a strategy to reduce cardiovascular disease by more than 80
Download
Skip this Video
Download Presentation
A Strategy to Reduce Cardiovascular Disease by More Than 80%

Loading in 2 Seconds...

play fullscreen
1 / 17

A Strategy to Reduce Cardiovascular Disease by More Than 80 - PowerPoint PPT Presentation


  • 109 Views
  • Uploaded on

A Strategy to Reduce Cardiovascular Disease by More Than 80% . BMJ   2003;326:1419 (28 June). Why This Paper ?. Pre operative Operative Post Operative. Why This Paper ?. CABG patients only - Majority of our work Majority have BP, Chol, Platelet, poor LV and Homocysteine problems

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'A Strategy to Reduce Cardiovascular Disease by More Than 80' - noelani


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
why this paper
Why This Paper ?

Pre operative Operative Post Operative

why this paper1
Why This Paper ?
  • CABG patients only - Majority of our work
  • Majority have BP, Chol, Platelet, poor LV and Homocysteine problems
  • One benefit of operation is to reduce tablet number
  • One tablet only could be beneficial
    • BP Thiazide
    • Chol Statin
    • Poor LV ACEI
    • Homocysteine folic acid
    • Recurrent cardiovascular risk Beta Blocker
    • Platelet Aspirin
objectives
Objectives
  • To determine the combination of drugs and vitamins,and their doses, for use in a single daily pill to achievea large effect in preventing cardiovascular disease with minimaladverse effects.
  • Four cardiovascular risk factors (low density lipoprotein cholesterol,blood pressure, serum homocysteine, and platelet function)
  • Regardless of pretreatment levels.
design
Design
  • Quantified the efficacy and adverse effects of the proposed formulation from published meta-analyses of randomisedtrials and cohort studies and a meta-analysis of 15 trialsof low dose (50-125 mg/day) aspirin.
outcome measures
Outcome Measures
  • Proportional reduction in ischaemic heart disease (IHD) events and strokes; life years gained; and prevalenceof adverse effects.
slide7

Relative Risks (95% Confidence Intervals) of ischaemic Heart Disease Events and All Strokes (Fatal and Non-fatal) in 15 Randomised Trials of Low Dose Aspirin

slide8
Extracranial Adverse Effects of Low Dose Aspirin (50-125 Mg) From the Meta-analysis of 15 Randomised Trials
what drug and what dose
What Drug and What Dose ?

Absolute reductions* (mmol/l) (with 95% confidence intervals) and percentage reductions in serum LDL cholesterol concentration according to statin and daily dose (summary estimates from 164 randomised placebo controlled trials)

slide10

Relative distributions of risk factors in men who subsequently died of ischaemic heart disease or stroke and in men who did not. Gaussian distribution fitted to data from a cohort of 22 000 men followed prospectively for 10 years

slide11
Effects of the Polypill on the Risks of ischaemic Heart Disease (IHD) and Stroke After Two Years of Treatment at Age 55-64
slide12
Expected Benefits in 100 Men and 100 Women Without a Known Vascular Disease Who Start Taking the Polypill at Age 55.
slide13
Prevalence of Participants in Randomised Trials Reporting Symptoms Attributable to the Polypill Components
results 1
Results - 1

Formulation:

  • a statin(for example, atorvastatin (daily dose 10 mg) or simvastatin(40 mg));
  • three blood pressure lowering drugs (for example,a thiazide, a blocker, and an angiotensin converting enzymeinhibitor), each at half standard dose;
  • folic acid (0.8 mg);and
  • aspirin (75 mg).

The combination (Polypill) reduces IHD events by 88% (95% confidenceinterval 84% to 91%) and stroke by 80% (71% to 87%).

results 2
Results - 2

One thirdof people taking this pill from age 55 would benefit, gainingon average about 11 years of life free from an IHD event orstroke.

Summing the adverse effects of the components observedin randomised trials shows that the Polypill would cause symptomsin 8-15% of people (depending on the precise formulation).

conclusion
Conclusion
  • The Polypill strategy could largely prevent heartattacks and stroke if taken by everyone aged 55 and older andeveryone with existing cardiovascular disease.
  • It would beacceptably safe and with widespread use would have a greaterimpact on the prevention of disease in the Western world thanany other single intervention.
mr sooraes question
Mr Sooraes Question
  • But you can’t tailor the dose?
  • Population based relative risk reduction proposal
ad