21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0...
Transcript of 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0...
![Page 1: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/1.jpg)
21ème congrès SADIAB 2019
the International Cholesterol management Practice Study
ICLPS ALGERIA
Pr Abdelkrim Berrah
Service de Médecine interne
Hôpital Dr Mohamed Lamine Debaghine
CHU Bab El Oued Alger
![Page 2: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/2.jpg)
1974,1976
NOBEL 1985
![Page 3: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/3.jpg)
Les preuves
Boekholdt et al JACC 2014
![Page 4: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/4.jpg)
Les preuves
CTT Lancet vol 385 April 11, 2015
![Page 5: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/5.jpg)
Les preuves
Collins R, et al .2016;388:2532-2461
![Page 6: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/6.jpg)
![Page 7: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/7.jpg)
Multiplication des recommandations
![Page 8: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/8.jpg)
Evolution des objectifs
Mach F, et al Eur Heart J 2019;0: 1-78
![Page 9: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/9.jpg)
AACE 2017
![Page 10: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/10.jpg)
ESC/EAS Guidelines 2019
Prévention secondaire Très haut risque Classe I niveau A
Prévention primaire Très haut risque sans HCF Classe I niveau C
Prévention primaire Très haut risque avec HCF Classe IIa niveau C
Mach F et al. Eur Heart J. 2019; 00:1-78
![Page 11: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/11.jpg)
ESC/EAS Guidelines 2019
Prévention secondaire Très haut risque Classe I niveau A
Prévention primaire Très haut risque sans HCF Classe I niveau C
Prévention primaire Très haut risque avec HCF Classe II niveau C
Objectifs Réduction du LDLC d’au moins 50% par rapport au taux de départ et LDLC < 1.4 mmol/l (< 55 mg/l)
Mach F et al. Eur Heart J. 2019; 00:1-78
![Page 12: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/12.jpg)
ESC/EAS 2019 Evolution des objectifs
Mach F et al. Eur Heart J. 2019; 00:1-78
![Page 13: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/13.jpg)
Intérêt d’un LDL-C inférieur à 0.55 g/l : Les évidences
![Page 14: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/14.jpg)
Etude L-TAP : Le Gap
Pearson TA et al. Arch Intern Med 2000;160:459-467.
0
20
40
60
80
100
18
95
Médecins Awareness Guidelines
Patients Coronariens à
l’objectif
![Page 15: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/15.jpg)
![Page 16: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/16.jpg)
ICLPS
Palestine
Inclusion:Patients ≥ 18 ans sous statine depuis au moins 3 mois
![Page 17: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/17.jpg)
Objectifs Principal
Evaluer le pourcentage de patients atteignant Les cibles LDL-C selon les recommandations ESC / EAS 2011 pour le management des dyslipidémies compte tenu de leur niveau de risque cardiovasculaire très élevé, élevé ou modéré.
Secondaires • Focus sur les profils de patients, la non atteinte des cibles LDL C,
• la tolérance des médicaments utilisés,
• La consommation et l’utilisation des ressources de santé,
• l’implémentation des recommandations… -
• Comparer le niveau de risque cardiovasculaire calculé (ESC Score) avec le niveau évalué par le médecin
• Comparer la cible LDL-C considérée par le médecin à celle définie par les recommandations ESC/EAS,
• et comparer la proportion des patients déclarés « Hypercholestérolémie familiale » à celle utilisant les critères de Dutch.
..(11)
![Page 18: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/18.jpg)
Comparaison ESC-EAS/ACC-AHA
![Page 19: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/19.jpg)
Study Population
• The study was implemented in 453 centres in 18 countries
• Location of eligible patients: – 3546 (39.2%) from Asia – 1896 (21.0%) from Latin America – 1890 (20.9%) from Middle East – 881 (9.7%) from Africa – 846 (9.3%) from Eastern Europe
• The largest numbers of patients were from: – India (n=2013) – South Korea (n=1034) – Turkey (n=830) – Mexico (n=622) – Algeria (n=500)
9886 patients screened
727 excluded: • Patient decision 35.7% • Investigator decision 37.6% • Other reasons 26.6%
9159 patients included
9049 eligible patients
109 patients ineligible
OBS14286 – ICLPS 9 May 2017 Patients screened between 3 August 2015 and 31 August 2016 Database was locked on 4 November 2016.
