cardiovascular disease prevention: current knowledge
TRANSCRIPT
Systolic Blood PressureProfessor of Medicine, Boston University
School of Medicine Editor-in-Chief, Journal of the American Society
of Hypertension
American College of Osteopathic Internists October 18, 2018
Disclosure of Relationships
No relationships with industry
The views and opinions expressed in this presentation are those of the speaker and not necessarily those of the NIH or HHS
Leading Causes of Death in the US Year 1900 1. Pneumonia/influenza 2. Tuberculosis 3. Diarrhea
Today 1. Heart disease 2. Cancer 3. Stroke
Life expectancy 48 (m) 51 (f) Life expectancy 75 (m) 80 (f)
Source: www.cdc.gov/nchs/data/hestat/preliminarydeaths04_tables.pdf
Cardiovascular Disease Prevention: Current Knowledge, Future Directions
• Magnitude of the problem • Traditional risk factors • Emerging risk factors • Genetic risk • Future directions
The Big Five
Risk of CHD Death According to SBP and DBP in MRFIT
Data from Stamler J, Stamler R, Neaton JD. Arch Intern Med 1993; 153: 598-615.
0
1
2
3
4
1 2 3 4 5 6 7 8 9 10
Systolic Diastolic
112- 71-
118- 76-
121- 79-
125- 81-
129- 84-
132- 86-
137- 89-
142- 92-
≥151 ≥98
Decile
Data from Stamler J, Stamler R, Neaton JD. Arch Intern Med 1993; 153: 598-615.
9
1 2 3 4 5 6 7 8 9 10
Systolic Diastolic
112- 71-
118- 76-
121- 79-
125- 81-
129- 84-
132- 86-
137- 89-
142- 92-
>151 >98
Decile
Risk of Stroke Death According to SBP and DBP in MRFIT
CHD Mortality: Prospective Studies Collaboration
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913.
IH D
M or
ta lit
y (fl
oa tin
g ab
so lu
te ri
sk a
nd 9
5% C
50-59 years
60-69 years
70-79 years
80-89 years
40-49 years
Usual Diastolic Blood Pressure (mm Hg)
50-59 years
60-69 years
70-79 years
80-89 years
40-49 years
St ro
ke M
or ta
lit y
(fl oa
tin g
ab so
lu te
ri sk
a nd
9 5%
C I)
256
128
64
32
16
8
4
2
1
256
128
64
32
16
8
4
2
1
50-59 years 60-69 years
Hypertension Awareness, Treatment, and Control among Adults in the US
NHANES (1999–2006, 2007–2014)
Prevalence of Hypertension Among Adults in the US
NHANES 2011–2014
Trends in Prevalence of Hypertension among Adults in the US
NHANES 1988–1994, 1999–2006, and 2007–2014
Risk of Death from CHD: In 356,222 Men in the MRFIT Study
3 4
6 7
Stamler et al. JAMA 1986;256:2823
Risk of Death from Coronary Heart Disease: In 356,222 Men in the MRFIT Study
Stamler et al. JAMA 1986;256:2823
Chart1
<182
182-202
203-220
221-244
>244
East
3.2
4.2
5.6
7.1
11.1
Sheet1
<182
182-202
203-220
221-244
>244
East
3.2
4.2
5.6
7-Jan
11.1
0
5
10
15
20
25
30
(2.60) (3.25) (3.90) (4.50) (5.15) (5.80) (6.45) (7.10) (7.75) (8.40) (9.05)
TC mg/dL (mmol/L)
rates (%)
100 125 150 175 200 225 250 275 300 325 350
Northern Europe United States Southern Europe, Inland Southern Europe, Mediterranean Siberia Japan
Prevalence of Elevated Cholesterol in Adults in the US
National Health and Nutrition Examination Survey (2011–2014)
Trends in Prevalence of Elevated Cholesterol Levels Among Adolescents Age 12-19 in the US
NHANES 1988–1994, 1999–2006, and 2007–2014
Trends in Mean Cholesterol Levels in Adults in the US
NHANES 1988–1994, 1999–2006, and 2007–2014
Trends in Elevated Cholesterol Levels in Adults in the US
NHANES 2011–2012 and 2013–2014
Prevalence of Cigarette Smoking
Prevalence f Diabetes and Pre-Diabetes Among Adults in the US
Centers for Disease Control and Prevention, National Diabetes Statistics Report, 2014
DM: FBG >125 mg/dL Pre-DM: FBG 100-125
Trends in Prevalence of Diabetes among Adults in the US
NHANES 1988–1994 and 2011–2014
Diabetes Awareness, Treatment, and Control among Adults in the US
NHANES 2011–2014
National Health and Nutrition Examination Survey (NHANES) 2011 to 2014
Prevalence of Obesity in Children and Adolescents
National Center for Health Statistics
Prevalence of Obesity in Adults
NHANES 2011–2014
Trends in Obesity
Prevalence of Obesity in Adults
BRFSS, 2015
BRFSS, 2015
Whites Blacks
Ideal Health
Ideal Health
Incidence of CVD by the number of ideal health factors
Folsom et al. JACC 2011;57:1690
