management. Managing risk or risk factors? Igor Sergienko, PhD, MD - PowerPoint PPT Presentation

Practical challenges in CV risk management. Managing risk or risk factors? Igor Sergienko, PhD, MD Russian Cardiology Research Complex, Russian National Atherosclerosis Society

DYSIS study. Real clinical practice Очень Very high and high risk высокий и 20% высокий Low and moderate risk риск 80% Умеренный и низкий риск Low doses Начальные of statins дозы 11% статинов 89% High doses Средние и of statins высокие дозы статинов Gitt AK, et al., 2011

DYSIS – RUSSIA LDL Cholesterol level in patients of different rick categories Средний уровень ХС ЛНП в зависимости от степени ССР, ммоль/л Very high Moderate High risk risk risk Despite on different target levels of C-LDL for very high, high and CARD-1092656-0000; 08 2013 moderate rick categories, in real clinical practice C-LDL concentrations were similar * Oganov RG, Kukharchuk VV. Cardiovascular therapy and prevention , №4, 2012.

DYSIS – RUSSIA 53,4% % of patients, which reached C-LDL target level Процент пациентов, достигших целевого уровня ХС ЛНП на фоне терапии статинами 30,3% 12,2% Very high Moderate High risk risk risk * Oganov RG, Kukharchuk VV. Cardiovascular therapy and prevention , №4, 2012.

Prevalence of behavioral risk factors for cardiovascular disease in the Russian population: Results of the ESSE-RF epidemiological study Objective: To study the prevalence of behavioral risk factors (dietary habits, low-intensity physical activity, smoking, and alcohol consumption) among the population of some Russian regions differing in climatic, geographic, economic, and demographic characteristics. 2012-2013, 13 Regions of Russia, 18305 people were included All the subjects were interviewed by the standard questionnaire (consisting of 12 modules) SA Shalnova AO Konrady Prophylactic medicine, 2015, № 5

The prevalence of smoking in Russian population Group Sex Total (n=18 272; 27,7%) Men (n=6903; 43,5%) Women (n=11 369; 4,2%) Absol. % Absol. % Absol. % Variation 1457- 456-757 34.9-48.9 860-1472 5.2-23.6 18.7-34.6 by region 2136 By age 25-34 y. 1778 47.8 1944 19.9 3722 33.2 34-44 y. 1492 44.6 2091 17.2 3583 28.7 45-54 y. 1789 44.5 3360 12.0 5149 23.5 55-64 y. 1844 35.5 3974 5.9 5818 15.3 Education Low than 354 53.7 481 23.4 835 37.3 secondary Secondary 3566 50.7 6157 17.0 9723 30.7 Higher 2983 34.4 4731 11.3 7714 20.3

The alcohol consumption in Russian population, % Group Sex Total Men Women low moderate high low moderate high low moderate high All 21.6 72.1 6.3 23.7 74.1 2.2 23.0 73.2 3.8 By age 25-34 y. 19.2 74.5 6.3 19.9 77.2 2.9 19.5 75.9 4.5 34-44 y. 19.2 71.5 9.3 21.1 76.0 2.9 20.4 74.1 5.6 In Russia alcohol consumption is the highest in Europe. For one person -15.1 l of 45-54 y. 23.2 71.2 5.6 23.4 74.7 2.0 23.3 73.5 3.3 ethanol per year! 55-64 y. 25.7 70.9 3.4 32.4 66.9 0.7 30.3 68.1 1.6  Low: Do not drink alcohol during the past year Education  Moderate: rarely used, ≤168 g (men), ≤84 g (women) of ethanol per week Low than  High: >168 g (men), >84 g (women) of ethanol per week 30.1 63.5 6.4 37.3 60.5 2.2 34.1 61.8 4.0 secondary Secondary 22.0 71.2 6.8 25.0 72.5 2.5 23.8 71.9 4.4 Higher 20.3 73.8 5.9 21.4 76.7 1.9 21.0 75.6 3.5

The prevalence of physical inactivity in Russian population, % Group Sex Total (n=18 305; 38,8%) Men (n=6919; 36,1%) Women (n=11 368; 0,8%) Variation 23.1-49.2 30.7-47.4 27.9-47.8 by region By age 25-34 y. 37.6 46.8 42.3 34-44 y. 39.5 44.1 42.2 Physical inactivity: 45-54 y. 35.3 40.9 39.0 for adults 150 minutes of moderate or 75 minutes of intense aerobic 55-64 y. 30.9 28.9 29.5 physical activity per week (walking in the middle or high rate, or the Education equivalent in intensity is another option loads) Low than 51.0 42.8 46.6 secondary Secondary 54.4 39.0 45.5 Higher 45.2 32.2 37.3

Inadequate fruit and vegetable consumption in Russian population, % Group Sex Total (n=18 304; 41,9%) Men (n=6918; 50,3%) Women (n=11 386; 36,2%) Variation 31.2-71.2 25.4-50.1 32.7-59.0 by region By age 25-34 y. 57.2 41.3 48.9 34-44 y. 52.9 37.4 44.0 Inadequate fruit and vegetable consumption: 45-54 y. 46.4 32.9 37.6 Considered insufficient intake of vegetables and fruits at least 1 times 55-64 y. 42.1 32.3 35.7 a day, fish at least 2 times a week Education Low than 51.0 42.8 46.6 secondary Secondary 54.4 39.0 45.5 Higher 45.2 32.2 37.3

