Lo mejor del ACC 2015 (San Diego)
Miércoles, 18/3/15 De 14:00 a 15:30
Casa del Corazón. Sociedad Española de Cardiología.
http://acc15.secardiologia.es/
Dislipemias
Dr. Juan Pedro Botet
Servicio de Medicina Interna. Hospital del Mar, Barcelona
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Dislipemias
1. #PostACC15
Juan Pedro-Botet
18 Marzo a las 14:00h
Casa del Corazón, Madrid
La Sociedad Española de Cardiología
en colaboración con MSD,
presentan en directo
2. #PostACC15
Lipid Guidelines: Evolution, Revolution or
Devolution
Lipid Guidelines: Let’s Find Some Common Ground.
Salim S. Virani
ACC-AHA Cholesterol Guidelines – Where’s the Beef?
Neil J. Stone
Guidelines for the management of dyslipidaemias. No time for revolution (?) let’s
stay the course.
Alberico L. Catapano
NLA Recommendations for Managing Dyslipidemia: A Patient-centered
Approach
Peter H. Jones MD
CCS Guidelines: Identifying, Targeting and Managing Dyslipidemia: A Clinical
Application of the CCS 2012 Dyslipidemia Guidelines.
Paul Poirier
Impact of New Prevention Guidelines on Care: Insights From PINNACLE Registry.
Thomas M. Maddox
12. #PostACC15
Reduction in Total (First and
Recurrent) Cardiovascular Events
with Ezetimibe/ Simvastatin
compared with Simvastatin Alone
post ACS in the I MPROVE-I T Trial
Sabina A. Murphy, Christopher Cannon, Robert Giugliano, Michael
Blazing, Thomas Musliner, Andrew Tershakovec, Jennifer White, Kelly Im,
Naveen Deenadayalu, Haral Darius, Witold Ruzyllo, Andrew Tonkin, Uma
Kher, Robert Califf, Eugene Braunwald
On behalf of the IMPROVE IT Investigators
13. #PostACC15
Background:
Cholesterol Lowering
➢ Previous statin trials have examined total events
for comparing high-intensity vs moderate-
intensity statins
– PROVE-IT TIMI 22
– IDEAL
➢ Evidence from trials show reduction with high-
intensity statins in total as well as first events
post ACS
➢ IMPROVE-IT trial evaluated whether ezetimibe
added to simvastatin would provide a clinical
benefit compared with simvastatin therapy alone
Murphy SA, et al. JACC 2009;54:2358–62
Tikkanen, MJ et al. JACC 2009;54:2353–7
14. #PostACC15
Number of Primary Endpoint
Events
42315314
NFMI
NF
Stroke
UA
CVD
Revasc
NFMI
NF
Stroke
UA
CVD
RevascTotal
N=9545
First
Event
Additional
Events
15. #PostACC15
Total Primary Endpoint Events
506 456
972
2297
5314
5th-14th event
Fourth event
Third event
Second event
First event
Total
N=9545
18. #PostACC15
Total PEP Events by Type of
Event
538 537
168 173
2481 2319
354
274
1442
1259
0
1000
2000
3000
4000
5000
NF MI
NF Stroke
Revascularization
UA
CV Death
#Events
Ezetimibe
Simvastatin
Simvastatin
Alone
4562
4983
Total NF MI
RR 0.87
p=0.004
Total NF Stroke
RR 0.77
p=0.005
19. #PostACC15
Conclusions
➢ These data provide further support of the benefit
of continuation of intensive combination lipid
lowering therapy after a recurrent CV event
➢ Analyses of recurrent events are important as total
events have implications:
– Patient morbidity
– Need for recurrent hospitalizations
– Costs
➢ These considerations not always accounted for
when analyzing first events only
20. #PostACC15
CONCLUSIONES
Guías clínicas
Nada nuevo. Cada uno sigue en sus 13.
PCSK9 (estudios OSLER 1 y 2)
La reducción de cLDL con fármacos no estatinas se
acompaña de beneficios clínicos.
Concentraciones de cLDL muy bajas (< 25 mg/dl) se han
mostrado seguras.
IMPROVE-IT
Disminución no sólo del 1º episodio, sino del nº total de ECVs.
Los beneficios clínicos son independientes de la concentración
basal de cLDL y de la estrataificación según el REACH score
para predecir futuros ECVs.