![Page 20: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/20.jpg)
Physician Characteristics (n = 452)
40,5
25,4
13,5
11,7
1,8
4,4
2,7
0 10 20 30 40 50
Cardiologist
Internal medicine
General or…
Endocrinologist
Lipidologist
Other
Several…
Proportion of physicians (%)
Physician specialty Characteristic
Physicians (N=452)
Age (years), mean (SD) 49.0 (9.3)
Years of practice, mean (SD) 22.3 (9.2)
Practice location, n (%) Urban Rural Suburban
385 (85.2)
6 (1.3) 61 (13.5)
Type of practice, n (%) Public hospital Private clinic Office
236 (52.2) 191 (42.3) 88 (19.5)
Guidelines followed, n (%) ACC/AHA1
ESC/EAS2
Other international Local
231 (53.3) 276 (63.7)
23 (5.3) 72 (16.6)
OBS14286 – ICLPS 9 May 2017 ACC, American College of Cardiology; AHA, American Heart Association; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; LMT, lipid-modifying therapy; SD, standard deviation
![Page 21: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/21.jpg)
61 14%
183 40%
61 14%
115 25%
20 4%
12 3%
Généraliste Cardiologue
Lipidologiste endocrinologue Interniste
Autre spécialité Plusieurs spécialités
5 10%
30 61%
4 8%
9 19%
0 0%
1 2%
Global Algérie
Praticiens
![Page 22: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/22.jpg)
Expérience
Variable Données
manquantes
Valeurs
extrêmes
Moyenne Médiane Ecart type Quartiles
Ancienneté 0 12 à 40 24,3 22 7,1 19 ; 28
L’ancienneté professionnelle varie de 12 à 40 ans, en moyenne 24,3 ± 7,1 ans
![Page 23: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/23.jpg)
Recrutement
• Au total, 608 patients ont été recrutés dont 500 retenus et 108 non retenus, la décision de ne pas retenir étant :
• Une décision du patient pour 16 d’entre eux
• Une décision du médecin pour 54 d’entre eux
• Une autre raison pour 31 d’entre eux
• Non précisé pour 7 d’entre eux.
• Parmi les 500 retenus, 15 ont été déclarés non éligibles.
• L’analyse a porté sur 485 patients éligibles.
![Page 24: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/24.jpg)
Caractéristiques des patients : Algérie vs Global
Syndrome métabolique
IDF
3 42 39 281 120 485
2 28 26 196 78 330 (68%)
Metabolic syndrome† 69 346 291 2522 1361 4589(59.6)
Variable Risque bas Risque modéré Risque élevé Risque très élevé Risque non évalué Total
![Page 25: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/25.jpg)
Caractéristiques des patients : Algérie vs Global
Syndrome métabolique
IDF
3 42 39 281 120 485
2 28 26 196 78 330 (68%)
Diabète 3 29 24 188 72 316 ( 65%)
Metabolic syndrome† 69 346 291 2522 1361 4589(59.6)
Diabetes mellitus 69 365 253 2627 1602 4916 (54.3)
Variable Risque bas Risque modéré Risque élevé Risque très élevé Risque non évalué Total
![Page 26: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/26.jpg)
Caractéristiques des patients : Algérie vs Global
Hypertension artérielle 0 27 31 202 99 359 (74%)
Syndrome métabolique
IDF
3 42 39 281 120 485
2 28 26 196 78 330 (68%)
Diabète 3 29 24 188 72 316 ( 65%)
Metabolic syndrome† 69 346 291 2522 1361 4589(59.6)
Diabetes mellitus 69 365 253 2627 1602 4916 (54.3)
Hypertension 47 380 445 3876 1725 6473(71.5)
Variable Risque bas Risque modéré Risque élevé Risque très élevé Risque non évalué Total
![Page 27: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/27.jpg)
Caractéristiques des patients : Algérie vs Global
Hypertension artérielle 0 27 31 202 99 359 (74%)
Tabagisme 0 6 7 140 16 135( 27%)
Syndrome métabolique
IDF
3 42 39 281 120 485
2 28 26 196 78 330 (68%)
Diabète 3 29 24 188 72 316 ( 65%)
Metabolic syndrome† 69 346 291 2522 1361 4589(59.6)
Diabetes mellitus 69 365 253 2627 1602 4916 (54.3)
Hypertension 47 380 445 3876 1725 6473(71.5)