Inadequate fish consumption in Russian population, % Group Sex Total (n=18 304; 36,9%) Men (n=6918; 34,2%) Women (n=11 386; 38,8%) Variation 18.8-53.3 20.7-59.2 20.6-57.1 by region By age 25-34 y. 40.5 45.2 42.0 34-44 y. 34.9 40.3 38.0 45-54 y. 31.1 34.4 33.2 55-64 y. 29.2 34.4 32.7 Education Low than 36.5 47.8 41.8 secondary Secondary 34.0 40.1 37.4 Higher 34.2 37.1 36.0

The prevalence of dyslipidemia in Russian population • Total cholesterol > 5.2 mmol/l - 62% • Total cholesterol > 6.2 mmol/l - 44% Muromtseva G.A., Kontsevaya A.V., Konstantinov V.V. et al. Prevalence of risk factors for noncommunicable diseases in the Russian population in 2012-2013. The study ESSE-RF. Kardiovaskulyarnaya Terapiya i Profilaktika 2014; 6: 4-11. Ershova AI, Meshkov AN, Yakushin SS, et al. Diagnosis and treatment of patients with severe hypercholesterolemia in real outpatient practice (according to the register REKVAZA). Ration Pharmacother Cardiol 2014; 10 (6): 612-6.

Conclusion for ESSE-RF epidemiological study  Although the smoking rate is reduced, it still remains high, especially among men  The frequency of alcohol abuse decreased as a result of prevention at the population level  Increased frequency of malnutrition, especially among young and middle-aged people  Experience of effective population-level power adjustment demonstrates the effectiveness of cooperation with the food industry, for effective correction of RF development of infrastructure projects is necessary  Significant geographic variation of RF requires the establishment of the regional prevention programs

OUTPATIENT REGISTER OF CARDIOVASCULAR DISEASES IN THE RYAZAN REGION ( RECVASA ): PRINCIPAL TASKS, EXPERIENCE OF DEVELOPMENT AND FIRST RESULTS S.A. Boytsov, S.S. Yakushin, S.Yu. Martsevich, M.M. Loukianov, N.N. Nikulina, A.V. Zagrebelnyy, A.N. Vorobyov, K.G. Pereverseva, E.A. Pravkina, A.D. Deev1, E.Yu. Andreenko, A.I. Ershova1, A.N. Meshkov, R.P. Myasnikov, S.E. Serdyuk, M.S. Kharlap State Research Centre for Preventive Medicine, Moscow Ryazan State Medical University named after academician I.P. Pavlov, Ryazan Included: 3300 patients with hypertension (HT), ischemic heart disease (IHD), congestive heart failure (CHF), atrial fibrillation (AF) Rational Pharmacother. Card. 2013;9(1):4-14

Analysis of outpatient cards of patients who applied for general practitioners or cardiologists in 3 outpatient clinics of Ryazan and the Ryazan Region Enrollment in the register the total of 3300 patients with HT, IHD, CHF, AF and their combinations in 2012-2013 (including 1000 patients at the pilot stage in March-May of 2012) Estimation of diagnostics and treatment quality in 600 randomized patients called to an outpatient Information of end clinic 12 months after the points once in 12 enrollment in the register months: Additional examination - hospital admission, Necessity of additional of patients in outpatient - ambulance call, examination and hospital setting in - Surgical intervention Ryazan and Moscow (due to CVD), - myocardial infarction, No Yes - stroke, - lethal outcome

Diagnoses of cardiovascular diseases and their combinations in HT, IHD, CHF and AF patients enrolled in the register, n=1000 Arterial hypertension (HT) – 990 patients (99.0%) Ischemic heart disease (IHD) – 709 (70.9%) ≥ 75 years old Chronic heart failure (CHF) – 748 (74.8%) Atrial fibrillation (AF) – 137 (13.7%) 55-74 years old 60 25-54 years old 50.4% 50 40 % 30 18.0% 20 10.6% 12.9% 6.5% 10 0 HT HT+IHD HT+CHF HT+IHD HT+IHD +CHF +CHF+AF

Diagnostic techniques used in patients with cardiovascular diseases applied for the Ryazan outpatient clinic BP-monitoring 167 180 Stress-test 160 Coronary angiography ECO CG 140 Number of patients BCA sonography ECG monitoring 120 100 89 80 70 60 35 40 16 20 10 15 10 20 7 0 1 0 Men, n=260 Women, n=740

Various drug groups prescription in patients with HT, IHD, CHF and AF applied for the Ryazan outpatient clinic (n=1000) HT – 99.0% Number of patients IHD – 70.9% 700 CHF – 74.8% 605 AF – 13.7% 600 529 500 439 431 400 359 295 300 223 200 100 56 21 0 ARA Β -blockers Ca ACE Diuretics Statins Antiplatelet Anti- Nit- antagonists inhibitors agents coagulants rates

The TC level in patients from Russian FH registry The independent Research Laboratory INVITRO has provided the national atherosclerosis society the data Moscow adult population, including 18,000 consecutive people who had lipid panel measurement during one randomly taken month in 2013 1500 persons 5% 4% 32% 59% Levels of TC ≥ 7.5 mmol/L were observed in 1505 individuals (9%) !