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The Broad Plain of CV Prevention Atrial fibrillation Coronary heart disease Heart failure Erectile dysfunction Stroke Peripheral artery disease Diabetes... Age-adjusted US Heart Disease

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The Broad Plain of CV Prevention

Atrial fibrillation Coronary heart disease

Heart failure Erectile dysfunction Stroke Peripheral artery disease

Diabetes

Continuum of Cardiovascular Disease

Polypill

Personal lifestyle

Acute Treatment Hospital-Based

Cardiac Rehabilitation

Progression of CV Prevention

• Primordial – young, healthy individuals

• Preventing atherosclerotic vascular disease

• Primary – high risk patients/subclinical disease

• Stopping or reversing disease progression

• Preventing clinical events – MI, CVA, SCD

• Secondary – after the clinical event

• Reducing CV morbidity – AF, HF, CVA

Cardiovascular Prevention Works

Age-adjusted US Heart Disease Trends

Nemetz et al Arch Intern Med 2008;163:264-270

42% decrease in age-adjusted heart disease

death rate since 1967

PREDIMED Study

Estruch R et al N Engl J Med 2013;368:1279-90

7447 people with high CV risk

No known CVD Randomized to

Med diet + EVOO Med diet + nuts Control

Followed median 4.8 years

Age-standardized mortality from ischaemic heart disease from 1969 to 1992 in men and

women aged 35–64 in Finland

Vartiainen E et al BMJ 1994;309:23-27

Observed and predicted decline in mortality from ischaemic disease in men aged 35–64 in Finland

• Reduced sodium intake

• Opportunities for physical

activity

• Benefit from improved

cardiac care and

secondary prevention

Major Statin Trials

ASCOT-LLA

PROVE IT

TNT

JUPITER

Living Under the

CV Disease Rates by Country Income

CV death rates in 17 low-middle-high income

countries

Yusuf S et al NEJM 2014;371 (9):818-827

Yusuf S et al NEJM 2014;371 (9):818-827

Factors contributing to the epidemic of cardiovascular

disease in low- and middle-income countries

Gersh B J et al Eur Heart J 2010;31:642-648

Acute MI protocol

CAD Prevalence in Patients Who Died of

Unnatural Causes in Olmsted County, MN

and Had Autopsy

Nemetz et al Arch Intern Med 2008;163:264-270

Smoking and Lung Cancer (or CV Disease)

20-Year Lag for Chronic Disease Mortality

Living Under the Umbrella of Good Cardiovascular

Health

Impact of Secondary Prevention

Therapies from 4S: Effects on Coronary Events

with just 3 therapies

CHD Trends

McGovern et al, Circulation 2001;104:19-24

Jernberg T et al JAMA 2011;305:1677-1684

Jernberg T et al JAMA 2011;305:1677-1684

Jernberg T et al JAMA 2011;305:1677-1684

43% reduction

in mortality

from 1996-1997

to 2006-2007

CV disease lends itself to prevention

Fatty Streaks in Aorta of Male age 19

Advanced Lesion with Large Lipid Core

Plaque Rupture with Torn Cap

Advanced Lesion Occluded with Thrombus

Value of History

condemned to repeat it

• George Santayana (1863-1952)

middle-income countries will suffer a

devastating epidemic of CV disease

• Already happening

• History is bunk

• Henry Ford (1863-1947)

attenuate the CV disease epidemic