Current smoker 8 69 53 756 238 1124(12.4%)
Variable Risque bas Risque modéré Risque élevé Risque très élevé Risque non évalué Total
![Page 28: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/28.jpg)
35,46% (172)
14,84% (68)
6,59% (32) 7,42% (36)
0,41% (2) 5,55% (27)
0
10
20
30
40
50
60
70
80
90
100
RCV
Coronaropathie angioplastie CABG AVC AVC revasc AOMI
![Page 29: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/29.jpg)
Medical History by CV Risk Level
• 3320 (37%) of patients presented with a documented CAD • The most frequent pathologies were previous ACS or MI and previous PCI
• 6.3% of patients had documented cerebrovascular disease (stroke)
• 4.8% of patients had documented PAD
Medical history, n (%) Total
(N=9049)
Cardiovascular risk level
Low (n=139)
Moderate (n=776) High (n=585)
Very-high (n=4842)
Not known (n=2707)
CAD (documented) 3320 (37) 0 0 0 3320 (68.6) 0
Cancer 298 (3.3) 0 (0.0) 25 (3.2) 28 (4.8) 187 (3.9) 58 (2.1)
CKD (GFR <60 mL/min/1.73 m2) 922 (10.2) 2 (1.4) 20 (2.6) 21 (3.6) 821 (17.0) 58 (2.1)
Congestive heart failure 796 (8.8) 1 (0.7) 9 (1.2) 20 (3.4) 717 (14.8) 49 (1.8)
COPD 319 (3.5) 0 (0.0) 10 (1.3) 18 (3.1) 239 (4.9) 52 (1.9)
Neurocognitive disorder 291 (3.2) 0 (0.0) 13 (1.7) 17 (2.9) 224 (4.6) 37 (1.4)
Peripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0
Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0
OBS14286 – ICLPS 9 May 2017. ACS, acute coronary syndrome; COPD, chronic obstructive pulmonary disease; GFR, glomerular filtration rate; MI, myocardial infarction PCI, percutaneous coronary intervention
![Page 30: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/30.jpg)
35,46% (172)
14,84% (68)
6,59% (32) 7,42% (36)
0,41% (2) 5,55% (27)
0
10
20
30
40
50
60
70
80
90
100
RCV
Coronaropathie angioplastie CABG AVC AVC revasc AOMI
![Page 31: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/31.jpg)
139 2%
776 9%
585 6%
4842 53%
2707 30%
Risque CV bas Risque CV modéré
Risque CV élevé Risque CV très élevé
Risque CV non évalué
3 0%
42 9%
39 8%
281 58%
120 25%
Global Algérie
Risque cardiovasculaire des patients
![Page 32: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/32.jpg)
Diabète
Diabète
316 (DT2 301) 65%
93 (29,4%)
31(33%)
23 (7%)
18
1
4
2
26 (8%)
59 (19%)
17 (5%)
Effectif
Maladie coronarienne
Antécédent d’intervention coronarienne
Antécédent d’AVC
- Ischémique
- Hémorragique
- Non précisé
Revascularisation de l’artère cérébrale
Antécédent d’AOMI
Ins. rénale chronique
Insuffisance cardiaque congestive
![Page 33: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/33.jpg)
85,12% (269)
72,78% (230)
45,56% (144)
15,50% (49) 11,70% (37)
100% (316)
ADO Metformine Insuline Basale Premix Total
Traitement du diabète
![Page 34: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/34.jpg)
29,43% (93)
21,51% (68) 14,24% (45)
7,27% (23)
27,53% (87)
Hémoglobine glyquée
7% <
7 - 8%
8 - 9%
9% >
NP
![Page 35: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/35.jpg)
Molécules anti hypertensives utilisées
Modalités Risque bas
Risque modéré
Risque élevé
Risque très élevé
Risque non évalué
Total
Effectif 3 42 39 281 120 485
ARAII 0 17 21 122 73 233
Inhibiteur calcique (IC) 0 9 15 98 40 162
IEC 0 6 5 128 20 159
Beta bloquants 0 7 9 160 39 215
Diurétiques 0 6 7 99 50 162
Autre anti hypertenseur 0 1 1 11 4 17
Pas de traitement antihypertenseur 3 14 7 17 18 59
![Page 36: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/36.jpg)
Primary Objective: Percentage of Patients Reaching LDL-C Targets by CV Risk Level
Percentage of patients reaching risk-based LDL-C target decreased with increasing level of CV risk
0
10
20
30
40
50
60