Prevalence of poor, intermediate, and ideal cardiovascular health among US children aged 12-19 years
National Center for Health Statistics, NHANES 2013 to 2014
Prevalence of poor, intermediate, and ideal cardiovascular health among US adults
National Center for Health Statistics, NHANES 2013 to 2014
Completion of Draft Sequence of the Human Genome – June 2000
“I would be willing to make a prediction that within 10 years, we will have the potential of offering any of you the opportunity to find out what particular genetic conditions you may be at increased risk for, based upon the discovery of genes involved in common illnesses like diabetes, hypertension, heart disease, and so on.”
Francis Collins, June 26, 2000
Best Career Opportunities
Precision Medicine
“Tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier.”
President Obama, State of the Union Address, January 20, 2015
Polymorphisms in 9 Lipid Genes Predict Lipid Levels
LDL HDL
APOB ABCA1
APOE CETP
HMGCR LIPC
LDLR LPL
Kathiresan et al. N Engl J Med March 20, 2008
Polymorphisms in 9 Lipid Genes Predict Lipid Levels
LDL P=2x10-18 HDL P=3x10-24
Kathiresan et al. N Engl J Med March 20, 2008
Chart1
<=6
7
8
9
10
11
12
>=13
LDL
Kathiresan et al. N Engl J Med March 20, 2008
Genetically Driven Drug Discovery
PCSK9 Mutations and CHD
A Genetic Risk Score for Coronary Artery Disease
Performance of Genetic Risk Scores for Other Diseases
A-Fib T2D
Cardiovascular Disease Prevention: Current Knowledge, Future Directions
Disclosure of Relationships
Naïve Beliefs About Healthy Lifestyles
Cardiovascular Disease Prevention: Current Knowledge, Future Directions
The Big Five
Slide Number 7
Risk of CHD Death According to SBP and DBP in MRFIT
Risk of Stroke Death According to SBP and DBP in MRFIT
CHD Mortality: Prospective Studies Collaboration
Stroke Mortality: Prospective Studies Collaboration
Hypertension Awareness, Treatment, and Control among Adults in the US
Prevalence of Hypertension Among Adults in the US
Trends in Prevalence of Hypertension among Adults in the US
Slide Number 15
Risk of Death from CHD: In 356,222 Men in the MRFIT Study
Risk of Death from Coronary Heart Disease: In 356,222 Men in the MRFIT Study
Cholesterol and CHD: Seven Countries Study
Prevalence of Elevated Cholesterol in Adults in the US
Trends in Prevalence of Elevated Cholesterol Levels Among Adolescents Age 12-19 in the US
Trends in Mean Cholesterol Levels in Adults in the US
Trends in Elevated Cholesterol Levels in Adults in the US
Slide Number 23
Prevalence f Diabetes and Pre-Diabetes Among Adults in the US
Trends in Prevalence of Diabetes among Adults in the US
Diabetes Awareness, Treatment, and Control among Adults in the US
Slide Number 29
Slide Number 30
Prevalence of Obesity in Children and Adolescents
Prevalence of Obesity in Adults
Trends in Obesity
Ideal Health
Ideal Health
Incidence of CVD by the number of ideal health factors
Prevalence of poor, intermediate, and ideal cardiovascular health among US children aged 12-19 years
Prevalence of poor, intermediate, and ideal cardiovascular health among US adults
Completion of Draft Sequence of the Human Genome – June 2000
Best Career Opportunities
Polymorphisms in 9 Lipid Genes Predict Risk of CVD
Genetically Driven Drug Discovery
PCSK9 Mutations and CHD
Slide Number 51
American College of Osteopathic Internists October 18, 2018
Disclosure of Relationships
No relationships with industry
The views and opinions expressed in this presentation are those of the speaker and not necessarily those of the NIH or HHS
Leading Causes of Death in the US Year 1900 1. Pneumonia/influenza 2. Tuberculosis 3. Diarrhea
Today 1. Heart disease 2. Cancer 3. Stroke
Life expectancy 48 (m) 51 (f) Life expectancy 75 (m) 80 (f)
Source: www.cdc.gov/nchs/data/hestat/preliminarydeaths04_tables.pdf
Cardiovascular Disease Prevention: Current Knowledge, Future Directions
• Magnitude of the problem • Traditional risk factors • Emerging risk factors • Genetic risk • Future directions
The Big Five
Risk of CHD Death According to SBP and DBP in MRFIT
Data from Stamler J, Stamler R, Neaton JD. Arch Intern Med 1993; 153: 598-615.
