二级预防的研究组织的前提课件

1、Source Mackay, J, Mensah, G. The Atlas of Heart Disease and Stroke.WHO-CDC, 2004.Total number of Deaths: 57 millionOnset6 months1 year0.000.020.040.060.080.100.120.1418 months2 yearsCumulativedistributionWHO PREMISE Study of secondary prevention of strokeCauses of stroke and its established risk fac

2、torsNon-modifiable and modifiable risk factorsResults of the WHO PREMISE Study Prevalence of the most important risk factorsUse of medication from the WHO PREMISE Study By socio-demographic characteristicsAccording to risk factorsBy clinical characteristicsPredictors for the use of medicationPerspec

3、tives of pharmacological interventionClinical trials with universal treatmentSpecific treatment according to diagnosis: isquemic/hemorrhaegic strokeComplianceWHO PREMISE Study of secondary prevention of strokeCauses of stroke and its established risk factorsNon-modifiable and modifiable risk factors

4、Results of the WHO PREMISE StudyPrevalence of the most important risk factorsUse of medication from the WHO PREMISE StudyBy socio-demographic characteristicsAccording to risk factorsBy clinical characteristicsPredictors for the use of medicationPerspectives of pharmacological interventionClinical tr

5、ials with universal treatmentSpecific treatment according to diagnosis: isquemic/hemorrhaegic strokeComplianceSource Mackay, J, Mensah, G. The Atlas of Heart Disease and Stroke.WHO-CDC, 2004.WHO PREMISE Study of secondary prevention of strokeCauses of stroke and its established risk factorsNon-modif

6、iable and modifiable risk factorsResults of the WHO-PREMISE StudyPrevalence of the most important risk factorsUse of medication from the WHO PREMISE StudyBy socio-demographic characteristicsAccording to risk factorsBy clinical characteristicsPredictors for the use of medicationPerspectives of pharma

7、cological interventionClinical trials with universal treatmentSpecific treatment according to diagnosis: isquemic / hemorrhaegic strokeCompliance010203040506070BREGINIDIRPKSLTK RUTNTOTALCountries%60 yearsAGE GROUPS FOR MALES AND FEMALES0102030405060CHD FemalesCHD MalesCeVD FemalesCeVD Males%60 years

8、TOTAL NUMBER OF PARTICIPANTS OF CHD AND STROKEBY AGE AND SEX CeVD: Cerebrovascular disease WHO-PREMISE STUDY0102030405060708090100BREGINIDIRPKSLTKRUTNTOTALCountries%H B PH B CH B SWHO-PREMISE STUDY010203040506070BREGINIDIRPKSLTKRUTNTOTALCountries%0 FR1 FR2 FR3 FR4 FRHolzgreve and Middeke, 1994WHO PR

9、EMISE Study of secondary prevention of strokeCauses of stroke and its established risk factorsNon-modifiable and modifiable risk factorsResults of the WHO-PREMISE StudyPrevalence of the most important risk factorsUse of medication in the WHO PREMISE StudyBy socio-demographic characteristicsAccording

10、 to risk factorsBy clinical characteristicsPredictors for the use of medicationPerspectives of pharmacological interventionClinical trials with universal treatmentSpecific treatment according to diagnosis: isquemic/hemorrhaegic strokeComplianceWHO-PREMISE STUDYHBP: High blood pressure HBC: High bloo

11、d cholesterol HBS: High blood sugar WHO-PREMISE STUDYWHO-PREMISE STUDYWHO PREMISE Study of secondary prevention of strokeCauses of stroke and its established risk factorsNon-modifiable and modifiable risk factorsResults of the WHO PREMISE Study Prevalence of the most important risk factorsUse of med

12、ication from the WHO PREMISE StudyBy socio-demographic characteristicsAccording to risk factorsBy clinical characteristicsPredictors for the use of medicationPerspectives of pharmacological interventionClinical trials with universal treatmentSpecific treatment according to diagnosis: isquemic/hemorr

13、haegic strokeCompliance Total stroke 307/3051 420/3054 Major vascular events Total events 458/3051 604/3054 Events/patients Active* PlaceboFavorsactiveFavorsplaceboRisk reduction(95%CI)Stroke 32% (17 to 44) 27% (8 to 42) 28% (17 to 38) 29% (16 to 40) 24% (9 to 37) 26% (16 to 34)0.52.0 Hazard ratio1.

14、0Reference: Progress Study.Lancet 2001; 358: 1033-41*Active: Perindopril 4 mg Indapamide 2,5 mgSource: EAFT (European Atrial Fibrillation Trial) Study GroupConsiderations of available information on the following items permit to outline high-priority research questions on the secondary prevention of

15、 stroke:Serum uric acid, diuretics and risk of ischaemic stroke in the Atherosclerosis Risk in Communities (ARIC) Study 13 413 individuals free of stroke or coronary artery disease 381 strokes occurred during the mean follow up of 12.6 years Subjects Uric acid quartiles at baseline (mg.dL-1) P for l

16、inear trend Up to 4.8 4.95.8 5.96.8 Above 6.9 No. of subjects 3243 2534 3183 2303 No. of events 51 45 85 86 Diuretic non- users Relative hazard 1.00 0.99 1.41 1.89 (Sig.) 0.01 No. of subjects 291 318 609 932 No. of events 16 14 29 55 Diuretic users Relative hazard 1.00 0.72 0.69 0.72 0.46 Hozawa A,

17、Folsom A, Ibrahim H, et al. Atherosclerosis, Epub Oct 2005 Serum uric acid, diuretic use and ischaemic stroke Oxidative stress appears to have a bearing on the occurrence of ischaemic stroke on stroke-related neurological damage Plasma uric acid has a dual purport Uric acid is a powerful endogenous

18、antioxidant 2-4 units of oxidants (superoxide anion radical and hydrogen peroxide) are formed per unit of uric acid produced through the action of xanthine oxidase Diuretics, even at low doses, reduce the renal excretion of uric acid The rise in plasma uric acid caused by diuretics and the attendant

19、 increase in total plasma antioxidant capacity blunt the increase in stroke risk possible due to excess uric acid and reactive species synthesis mediated by xanthine oxidase Reyes AJ. Cardiovasc Drugs Ther 2003;17:397414. Reyes AJ, Leary WP. J Hypertens 2003;21:17751777. Comparison of ximelagatran,

20、warfarin and placebo in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation Source Compared treatments Incidence (n) Odds Ratio (95% CI) Meta-analysis* Warfarin Placebo 32/1225 89/1236 W:P 0.346 (0.2290.522) (SPORTIF)* III and V trials Ximelagatran Warfarin 93/3665 91/3664 X:W 0.978 (0.7301-311) Imputed placebo analysis Ximelagat