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Zaragoza, 11 de noviembre 2009

Estatinas en la Insuficiencia Cardiaca Fernando Civeira Hospital Universitario Miguel Servet ZARAGOZA. Zaragoza, 11 de noviembre 2009. V JORNADAS ACTUALIZACIÓN EN INSUFICIENCIA CARDIACA.

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Zaragoza, 11 de noviembre 2009

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  1. Estatinas en la Insuficiencia CardiacaFernando CiveiraHospital Universitario Miguel ServetZARAGOZA Zaragoza, 11 de noviembre 2009 V JORNADAS ACTUALIZACIÓN EN INSUFICIENCIA CARDIACA

  2. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins Cholesterol Treatment Trialists’ (CTT) Collaborators. Lancet 2005;366:1267

  3. Retrospective sub-group analysis of 4S trial 19% reduction placebo 35 31.9% simvastatin 30 25.5% 25 20 Mortality (%) 28% reduction 15 9.2% 10 6.6% 5 0 n=1995 n=2037 n=228 n=184 Heart failure No heart failure Kjekshus J et al. J Card Fail 1997;3:249–254

  4. Heart Failure Hospitalizations in the Treating to New Targets (TNT) Study 0.10 0.08 0.06 Proportion of patients experiencingCHF with hospitalization Hazard ratio = 0.74 95% CI 0.59-0.94P=0.012 atorvastatin 10 mg 0.04 atorvastatin 80 mg 0.02 0.00 0 12 24 36 48 60 72 Months Khush KK et al. Circulation 2007:115;576–583

  5. Efectos pleitrópicos de las estatinas

  6. Efectos pleiótrópicos estatinas e insuficiencia cardiaca • Disminuyen estrés oxidativo • Tienen propiedades antiinflamatorias • Mejoran disfunción endotelial • Angiogénesis • Disminuyen trombosis • Movilizan células progenitoras de médula ósea • Alteran remodelado ventricular

  7. CORONA - Study Design A Randomized, Double-Blind, Placebo-Controlled Study with Rosuvastatin in Patients with Chronic Symptomatic Systolic Heart Failure Patients (n=5011) Chronic ischaemic systolic heart failure receiving optimal HF treatment (diuretics, ACE inhibitors, ARBs, beta-blocker therapy) Ejection fraction≤0.40 (NYHA class III/IV)or ≤0.35 (NYHA class II) ≥60 years End points: Time to cardiovascular death, non-fatal MI, non-fatal stroke Total mortality rosuvastatin 10 mg (n=2514) placebo (n=2497) 1 –8 to –2 Visit: Week: 2 –4 to –2 4 6 Final ~3 y 3 0 5–21 3 monthly Eligibility Optimal HF treatment instituted Placebo run-in Median follow-up 2.7 years Kjekshus J et al. Eur J Heart Fail 2005;7:1059-1069

  8. CORONA - Secondary EndpointsTotal number of hospitalizations Placebo (n=2,497) 4,074 Rosuvastatin 10 mg (n=2,514) 4,000 3,694 3,000 2,464 No. hospitalisations 2,193 2,000 1,510 1,501 1,299 1,109 1,000 0 All cause CV cause Heart failure Non-CV cause p=0.007 p<0.001 p=0.01 Kjekshus J et al. N Eng J Med 2007; 357 doi 10.1056/NEJMoa0706201

  9. Post hoc analysis of the number fatal/non-fatal MI or stroke in the primary endpoint 15 Hazard ratio = 0.84 95% CI 0.70 to 1.00 p = 0.05 Placebo 12 Rosuvastatin 10 mg 9 Percent of patients with event 6 3 0 0 6 12 18 24 30 36 Months of follow-up No. at risk Placebo 2497 2315 2156 2003 1851 1431 811 Rosuvastatin 2514 2345 2207 2068 1932 1484 855 Data on File

  10. Ensayos clínicos con estatinas

  11. Robinson JC, et al. JACC 2005;46:1855-1862

  12. Conclusiones • Las estatinas son fármacos excelentes en la prevención cardiovascular, incluida la prevención de insuficiencia cardiaca • Las estatinas se toleran muy bien en pacientes con insuficiencia cardiaca • Las estatinas no afectan la evolución de los pacientes con insuficiencia cardiaca II-IV, con independencia de su etiología • Los potenciales efectos pleitrópicos de las estatinas parecen tener escaso impacto clínico en estos pacientes

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