Index. Stroke (2000) Coronary heart disease (2000) Stand und Potentiale der Bekämpfung von Herz-Kreislauf-Krankheiten und Diabetes in der Schweitz

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1 Stand und Potentiale der Bekämpfung von Herz-Kreislauf-Krankheiten und Diabetes in der Schweitz Netwektreffen 2013 CardioVascSuisse Bern, 22 August 2013 Index Cardiovascular mortality Prevalence and management of cardiovascular risk factors in Switzerland Cardiovascular prevention in Switzerland: it is worth? Diabetes in Switzerland: prevalence, incidence and prevention potential Pedro Marques-Vidal Institut Universitaire de Médecine Sociale et Préventive Management of AMI in Switzerland: the wild west? Summary and conclusion 2 Coronary heart disease (2000) Men Stroke (2000) Men Müller-Nordhorn et al. Eur Heart J. 2008;29: Müller-Nordhorn et al. EurHeart J. 2008;29:

2 Trends in mortality rates Trends in mortality rates, men Trends in mortality rates, women Geneva, Bluthochdruck Übergewicht/obesitas Höhes Cholesterin 7 Galobardes et al. Ann Epidemiol. 2003;13:

3 Smoking Overweight and obesity, men Marques-Vidal et al. J Epidemiol Community Health. 2011;65:281 9 Marques-Vidal et al. BMC Public Health. 2010;10:87 10 Educational level (Low, Middle, High) Overweight and obesity, women Obesity, men Marques-Vidal et al. BMC Public Health. 2010;10:87 11 Educational level (Low, Middle, High) Faeh et al. Swiss Medical Weekly. 2008;138:204 12

4 Obesity, women Trends in reported hypertension Faeh et al. Swiss Medical Weekly. 2008;138: Estoppey et al. BMC Public Health. 2011;11: Hypertension, men Hypertension, women Prevalence: 4 out of 10 Prevalence: 3 out of 10 Danon-Hersch et al. Eur J Cardiovasc Prev Rehab. 2009;16:66 15 Danon-Hersch et al. Eur J Cardiovasc Prev Rehab. 2009;16:66 16

5 Trends in reported hypercholesterolemia Dyslipidemia Percentage Age group Prevalence Treated Controlled Estoppey et al. BMC Public Health. 2011;11: Firmann et al. Eur J Cardiovasc Prev Rehab. 2010;17: Risk estimation Most CVD events occur in subjects with moderately elevated risk factors The presence of several moderately elevated risk factors adds up and might overcome the effect of a single elevated risk factor Current recommendations stress the need to base intervention on the individual's total risk rather than on the level of any particular risk factor. Risk estimation in Switzerland Lack of consensus Framingham (USA) PROCAM (Germany) SCORE (many European countries) Equations taken «as provided» Little if no validation. Results different. Conroy et al. Eur Heart J 2003;24:

6 Framingham: risk of overestimation PROCAM: risk of overestimation Spain, Men 4'500 4'000 3' Belfast 3'000 Number 2'500 2'000 1'500 1' France Predicted Observed Marrugat et al. J. Epidemiol. Community Health 2003;57: Empana et al. Eur Heart J 2003;24: SCORE calibration SCORE calibration Marques-Vidal et al. EurJ CardiovascPrevRehabil. 2008;15: Marques-Vidal et al. EurJ CardiovascPrevRehabil. 2008;15:402 24

7 25 CV prevention in Switzerland: it is worth? ESC/SCORE Eligible Deaths Cost for 1 year of life gained subjects adverted Option 1 Option 2 Option 3 Men 243, Women 96, All 340, IAS/PROCAM Men 360, Women 153, All 513, ATPIII/Framingham Men 436, Women 189, All 626, Ito et al. Am J Cardiovasc Drugs. 2011;11:33 Trends in reported diabetes, year incidence of T2DM: 5.5% (1% per year) Estoppey et al. BMC Public Health. 2011;11:114 Schmid et al. Arch intern Med 2012;172: Risk of developping diabetes Risk of developping diabetes As for cardiovascular disease, several scores have been proposed to predict the development of T2DM. A first analysis showed that the number of persons at risk varied considerably according to the score used. Based on prospective data, only 2/7 scores were considered as valid. Schmid et al. Diabetes Care. 2011;34:1863 Schmid et al. Arch Intern Med. 2012;172:188 Schmid et al. J Clin Endocrinol Metab Marques-Vidal et al. PLoS One, 2012;7 27 The inclusion of inflammatory or genetic data does not improve the prediction Schmid et al. Diabetes Care. 2011;34:

8 Management of AMI: the wild west? Management of AMI: the wild west? % Léman Mittelland Northwest Zurich East Central Ticino Emergency ICU Any IC intervention Bare stent DE stent CABG Insam et al. EurJ PrevCardiol Insam et al. BMC Public Health. 2013;13: Summary and conclusion CVD mortality decreasing overall, but increasing in the elderly. Although some risk factors are decreasing, their management can still be improved. The increase in the prevalence of obesity and diabetes is worrying. Prevention for all might not be cost-effective. Considerable variations in AMI management 31 32