CVD Risk Guidelines in Russia: what and how to follow? Professor* - PowerPoint PPT Presentation

CVD Risk Guidelines in Russia: what and how to follow? Professor* Andrey V. Susekov * Department of clinical pharmacology and therapeutics. Academy for Postgraduate Medical Education. Ministry of Health, Moscow. Russia. 14 О ctober 2016

Disclosures * Research Grants/ Sanofi-Aventis, Novartis, KRKA, Gedeon-Richter, Omthera, Clinical Trials Amgen, Merck, AstraZeneca, KOWA. LECTURER AstraZeneca, Pfizer, KRKA, Gedeon-Richter, Semper, TEVA Pharmaceuticals, Amgen, Sanofi-Aventis Member MSD, Pfizer, AstraZeneca, Amgen, Sanofi-Aventis, of Advisory Board Teva Pharmaceuticals, KRKA * Actual over since 1 Jan 2016.

Russian Federation – country with high CVD risk . SCORE Australian CVD Risk Japanese CVD (high CVD Risk) Chart Risk Chart High CVD Risk Low CVD Risk • Tamio Teramoto, Jun Sasaki, Shun Ishibashi et al. Executive Summary of Japan Atherosclerosis Society (JAS) Guidelines for diagnosis and prevention of Atherosclerotic Cardiovascular Diseases for Japanese 2012. J. Atherosclerosis and Thrombosis Vol 20. 2016 ESC/EAS Guidelines for the Management of Dyslipideamias. The Task Force for the Management European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal 2016;doi:10.1093/europheartj/ehj272; National Vascular Disease Prevention Alliance. Guidelines for the management of absolute сardiovascular disease risk. 2012.

Key National Research Societies (Cardiovascular Diseases) Russian Society of Cardiology www. scario. ru Russian Society of cardio-somatic rehabilitation www. rosokr .ru and secondary prevention Antihypertensive League www. ahleague . ru www. gipertonik. ru Russian Medical Society on arterial hypertension National Atherosclerosis Society www. noathero. ru Scientific Society of specialists on problems www. gzrf.ru of woman health Society of specialists on heart failure www. ossn. ru > 30 National Guidelines

Surfing on International Lipid Guidelines (> 1400):

Key International Guidelines 2016 (Lipids) Very high CVD risk Target non HDL and LDL cholesterol < 100 mg/dl < 70 mg/dl <2,6mmol/l < 1,8 mmol/l Start therapy with statins Non HDL- C≥ 100 mg/dl ( ≥ 2.6 mmol/l) LDL-C ≥70 mg/dl (≥ 1.8 mmol/l) 2016 ESC/EAS Guidelines for the Management of Dyslipideamias. The Task Force for the Management European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal 2016;doi:10.1093/europheartj/ehj272

2016 Update of Brazilian Guidelines on Dyslipidemias and Atherosclerosis Prevention LDL-C and Non-HDL-C Therapuetic Goals and LDL-C Percent Reduction According to CVD Risk Degree Percent Risk LDL-C Goal Non-HDL-C Goal Reduction < 50 mg/dL Very High < 80 mg/dL > 50% (<1,3 mmol/l) High < 70 mg/dL < 100 mg/dL > 50% Intermediate < 100 mg/dL < 130 mg/dL 30-50% Low < 130 mg/dL < 160 mg/dL > 30% Courtesy Andrea Faludi & Raul Santos Raul , personal communications 2016

Russian National Guidelines for prevention and treatment of CVD Atherosclerosis, Hypertension Atherosclerosis, Metabolic syndrome 4 th Update, 2009 5 th Update ,2012 2010 2009 Prevention of cardiac complications after Cardiovascular Coronary bypass in CHD: CVD risk reduction major surgery, 2011 Prevention, 2011 Rehab and 2° prevention in women, 2010 2016

What are the Guidelines? • Atherosclerosis and dyslipideamia (FH) • Statin Expert Consensus Papers and Standards • Hypertension • Metabolic syndrome /Diabetes mellitus • Chronic Kidney Disease (CKD) • Pediatric Guidelines • Other

What are the Guidelines? • Atherosclerosis and dyslipideamia (FH) • Statin Expert Consensus Papers and Standards • Hypertension • Metabolic syndrome /Diabetes mellitus • Chronic Kidney Disease (CKD) • Pediatric Guidelines • Other

Russian National Lipid Guidelines, 5th Revision (2012). Target LDL-C in very high-risk and FH patients CVD risk LDL-C Non HDL-C mmol/l mmol/l Low < 3,5 ≤ 4,3 Moderate <3,0 ≤ 3,8 High <2,5 ≤ 3,3 Very high <1,8 ≤ 2,6 FH patients Dutch Lipid Clinic Network Criteria, LDL-C, mmol/l CHD – ≤ 2,5 CHD + ≤ 1,8 Russian Cardiology Journal;2012;4(96), Attachment I