0
1
2
3
4
1 2 3 4 5 6 7 8 9 10
Systolic Diastolic
112- 71-
118- 76-
121- 79-
125- 81-
129- 84-
132- 86-
137- 89-
142- 92-
≥151 ≥98
Decile
Data from Stamler J, Stamler R, Neaton JD. Arch Intern Med 1993; 153: 598-615.
9
1 2 3 4 5 6 7 8 9 10
Systolic Diastolic
112- 71-
118- 76-
121- 79-
125- 81-
129- 84-
132- 86-
137- 89-
142- 92-
>151 >98
Decile
Risk of Stroke Death According to SBP and DBP in MRFIT
CHD Mortality: Prospective Studies Collaboration
Prospective Studies Collaboration. Lancet. 2002;360:1903-1913.
IH D
M or
ta lit
y (fl
oa tin
g ab
so lu
te ri
sk a
nd 9
5% C
50-59 years
60-69 years
70-79 years
80-89 years
40-49 years
Usual Diastolic Blood Pressure (mm Hg)
50-59 years
60-69 years
70-79 years
80-89 years
40-49 years
St ro
ke M
or ta
lit y
(fl oa
tin g
ab so
lu te
ri sk
a nd
9 5%
C I)
256
128
64
32
16
8
4
2
1
256
128
64
32
16
8
4
2
1
50-59 years 60-69 years
Hypertension Awareness, Treatment, and Control among Adults in the US
NHANES (1999–2006, 2007–2014)
Prevalence of Hypertension Among Adults in the US
NHANES 2011–2014
Trends in Prevalence of Hypertension among Adults in the US
NHANES 1988–1994, 1999–2006, and 2007–2014
Risk of Death from CHD: In 356,222 Men in the MRFIT Study
3 4
6 7
Stamler et al. JAMA 1986;256:2823
Risk of Death from Coronary Heart Disease: In 356,222 Men in the MRFIT Study
Stamler et al. JAMA 1986;256:2823
Chart1
<182
182-202
203-220
221-244
>244
East
3.2
4.2
5.6
7.1
11.1
Sheet1
<182
182-202
203-220
221-244
>244
East
3.2
4.2
5.6
7-Jan
11.1
0
5
10
15
20
25
30
(2.60) (3.25) (3.90) (4.50) (5.15) (5.80) (6.45) (7.10) (7.75) (8.40) (9.05)
TC mg/dL (mmol/L)
rates (%)
100 125 150 175 200 225 250 275 300 325 350
Northern Europe United States Southern Europe, Inland Southern Europe, Mediterranean Siberia Japan
Prevalence of Elevated Cholesterol in Adults in the US
National Health and Nutrition Examination Survey (2011–2014)
Trends in Prevalence of Elevated Cholesterol Levels Among Adolescents Age 12-19 in the US
NHANES 1988–1994, 1999–2006, and 2007–2014
Trends in Mean Cholesterol Levels in Adults in the US
NHANES 1988–1994, 1999–2006, and 2007–2014
Trends in Elevated Cholesterol Levels in Adults in the US
NHANES 2011–2012 and 2013–2014
Prevalence of Cigarette Smoking
Prevalence f Diabetes and Pre-Diabetes Among Adults in the US
Centers for Disease Control and Prevention, National Diabetes Statistics Report, 2014
DM: FBG >125 mg/dL Pre-DM: FBG 100-125
Trends in Prevalence of Diabetes among Adults in the US
NHANES 1988–1994 and 2011–2014
Diabetes Awareness, Treatment, and Control among Adults in the US
NHANES 2011–2014
National Health and Nutrition Examination Survey (NHANES) 2011 to 2014
Prevalence of Obesity in Children and Adolescents
National Center for Health Statistics
Prevalence of Obesity in Adults
NHANES 2011–2014
Trends in Obesity
Prevalence of Obesity in Adults
BRFSS, 2015
BRFSS, 2015
Whites Blacks
Ideal Health
Ideal Health
Incidence of CVD by the number of ideal health factors
Folsom et al. JACC 2011;57:1690
Prevalence of poor, intermediate, and ideal cardiovascular health among US children aged 12-19 years
National Center for Health Statistics, NHANES 2013 to 2014
