Advancing Our Understanding of RAAS Modulation in High-Risk Patients

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Advancing Our Understanding of RAAS Modulation
in High-Risk Patients

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CVD has risen, accompanied by diabetes
CVD
Diabetes
7
?119
6
Discharges (millions)
Number (millions)
5
4
0
90
03
00
95
90
04
98
94
92
00
96
02
Year
Year
National Hospital Discharge Survey
National HealthInterview Survey
AHA. Circulation. 2006113e85-151. CDC.
www.cdc.gov.
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Continued increase in CVD and diabetes is
predicted in US
By 2050, diabetes will account for an estimated
31.4 million deaths from CVD
?136
Incidence of diabetes, all ages (millions)
Year
Narayan KMV et al. Diabetes Care.
2006292114-6.NIDDK. http//diabetes.niddk.nih.g
ov.
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Discharge ACEI post-MI remains suboptimal
Q1 2006 CRUSADE data, n 6945
Discharge medication use()

LVEF lt40, CHF, DM, HTNKnown hyperlipidemia,
?TC, ?LDL-C
CRUSADE. www.crusadeqi.com.
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AHA/ACC secondary-prevention guidelines ACEIs
and ARBs

• ACEIs
• All patients with LVEF 40, hypertension,
  diabetes, or chronic kidney disease (IA)
• Consider for all other patients (IB)
• Optional Lower-risk, post-revascularization
  patients with normal LVEF and well-controlled
  risk factors (IIaB)
• ARBs
• ACEI-intolerant patients with HF or post-MI LVEF
  40 (IA)
• Consider in other ACEI-intolerant patients (IB)
• Consider use in combination with ACEIs in
  systolic dysfunction HF (IIbB)

Smith SC et al. Circulation. 20061132363-72.