Diapositiva 1

1
VI CONGRESSO NAZIONALE DELLA SOCIETÀ ITALIANA PER
LA PREVENZIONE CARDIOVASCOLARE
GENOVA 28 FEBBRAIO / 1 MARZO 2008 MAGAZZINI DEL
COTONE
L'epidemia Obesità Impatto sul Rischio
Cardiovascolare?
Si può correggere il rischio cardiovascolare con
le modifiche dello stile di vita?
M. Averna
Dipartimento di Medicina Clinica e delle
Patologie Emergenti Università di Palermo
2
(No Transcript)
3
Obesita HR, hazards ratio
Mortalita totale
Mortalita CV
Ventimiglia Heart Study- Int. J Obesity 2000
4
Si può correggere il rischio cardiovascolare con
le modifiche dello stile di vita?

• Losservazione dei grandi trend di popolazione
• Lintervento sui Fattori di Rischio
• Lintervento sugli Eventi fatali e non
• La Fattibilità

5
Si può correggere il rischio cardiovascolare con
le modifiche dello stile di vita?

• Losservazione dei grandi trend di popolazione

6
(No Transcript)
7
Combined Impact of Health Behaviours and
Mortality in Men and Women The EPIC-Norfolk
Prospective Population Study
PLoS Medicine 2008
8
Combined Impact of Health Behaviours and
Mortality in Men and Women The EPIC-Norfolk
Prospective Population Study
20,244 men and women 4579 y Follow-up 10y
PLoS Medicine 2008
9
Mediterranean Diet, Lifestyle Factors, and
10-Year Mortality in Elderly European Men and
Women The HALE Project
The HALE Project
1998-2000 1500 men 832 women Age 70-90
JAMA 2004
10
Overweight and obesity and weight change in
middle aged men impact on cardiovascular disease
and diabetes
6798 Men 4059 years Follow-up 20y
J Epidemiol Community Health 2005
11
Si può correggere il rischio cardiovascolare con
le modifiche dello stile di vita?

• Lintervento sui Fattori di Rischio

12
Systematic review of the long-term effects and
economic consequences of treatments for obesity
and implications for health improvement
HTA 2004
13
Systematic review of the long-term effects and
economic consequences of treatments for obesity
and implications for health improvement
HTA 2004
14
Systematic review of the long-term effects and
economic consequences of treatments for obesity
and implications for health improvement
HTA 2004
15
(No Transcript)
16

• UNA RIDUZIONE MODESTA DEL PESO CORPOREO (2-5) HA
  EFFETTI CLINICAMENTE SIGNIFICATIVI
• ? 20 della incidenza di Ipertensione (TOHP2)
• ? 53 della prevalenza di Ipertensione (PREMIER)
• ? 47 della prevalenza di elevati livelli
• di LDL-C (PREMIER)

17
(No Transcript)
18
PERDITA DI PESO E PCR La riduzione di 1 Kg di
peso determina una riduzione di 0.13mg/dL della
PCR metanalisi di Selvin et Al- Arch Intern
Med 2007
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
Si può correggere il rischio cardiovascolare con
le modifiche dello stile di vita?

• Lintervento sugli Eventi fatali e non

29
Early Primary-Prevention Trials Overview
TC
CHD events
0
Oslo Diet/smoking cessation N1,232, P0.02
-5
-10
WHO ClofibrateN15,745, Plt0.05
-8.5
-9
-9
-11
-15
-14
Upjohn ColestipolN2,278, P0.02
-20
-19
-20

-25
-23
LRC-CPPT CholestyramineN3,806, Plt0.05
-30
-35
-34
HHS Gemfibrozil N4,081, Plt0.02
-40
-45
-47
-50
Nnumber enrolled.
Net difference between treatment and control
groups (P values are for events).
Adapted from Levine GN et al. N Engl J Med.
1995332512-521.
30
Lyon Diet Heart Study Cumulative Survival
Without Cardiac Death and Nonfatal MI
100
Experimental
90
withoutevent
80
Control
P0.0001
70
1
2
3
4
5
Year
de Lorgeril M et al. Circulation. 199999779-785.
31
(No Transcript)
32
Mortality Risk Reduction Associated With Smoking
Cessation in Patients With Coronary Heart Disease
A Systematic Review
RR 0.64
JAMA 2003
33
Ongoing trials of weight loss and progression of
cardiovascular and metabolic disease
Am J Cardiol 2007
34
(No Transcript)
35
Si può correggere il rischio cardiovascolare con
le modifiche dello stile di vita?

• La fattibilità

36
Randomized Trial of Lifestyle Modification and
Pharmacotherapy for Obesity
N Engl J Med 2005
37
(No Transcript)
38
Chronic disease prevention health effects and
financial costs of strategies to reduce salt
intake and control tobacco use
23 countries- 80 of chronic disease burden
Lancet 2007
39
Lifetime Medical Costs of Obesity Prevention No
Cure for Increasing Health Expenditure
. successful prevention of obesity and smoking
would result in lower health-care costs in the
short run (assuming no costs of prevention), but
in the long run they would result in higher costs.
PLoS Medicine 2008
40
Action Framework For A Comprehensive Public
Health StrategyTo Prevent Heart Disease And
Stroke
41
Action Framework For A Comprehensive Public
Health StrategyTo Prevent Heart Disease And
Stroke
PREVENTION
42
(No Transcript)
43
(No Transcript)
44
NUTRIENTI CHE INFLUENZANO POSITIVAMENTE LA
SENSIBILITA INSULINICA
45
NUTRIENTI CHE INFLUENZANO NEGATIVAMENTE LA
SENSIBILITA INSULINICA
46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
Circulation 2002
52
Benefit of Treating the Metabolic Syndrome
23
After 4 years risk of diabetes reduced by 58
(1729 CI)
11
(615 CI)
Intervention
Control
with Diabetes
Tuomilehto J et al. N Engl J Med
20013441343-1350.
53
(No Transcript)
54
(No Transcript)
55
Effect of Lifestyle Changeson Angiographic CAD
Duration
(Control-Treatment)

Study
N
Patient type
Therapy
(yr)
Progression
Regression
Lifestyle
28
CAD
Diet,
exercise,
1
35
-40
meditation
STARS
90
CAD, high
TC
Diet (including
3.2
35
-38

fiber)
Heidelberg
113
CAD
Diet exercise
1
25
-15