frequency of lipid abnormalities in male chd patients rubins hb et al. am j cardiol...

Frequency of lipid abnormalities in male CHD patients

Rubins HB et al. Am J Cardiol 1995;75:1196-1201

Occu

rren

ce o

f ab

norm

aliti

es (

%)

62

87

33

64

0

20

40

60

80

100

Elevatedtotal-C

ElevatedLDL-C

Elevatedtriglycerides

LowHDL-C

Comparative efficacy in raising low HDL-C

HD

L-C

(m

g/d

L)

Simva 20 vs Feno 200MType IIb Steinmetz1

Prava 20/40 vs Feno 200MDucobu2

Atorva 10 vs Feno 300SHeinonen3

45

40

35

30

25

Baseline Statin Fenofibrate

1Steinmetz, J Cardiovasc Pharmacol 1996;27:563–70 2Ducobu, Drugs 1997;54:615–333Heinonen, Abstract 66th Congress of the European Atherosclerosis Society, Florence 1996

A-IA-I

A-IIA-II

LPLLPL

C-IIIC-III

Fibrates

PPAR

Fibrates: Regulation of lipoproteinFibrates: Regulation of lipoproteinmetabolism by PPARmetabolism by PPAR

HDL particlesHDL particles TG rich particlesTG rich particles

PPRE

PPAR

RXR

PPRE

PPAR

RXR

PPRE

PPAR

RXR

PPRE

PPAR

RXR

Staels B et al. Circulation 1998;98:2088–93.

ABCA-1 gene

expression

Apo A-I

PPAR activator

Activated PPAR

Intracellularcholesterol

Human macrophages were cholesterol loaded

with AcLDL in the presence of PPAR

activator and incubated for 24 hourswith apo A-I

0

1

2

3

4

Relative decrease in cellular cholesterol after Apo A-I efflux

TC CE FC

Cholesterolefflux

PPAR activators induce cholesterol efflux from human macrophages

VA-HIT Study: Diabète type 2& traitement par fibrate (1)

(1) Bloomfield Rubins H et al.Arch Intern Med 2002; 162: 2597-2604

Facteurs de risque cardio-vasculaire• Sexe• Antécédents familiaux• Antécédents personnels • Lipides et lipoprotéines• Hypertension artérielle• Diabète• Insuffisance rénale chronique• Inflammations chroniques• Tabagisme• Mauvaises habitudes alimentaires• Sédentarité et activité physique insuffisante

Lipides plasmatiquesPression artérielle

Tendance aux thrombosesRésistance à insuline

OxydationHomocystéineInflammation

Fonction endothélialeIrritabilité ventriculaire

NUTRITION MCV

Nutrition et Pathologies Cardio-vasculaires

Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-Reactive Protein

46 sujets adultes, sains mais hyperlipidémie25 H; 21 F; 59 1 ans; BMI 27.6 0.5

Intervention : distribution aléatoire A : apports pauvres en graisses sat & riches en céréales ent.B : mêmes apports + Lovastatin 20 mgC : apports riches en phytostérols (1.0 g / 1000 kcal)

protéines de soja (21.4 g / 1000 kcal) fibres visqueuses (9.8 g / 1000 kcal) amandes (14 g / 1000 kcal)

D.J.A. Jenkins et al, JAMA, 2003

Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-Reactive Protein

D.J.A. Jenkins et al, JAMA, 2003

Adherence to a Mediterranean diet and survival in a Greek population

Etude prospective sur 22.043 adultes (20-86 ans)

Evaluation des apports alimentaires

Classification selon un «score méditerranéen»

Suivi sur 44 mois :

Adhésion au régime méditerranéen associée à

mortalité par maladies cardio-vasculaires et cancer

Trichopoulou A et al, N Engl J Med, 2003

Trichopoulou A et al, N Engl J Med, 2003

Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction

Final Report of the Lyon Diet Heart Study, de Lorgeril et al, 1999

Survie sans I.M. non mortel Survie sans complication

ALL: 1-week Food Records, Wt, BP & Metabolic ProfilesALL: 1-week Food Records, Wt, BP & Metabolic Profiles

All participants: Step 1 Prudent DietAll participants: Step 1 Prudent DietNational Cholesterol Education ProgramNational Cholesterol Education Program

+ Regular physical activity+ Regular physical activity

+ + Fruits: 250-300g per dayFruits: 250-300g per day+ Vegetables: 125-150g+ Vegetables: 125-150g+ Nuts: 25-50g walnuts/almonds+ Nuts: 25-50g walnuts/almonds+ + 400-500g/day of whole grains: 400-500g/day of whole grains:

legumes, rice, maize, wheatlegumes, rice, maize, wheat+ 3-4 servings mustard / soy bean oil+ 3-4 servings mustard / soy bean oil

Control Group BControl Group B501501

Intervention AIntervention A499499

Follow up: weekly, monthly, 3-monthly to 2 yearsFollow up: weekly, monthly, 3-monthly to 2 yearsEnd Points:End Points:1 Myocardial Infarction - fatal /nonfatal1 Myocardial Infarction - fatal /nonfatal2 Sudden Cardiac Death, 2 Sudden Cardiac Death, 3 Composite total of cardiac events3 Composite total of cardiac events

