.who.int/diabetes/. July 2005.
33
15
33
47
36
18
67
4248
120
71
7
0
20
40
60
80
100
120
140
Africa Americas E Medit Europe SE Asia W Pacific
Diabetes prevalence(in millions)
2000 2030
+102%
+160%
+181% +44%
+155%
+99%
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0
100
200
300
400
29–44 45–64 ≥65
New andrecurrent
MIs(in thousands)
Age (years)
Men Women
500
3410
250
88
410372
AHA. Heart Disease and Stroke Statistics–2005 Update.
Over 1 million Americans will have an MI this year
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