hyperlipidemia - sapraa课件

HYPERLIPIDEMIA DRLRABANYE DEFINITION MajorriskfactorforatherosclerosisasaresultofelevatedlevelsofserumcholesterolMajorcomponentofSerumCholesterol LDL C Lowdensitylevellipoprotein HDL C Highdensitylevellipoprotein TG Triglycyrides ObjectiveofTreatmentGuidelines IdentifypatientsatcardiovascularriskIn linewithadvancesindiagnosisIncorporatingnewlyidentified quantifiedriskfactorsMetabolicsyndromeDiabetesTreatmentguidelinesbasedonevidencepoolavailableatthetimeofpublicationCanbeexpectedtochangewiththeemergenceofnewevidenceAsevidenceaccumulatesthatgreaterLDL CreductionsareassociatedwithgreaterreductionsinCVDrisk guidelinesareupdatedtoreflectloweredLDL Cgoals TARGETCHOLESTEROLLEVELS LDL C 3mmol LinasymptomaticpatientsLDL C 2 5mmol LinestablishedCVDanddiabeticpatients DevelopmentalProcessofAtherosclerosis BurdenofDiseases CV Thethreeleadingcausesofdiseasein2030HIV AIDSUnipolardepressivediseaseIschaemicheartDisease PrevalenceofChronicConditionsinRegisteredSchemes Themostprevalentconditions per1000beneficiaries Hypertension 86 Hyperlipidaemia 42 Asthma 24 T2DM 19 CAD 17 MultipleRiskFactorsCauseCumulativeIncreaseinRiskforCVD RISKFACTORS ObesitySmokingDiabetesMellitusLackofphysicalExerciseHypertensionGenetics TypesOfLipidLoweringDrugs StatinsFibratesNiacinResinsSelectivecholesterolinhibitor PrimaryPrevention AreWeIdentifyingtheRightPatients EconomicBurdenofCardiovascularDiseaseintheUSEstimatedfor2005 AmericanHeartAssociation HeartDiseaseandStrokeStatistics 2005Update Heartdisease Coronaryheartdisease Stroke Hypertensivedisease Congestiveheartfailure TotalCVD BillionsofDollars EffectofLong TermModestReductionsinCVRiskFactors Embersonetal EurHeartJ 2004 25 484 491 EffectofLong TermModestReductionsinCVRiskFactors HeartofSowetoStudy Cross SectionalStudyatChrisHaniBaragwanathObjective Describerecent inACSamongurbanblackSouthAfricansEpidemiologicaltransitionduetourbanizationadoptionofWesternlifestyleanddietvs traditional cardio protective Africanlifestyle1950 s averageof3patients annumidentifiedwithAMI1975 80 Totalof50cases averageof8patients annum2004 64patientswithACSinoneyearaloneAnnualincidenceofACS basedonpopulationsize 1975 80 0 5 1per1000002004 7per100000 RuleoutSecondaryCauses LIFETSYLEFACTORSDIET Triglycerides HDL CandLDL CSMOKING HDL CALCOHOL TriglyceridesUNDERLYINGDISEASES CHOL Hypothyroidism Renaldisease liverdisease DM TRIGS TruncalObesity Diabetes Cushing sSyndromePREGNANCY CholesterolProteaseinhibitors TreatmentRatesForDyslipidemiainUSAreHighbutFewPatientsReachGoals NHANES1999 2002 HomeUnweightedN 3 655 WeightedSample 211 125 161 2004Census Thereismorethatcanbedonetoimprovequalityofcaredeliveredtopatients PatientswithDyslipidaemia PatientsOnLipid LoweringTreatment TreatedtoGoal 50 receivetreatment 19962000Hypertensive55 54 OnBPMedication84 90 controlledto 140 90mmHg44 45 Hyperlipidemic86 59 Onstatins19 58 controlledto 5 0mmol L21 49 CVDPatientsinEurope FewerthanOne HalfReachGoal Someimprovement butstilllargegapintreatment Verylittleimprovement TheSouthAfricanNotatGoalstudy SA NAG EvaluationofLDL CgoalsachievedinpatientswithestablishedCVDand orhyperlipidaemiareceivinglipidloweringtherapyPtsontherapy 4mnths1201ptsrecruitedacrossSA41 definedaslowrisk 59 definedashighriskSAguidelinesusedtodefineriskandevaluateachievementofgoalConclusionMajorityfellinto notatgoal categoryTheseptswerealsofarabovetheirLDL Ctargets AndinSouthAfrica AchievingGuideline specifiedLDL CGoals TheSA NAGstudy A Ramjeeth N Butkow F Raal M Maholwana Mokgatlhe CVJA Vol19 2 88 94 LowRiskvs HighRiskPatients 3 0 3 7 2 5 3 6 0 7 1 1 HighRisk LDL Creductionneeded bygender agegroup TheSA NAGstudy A Ramjeeth N Butkow F Raal M Maholwana Mokgatlhe CVJA Vol19 2 88 94 Keypoints SA NAGStudy SignificanttreatmentgapexistsbetweenlipidguidelinesandgoalattainmentindyslipidaemicpatientswithorwithoutestablishedCVDAllpatientwereonlipid loweringtherapy deficitstillexistsBegsthequestion howmanyeventscouldbeavertedifpatientsreachedtreatmentgoal Potentialreasonsforthestudyresult InadequatetitrationofdosesPatientlong termcomplianceFinancialconstraintsIntheentirestudy N 1201 only45ptswereusingthehighestdosesofstatintherapy 4 Providerawarenessdoesnotequalsuccessfulimplementation CVDTreatmentGap Community DrAwarenessofTreatmentGuidelines PatientTreatedtoGoal WHATAREWEDOINGWRONG Notidentifyingpatientsfortreatmentinterve