Prevalence of poor, intermediate, and ideal cardiovascular health among US adults
National Center for Health Statistics, NHANES 2013 to 2014
Completion of Draft Sequence of the Human Genome – June 2000
“I would be willing to make a prediction that within 10 years, we will have the potential of offering any of you the opportunity to find out what particular genetic conditions you may be at increased risk for, based upon the discovery of genes involved in common illnesses like diabetes, hypertension, heart disease, and so on.”
Francis Collins, June 26, 2000
Best Career Opportunities
Precision Medicine
“Tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier.”
President Obama, State of the Union Address, January 20, 2015
Polymorphisms in 9 Lipid Genes Predict Lipid Levels
LDL HDL
APOB ABCA1
APOE CETP
HMGCR LIPC
LDLR LPL
Kathiresan et al. N Engl J Med March 20, 2008
Polymorphisms in 9 Lipid Genes Predict Lipid Levels
LDL P=2x10-18 HDL P=3x10-24
Kathiresan et al. N Engl J Med March 20, 2008
Chart1
<=6
7
8
9
10
11
12
>=13
LDL
Kathiresan et al. N Engl J Med March 20, 2008
Genetically Driven Drug Discovery
PCSK9 Mutations and CHD
A Genetic Risk Score for Coronary Artery Disease
Performance of Genetic Risk Scores for Other Diseases
A-Fib T2D
Cardiovascular Disease Prevention: Current Knowledge, Future Directions
Disclosure of Relationships
Naïve Beliefs About Healthy Lifestyles
Cardiovascular Disease Prevention: Current Knowledge, Future Directions
The Big Five
Slide Number 7
Risk of CHD Death According to SBP and DBP in MRFIT
Risk of Stroke Death According to SBP and DBP in MRFIT
CHD Mortality: Prospective Studies Collaboration
Stroke Mortality: Prospective Studies Collaboration
Hypertension Awareness, Treatment, and Control among Adults in the US
Prevalence of Hypertension Among Adults in the US
Trends in Prevalence of Hypertension among Adults in the US
Slide Number 15
Risk of Death from CHD: In 356,222 Men in the MRFIT Study
Risk of Death from Coronary Heart Disease: In 356,222 Men in the MRFIT Study
Cholesterol and CHD: Seven Countries Study
Prevalence of Elevated Cholesterol in Adults in the US
Trends in Prevalence of Elevated Cholesterol Levels Among Adolescents Age 12-19 in the US
Trends in Mean Cholesterol Levels in Adults in the US
Trends in Elevated Cholesterol Levels in Adults in the US
Slide Number 23
Prevalence f Diabetes and Pre-Diabetes Among Adults in the US
Trends in Prevalence of Diabetes among Adults in the US
Diabetes Awareness, Treatment, and Control among Adults in the US
Slide Number 29
Slide Number 30
Prevalence of Obesity in Children and Adolescents
Prevalence of Obesity in Adults
Trends in Obesity
Ideal Health
Ideal Health
Incidence of CVD by the number of ideal health factors
Prevalence of poor, intermediate, and ideal cardiovascular health among US children aged 12-19 years
Prevalence of poor, intermediate, and ideal cardiovascular health among US adults
Completion of Draft Sequence of the Human Genome – June 2000
Best Career Opportunities
Polymorphisms in 9 Lipid Genes Predict Risk of CVD
Genetically Driven Drug Discovery
PCSK9 Mutations and CHD
Slide Number 51