National/International FH Guidelines Guidelines: NLA ( 2011) ; NOA (2012) ; IFHF (2015), IAS Consensus Paper 2016 Chapter about FH 2009-12 in NOA Guidelines International FH Foundation 2014 translated into Russian www. scadio.ru www. lipidology.ru EAS Consensus Paper for FH 2013 translated into Russian www.lipidology.ru EAS Consensus Paper for children 2015 translated into Russian www.lipidology.ru IAS Consensus Paper for severe FH 2016 just translated into Russian www.lipidology.ru

What are the Guidelines? • Atherosclerosis and dyslipideamia (FH) • Statin Expert Consensus Papers and Standards • Hypertension • Metabolic syndrome /Diabetes mellitus • Chronic Kidney Disease (CKD) • Pediatric Guidelines • Other

Russian Expert Consensus of Statin Therapy (2011 г) . Expert Panel: Aronov D M, Akhmedjanov N M, Boytsov S A, Bubnova M G , Galyavich A S , Gecht A B,. Drapkina O M, Ezhov M V Konorskiy S G, Koziolova N A, Krasilnikova E I , Kukharchuk V V Lopatin Yu M, Medvedeva I V, Oganov R G, Ostroumova O D, Parfenov V A, Perepech N B , Sergienko I V , Skibitskiy V V , Stakhovskaya L V, Susekov A V, Tralovskaya E I, Tereshenko S N, Tugeeva E F, Shalaev S V. 1)Priority patient groups ( very high and high CVD risk) EAS 2011 2) “The lower the LDL - C level , the better “ Target LDL c-C < 1,8 mmol/l or Δ % LDL-C -50% from baseline 3) Maximal statin exposure , indefinite, long-time duration. 4) Atorvastatin 40-80 mg/d or equivalents without titration Cardiovascular therapy and prevention (in russian): 2011;10(2)

Statins In Recomendations and Standards Document Year Statins included Standard Medical Care patients 2006 Lovastatin, Simvastatin, with atherosclerosis, PVD, Atorvastatin thrombosis Guidelines for ACS and STEMI 2007 All statins Standard Medical Care for ischemic 2007 Simvastatin, Atorvastatin stroke (special neurological care) Guidelines VNOC for Heart Failure 2009 (III Revision) Rosuvastatin Guidelines for Metabolic Syndrome 2009 (II Revision) All statins Guidelines for Stable Angina 2009 (II Revision) All statins Guidelines for Arterial 2010 All statins Hypertension Guidelines for dyslipideamia 2012 (V th Revision) All Statins Pitavastatin is registered in Russia in 2016

Ministry of Health’s order to use high -dose statins in pts with ACS, NON STEMI – MI (2015) Ministry of Health, Russia 1 st July 2015 Order About approval of Standard specialized medical care to Patients with acute coronary syndrome, acute and recurrent NONSTEMI MI (without elevation ST of segment on ECG) C10AA HMG-CO-A reductase inhibitors Atorvastatin 80 mg Rosuvastatin 40 mg Simvastatin 40 mg

What are the Guidelines? • Atherosclerosis and dyslipideamia (FH) • Statin Expert Consensus Papers and Standards • Hypertension Guidelines • Metabolic syndrome /Diabetes mellitus • Chronic Kidney Disease (CKD) • Pediatric Guidelines • Other

European Hypertension Guidelines (2013) For all BP systolic < 140 mm HG DM2T BP diastolic < 80 mm HG Guidelines Target LDL-C, Class Level mmol/l Statins in patients with arterial Hypertension with moderate /high CVD risk <3,0 Statins in patients with clinical manifest CHD <1,8 Journal of Hypertension, doi:10.1097/01.hjh.0000431740.32696.cc Russian Cardiology Journal 2014; 1(105):7-94

Additional tests in patient with hypertension and dyslipideamia (EAS/ESC 2011 и ESH/ESC 2013) • HBA1 c , if FPG > 5.6mmol/l , or confirmed diagnosis of DM2 T • Quantitative test for proteinuria • Home and 24-H blood pressure monitoring • Echocardiography • Holter ECG monitoring • Dupplex of carotid arteries • Ultrasound of peripheral arteries , abdominal ultrasound • Measurement of blood wave velocity • Brachilal index • Fundoscopy Journal of Hypertension, doi:10.1097/01.hjh.0000431740.32696.cc Российский кардиологический журнал 2014; 1(105):7 -94

Routing Laboratory Tests in patients with arterial hypertension and dyslipideamia (EAS/ESC 2011 and ESH/ESC 2013) Total cholesterol, Analysis of urine LDL-C, With microscopy of urine sediment HDL-C, +non HDL-C Triglycerides NICE LIPID 2014 + apo B В -100 (obesity, MS) NLA Lipid Guidelines Part I Heamoglobin and /or heamatocrit Protein in urine K+ and Na+ in blood serum Analysis of urine and myoglobinuria Uric acid ECG 12 leads Creatinine and GFR + TSH in baseline NICE LIPID 2014 Journal of Hypertension, doi:10.1097/01.hjh.0000431740.32696.cc Russian Cardiology Journal 2014; 1(105):7-94