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TRANSCRIPT
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Il controllo dei fattori di rischio nella
realtà
Prof. ENRICO AGABITI ROSEI
Clinica Medica -Università of Brescia
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35
40
J Hypertens 2007
15
20
25
30
35
N=40.829
0
5
10
optimal (160/>100 mmHg)
ISH (>140/
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FORLIFEComparison between pressure values
at visits 1 and 3 in patients with diabetes
Visit 1
(
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Cholesterol and glycemia in Italy :
changes 1998-2008
1998 : 1912 M & 1870 F
2008 : 1738 M & 1741 F
150
200
250
total cholesterol LDL cholesterol HDL cholesterol
TGD glucose
** ↑
** ↑
Giampaoli S et al. Ital Heart J 2003 and 2010
0
50
100
150
1998 2008
** ↑
* ↑
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Smoke and body weight in Italy :
changes 1998-2008
1998 : 1912 M & 1870 F
2008 : 1738 M & 1741 F
40
50
60
smoke normal weight overweight obesity DM MS
** ↑** ↑
* ↑
Giampaoli S et al. Ital Heart J 2003 and 2010
0
10
20
30
1998 2008
** ↑** ↑* ↑
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Hypertension in Italy :
treatment and control changes 1998-2008
1998 : 1912 M & 1870 F
2008 : 1738 M & 1741 F
40
50
60
70
HT untreated HT treated uncontrolled
HT treated controlled Normotensives
Giampaoli S et al. Ital Heart J 2003 and 2010
0
10
20
30
40
1998 2008
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Prevalence of hypertension, dyslipidaemia and diabetes among men
80
30
40
50
60
70
8020-39 40-59 60-79
Menotti et al, J Hypertens 2009
0
10
20
HT survey1 HT survey 3 Dyslip
survey 1
Dyslip
survey 3
DM survey
1
DM survey
3
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70 allHT untreated
Prevalence of LVH in HT patients
(%)
30
40
50
60HT untreated
HT treated uncontrolled
HT treated controlled
*
* +* +
* +
*^
*
* +
*^
0
10
20
Vobarno Pamela Gubbio (2° s)
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* vs NT, + vs IE NT, ^ vs HT uncontrolled
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Renal dysfunction and BP control _I DEMAND
87 centers/4151 pts, 92 % treated, 34 % controlled
37 % diabetics
% p
ati
en
ts * *
*
22,0
26,825,0 26,5
45,2
38,9
20
30
40
50
microalb. eGFR
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EUROASPIRE III disappointments
Smoking Raised BP Over
weight
Obesity Central
Obesity
140/90 or
130/80 in DM
Survey I
1995-1996
19 58 81 22 43
Survey II 15 57 72 24 55Survey II
1999-2000
15 57 72 24 55
Survey III
2006-2007
14 63 81 29 52
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EUROASPIRE III
• Lifestyle of coronary patients major cause of concern
• Adverse trends in obesity and central obesity• Adverse trends in obesity and central obesity
• No change in BP control despite use of AHT treatment
(61 % above therapeutic target 140/90mmHg)
• Improvement in lipid control with increased use of
statins
• Increasing prevalence of diabetes, self reported and • Increasing prevalence of diabetes, self reported and
undetected, and deteriorating glucose control
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The Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group 2011
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Mean BMI
Stemming the global tsunami of cardiovascular disease
Mean Blood Pressure Mean total cholesterol
Anand & Yusuf, Lancet 2011 (data from Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group, Lancet 2011)
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Percentage growth in age-standardised diabetes
prevalence, 1980–2008, by region
M Tobies, Lancet 2011 (data from G Danaei et al, Lancet 2011)
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Lancet, August 28, 2011
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“Health-related research cannot be separated“Health-related research cannot be separated
from research into policies related to
agriculture, trade, education, taxation, and
urban design, and political solutions across
these sectors are needed to ensure that the
health of a nation’s people is a top priority”health of a nation’s people is a top priority”
Anand and Yusuf, Lancet 2011