The Indo-Mediterranean diet heart study, R. Singh et al, Lancet, 2002

Change in Risk factors during study:Change in Risk factors during study:Both groups improved significantlyBoth groups improved significantly, but , but more so in Gp A, p<0.001 for all parametersmore so in Gp A, p<0.001 for all parameters

-35-30

-25-20-15

-10-505

We

igh

t

Sy

stB

P

LD

L

HD

L

TG

FB

S

Gp A

Gp B

RelevantRelevant““UnitsUnits””

-35-30

-25-20-15

-10-505

We

igh

t

Sy

stB

P

LD

L

HD

L

TG

FB

S

Gp A

Gp B

RelevantRelevant““UnitsUnits””


Numbers & rate ratios for cardiac endpoints, Numbers & rate ratios for cardiac endpoints, adjusted for age, gender, BMI, cholesterol and BPadjusted for age, gender, BMI, cholesterol and BP

Group AGroup A BB RateRate499499 501 501 Ratios Ratios

Non Fatal MI 21Non Fatal MI 21 4343 0.47 [0.280.47 [0.28--0.79]0.79]

Fatal MIFatal MI 1212 1717 0.67 [0.310.67 [0.31--1.42]1.42]

Sudden cardiac 6 Sudden cardiac 6 1616 0.33 [0.130.33 [0.13--0.86]0.86]deathdeath

Total CardiacTotal CardiacEndpointsEndpoints 3939 76 76 0.48 [0.330.48 [0.33--0.71]0.71]


Conclusions


• The Indo Mediterranean diet is a safe and The Indo Mediterranean diet is a safe and

economical means for improving the health economical means for improving the health

of poorer populationsof poorer populations

• The whole grains, fruits, vegetables and oils The whole grains, fruits, vegetables and oils

used in this study were traditional fare, used in this study were traditional fare,

grown by farmers at the present market cost grown by farmers at the present market cost

of aboutof about 1 US$1 US$ per day per day

Lancet Lancet

20022002

GISSI-Prevenzione Investigators. Lancet 1999;354:447-455; Marchioli R et al. Eur Heart J Suppl 2001;3(Suppl D):D85-D97.

GISSI-Prevenzione Trial: Design

11,323 patients randomized

4 lost to follow-up687 discontinued

vitamin E11 received omega-3 PUFAs

3 lost to follow-up768 discontinued omega-3 PUFAs

4 lost to follow-up848 discontinued omega-3 PUFAs808 discontinued

vitamin E

2 lost to follow-up15 received omega-3 PUFAs

2 received vitamin E

2835 given omega-3 PUFAs

2830 given vitamin E

2830 given omega-3 PUFAs & vitamin E

2828 controls

2835 analysed for outcomes




GISSI-Prevenzione Trial:Secondary Endpoint Results

Control Omega-3 Risk P-value PUFAs reduction

All-cause mortality 10.6% 8.4% 21% 0.0064

CV death 7.2% 5.1% 30% <0.001

Cardiac death 6.1% 4.0% 35% <0.001

Coronary death 5.2% 3.6% 32% <0.01

Sudden death 3.3% 1.8% 44% 0.0006

Non-fatal CV events 4.9% 4.9% 2% n.s.

Marchioli R et al. Eur Heart J Suppl 2001;3(Suppl D):D85-D97; Marchioli R et al. Circulation 2002;105:1897-1903.

GISSI-Prevenzione Trial: Early Effect of Omega-3 PUFAs on All-Cause Mortality

1.00

0.99

0.98

0.97

0.96

0.95

Pro

bab

ility

330210150600 90 180 270

Days

30 120 240 300 360

0.59 (95% CI 0.36-0.97)

P = 0.037

Omega-3 PUFAs

Control

Marchioli R et al. Circulation 2002;105:1897-1903.

Calculated adjusting for treatment interaction and major confounding variables

Modifications des recommandations • Réduire apports en graisses saturées (animales)• Remplacement par graisses mono-insaturées (olive, …)• Inclusion et augmentation des acides gras oméga-3

• Réduction des sucres simples• Remplacement par sucres lents (féculents, pâtes, pain

entier, …) • Retour aux céréales entières (fibres)

notion de mauvaises & bonnes graisses

mauvais et bons sucres

Modes de nutrition protecteurs

• Régime(s) méditerranéen(s)

• Adaptation possible à goûts/cultures différents graisses saturées sucres simples légumes et/ou fruits (y compris fruits secs)

• Apports caloriques raisonnables

• Apports protéiques raisonnables

• Vin en quantité modérée (sauf si contre-indications)

font partie d’un mode de vie (« lifestyle »)

Nutrition et Maladies c.v. : les messages

• Lésions d’athéroslérose souvent réversibles• Réduction du risque par mode de vie (-50% à –80%)• Suppléments alimentaires : NON, sauf si indications:

stérols végétaux

acides gras oméga-3

acide folique

(sélénium)

Modifications du mode de vie

• Arrêt cigarette

• Alimentation « santé »

sélection aliments / nutriments plaisants & sains activité physique (régulière) risque cardio-vasculaire ( - 80%)

• Effet additif à celui des médicaments ( lipides, tension artérielle)

frequency of lipid abnormalities in male chd patients rubins hb et al. am j cardiol...

Documents