Malattie cerebrovascolari Prevenzione secondaria delle malattie cardiovascolari.

1. Malattie cerebrovascolari Prevenzione secondaria delle malattie cardiovascolari. Domenico Inzitari Dipartimento di Scienze Neurologiche e Psichiatriche Universit� degli Studi di Firenze

16. Fattori di rischio e sottotipi di ictus

17. Figure 2. Antiatherosclerosis Therapy in DiabetesDiabetic patients require therapy of each metabolic abnormality to attenuate atherogenesis. Excess liberation of free fatty acids results in the typical diabetic dyslipidemic phenotype consisting of increased triglycerides, decreased high-density lipoprotein, and increased oxidized, low-density lipoprotein. Statins and fibric acid derivatives improve the lipid profile and decrease its atherogenic tendency. Treatment of hypertension significantly decreases the rate of myocardial infarction and stroke in diabetes. Initial therapy should include agents that modify the renin-angiotensin system because of their proven additional microvascular and atherosclerosis benefits. [beta]-Blocker therapy in diabetic patients with cardiovascular disease decreases morbidity and mortality. The heightened thrombotic potential of the diabetic state supports consideration of antiplatelet therapy to decrease the incidence of myocardial infarction and death in persons with diabetes. Although strict treatment of hyperglycemia does not significantly reduce the incidence of myocardial infarction or death, the preponderance of epidemiologic and pathophysiologic evidence suggests that hyperglycemia increases cardiovascular event rates and worsens outcome. The improvement in microvascular outcomes itself warrants vigorous pursuit of rigorous glycemic control in diabetes. ACE indicates angiotensin-converting enzyme. From: � Beckman: JAMA, Volume 287(19).May 15, 2002.2570-2581 Figure 2. Antiatherosclerosis Therapy in DiabetesDiabetic patients require therapy of each metabolic abnormality to attenuate atherogenesis. Excess liberation of free fatty acids results in the typical diabetic dyslipidemic phenotype consisting of increased triglycerides, decreased high-density lipoprotein, and increased oxidized, low-density lipoprotein. Statins and fibric acid derivatives improve the lipid profile and decrease its atherogenic tendency. Treatment of hypertension significantly decreases the rate of myocardial infarction and stroke in diabetes. Initial therapy should include agents that modify the renin-angiotensin system because of their proven additional microvascular and atherosclerosis benefits. [beta]-Blocker therapy in diabetic patients with cardiovascular disease decreases morbidity and mortality. The heightened thrombotic potential of the diabetic state supports consideration of antiplatelet therapy to decrease the incidence of myocardial infarction and death in persons with diabetes. Although strict treatment of hyperglycemia does not significantly reduce the incidence of myocardial infarction or death, the preponderance of epidemiologic and pathophysiologic evidence suggests that hyperglycemia increases cardiovascular event rates and worsens outcome. The improvement in microvascular outcomes itself warrants vigorous pursuit of rigorous glycemic control in diabetes. ACE indicates angiotensin-converting enzyme. From: � Beckman: JAMA, Volume 287(19).May 15, 2002.2570-2581

24. SPACE: primary & secondary events

26. Colesterolo Totale e LDL e rischio di stroke ischemico

29. Benefits of statins on stroke vs IHD: main studies

30. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL)

36. ASAP: Regressione dell�IMT carotideo con Atorvastatina Dopo 2 anni, l�IMT diminuiva significativamente dal basale nel gruppo atorvastatina,mentre nel gruppo simvastatina aumentava. La differenza tra atorvastatina e simvastatina sull�IMT era statisticamente significativa (P = 0.0001). La regressione dell�IMT era osservata nel 66% dei pazienti in terapia con atorvastatina vs il 42% dei pazienti in terapia con simvastatina. Smilde TJ, et al. Lancet. 2001;357:577-581. Dopo 2 anni, l�IMT diminuiva significativamente dal basale nel gruppo atorvastatina,mentre nel gruppo simvastatina aumentava. La differenza tra atorvastatina e simvastatina sull�IMT era statisticamente significativa (P = 0.0001). La regressione dell�IMT era osservata nel 66% dei pazienti in terapia con atorvastatina vs il 42% dei pazienti in terapia con simvastatina. Smilde TJ, et al. Lancet. 2001;357:577-581.