40221 - Best Diet for CHD Prevention Dr. Thomas G. Allison...

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Best Diet for CHD Prevention Dr. Thomas G. Allison Mayo Clinic Rochester
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Fatty Streaks in Aorta of 19-Year Old Male
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Advanced Lesion with Large Lipid Core
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Plaque Rupture with Torn Cap
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Major Statin Trials 50 210 LDL-C (mg/dL) 70 190 170 150 130 110 90 0 5 10 15 20 25 % with CAD event WOSCOPS AFCAPS CARE 4S LIPID HPS PROSPER Secondary Mixed Primary ASCOT-LLA PROVE IT TNT JUPITER
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SIMVASTATIN: CAUSE-SPECIFIC MORTALITY Risk ratio and 95% CI STATIN PLACEBO Cause of death (10269) (10267) STATIN better STATIN worse CHD 577 701 Other vascular 214 242 ALL VASCULAR 791 943 (7.7%) (9.2%) 17% SE 4.4 reduction (2P<0.0002) Neoplastic 352 337 Respiratory 93 111 Other medical 76 91 Non-medical 16 21 ALL NON-VASCULAR 537 560 (5.2%) (5.5%) 5% SE 5.9 reduction ALL CAUSES 1328 1503 (12.9%) (14.6%) 12% SE 3.5 reduction (2P<0.001) 0.4 0.6 0.8 1.0 1.2 1.4
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Nissen, S. E. et al. JAMA 2004;291:1071-1080. Intravascular Ultrasound Images at Baseline and Follow-up REVERSAL Trial
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Limitations to Pharmacologic Lipid Management Cost of treatment Not an issue if generic drug will control LDL-C Treatment cost ~ $1000 per year if non-generic agent needed Not all patients tolerant of statins Myalgia most common complaint (5-15%) Alternative drugs (intestinal agents, niacin, fibrates) have limited effect on LDL-C, limited outcome data Benefits of add-on drug therapy not established
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International Comparisons 44 54 57 87 100 202 420 638 0 100 200 300 400 500 600 700 Korea China - Rural Japan France China - Urban USA Hungary Russia CHD Death Rates/100,000 (Men ages 35-74) International rates not due to differences in statin therapy rates! 2002 AHA Heart and Stroke Statistical Update
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Diets and CAD: What’s the Evidence? Dietary therapy can be an alternative to pharmacologic management of lipids in primary prevention Important adjunctive therapy in secondary prevention What is the best diet for CHD prevention?
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East Finland
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Mortality from Coronary Heart Disease Men 35-64 Years (1969-1994) Puska P: Cardiovasc Risk factors 6:203-10, 1996 Puska P: Cardiovasc Risk factors 6:203-10, 1996 Cardiac death rates Cardiac death rates have dropped by 75%! have dropped by 75%! North Karelia All Finland Per 100,000 800 700 600 500 400 300 200 100 CP999299-39 Now 80%
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Trends in Women’s Lifestyles 1980-82 versus 1992-94 31% decline in CHD incidence across all ages 41% decrease in smoking (27% 16%) Diet changes 31% decrease in trans fatty acid intake 69% increase in P/S ratio 90% increase in cereal fiber 180% increase in ϖ -3 fatty acids 12% increase in folate Nurses’ Health Study -- Hu et al: NEJM 2000;343:530-537
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Trends in Women’s Lifestyles 1980-82 versus 1992-94 38% increase in overweight (BMI>25) average BMI 24.5 26.1 kg/m 2 22% increase in glycemic load
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Regional Diets with Low CHD Rates Seventh Day Adventist Japanese Rural Chinese Eskimo Mediterranean
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This note was uploaded on 02/26/2012 for the course PHARM 210 taught by Professor Staff during the Fall '10 term at Rutgers.

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40221 - Best Diet for CHD Prevention Dr. Thomas G. Allison...

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