70
80
90
100
Risk-based LDL-C target not reached Risk-based LDL-C target reached
Pro
po
rtio
n o
f p
atie
nts
, % (
95
% C
I) Total (N=6203) Moderate-risk (n=776)
High-risk (n=585) Very-high-risk (n=4842)
OBS14286 – ICLPS 9 May 2017. CI, confidence interval; CV, cardiovascular Patient numbers are based on those in whom CV risk could be assessed at baseline (non-assessable patients excluded from the total population)
32.1
43.9
64.0
37.2 36.0
62.8 56.1
67.9
![Page 37: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/37.jpg)
Primary Objective: Percentage of Patients Reaching LDL-C Targets by CV Risk Level
Algeria
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
Risk-based LDL-C target not reached Risk-based LDL-C target reached
Pro
po
rtio
n o
f p
atie
nts
, % (
95
% C
I) Total (N=362) Moderate-risk (n=42)
High-risk (n=39) Very-high-risk (n=281)
39.5 38.5
71.4
43.1
28.6
56.9 61.5 60.5
![Page 38: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/38.jpg)
Proportions de patients à l’objectif LDL selon les pays
![Page 39: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/39.jpg)
Médecin satisfaitdu résultat
Conditionscliniques du patient
Intolérance Raison économique Total
84,89% (236)
8,99% (25) 6,83% (19)
1,79% (5)
100% (278)
Non prescription d'une statine à forte dose
![Page 40: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/40.jpg)
● Among patients who had tried but did not tolerate previous statin (N=1351), 70.9% had received one statin, 24.6% two statins and 4.4% ≥3 statins
Reasons for Not Receiving High-dose Statin by CV Risk Level
0
10
20
30
40
50
60
70
80
90
100
Physician satisfied with LDL-C levelon current dose regimen
Due to patient’s clinical conditions, higher dose not medically
appropriate
Higher dose regimen and/or higher-intensity statin not tolerated
Cost/price reasons
Reasons for not receiving high-dose statin*
Total (N=6591) Low-risk (n=107) Moderate-risk (n=594) High-risk (n=431) Very-high-risk (n=3329)
14.2
OBS14286 – ICLPS 9 May 2017. *Atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg, or highest dose available in the patient’s country.
13.1 7.9 6.7 7.5
10.9 10.8 8.6 8.4 8.9 8.4 8.4 11.1 7.5 6.9
74.9 69.8
78.4 80.0 80.4
% o
f p
atie
nts
![Page 41: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/41.jpg)
LDL-C Level Achieved by CV Risk Level
Under the current LMT, more moderate- (63.3%) than high- (47%) or very-high-risk (28.5%) patients achieved their risk-based target
Low-risk(n=139)
Moderate-risk(n=776)
High-risk(n=585)
Very-high-risk(n=4842)
Not assessable(n=2707)
Pro
po
rtio
n o
f p
ati
en
ts a
ch
ievin
g L
DL
-C
leve
l (%
)
<1.8 mmol/L (70 mg/dL) ≥1.8–<2.6 mmol/L (70–100 mg/dL) ≥2.6–<3.0 mmol/L (100–115 mg/dL)
≥3.0–<3.4 mmol/L (115–130 mg/dL) ≥3.4–<4.1 mmol/L (130–160 mg/dL) ≥4.1 mmol/L (160 mg/dL)
100
80
60
40
20
OBS14286 – ICLPS 9 May 2017. Patient numbers are based on those in whom CV risk could be assessed at baseline
9.4
8.6
15.8
16.5
32.4
17.3
9.1
14.8
12.8
14.6
34.5
14.2
12.1
14.2
10.1
16.6
32.3
14.7
6.4 8.1
8.4
12.0
36.6
28.5
11.3
14.1
11.4
13.6
32.2
17.3
Varia
ble
Modalités Risq
ue
bas
Risque
modér
é
Risqu
e
élevé
Risqu
e très
élevé
Risque
non
évalué
Total
Age Effectif 3 42 39 281 120 485
N=30%
N=24%
![Page 42: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/42.jpg)
>50% of patients at high/very-high calculated risk were estimated to be a lower risk level by physicians
Physician-Estimated versus ESC/EAS Assessment of Patient CV Risk
0
10
20
30
40
50
60
70
80
90
100
Low (n=138) Moderate (n=775) High (n=585) Very-high (n=4835)
Ph
ysic
ian
-est
imat
ed C
V r
isk
(%)
ESC/EAS cardiovascular risk level1
Low Moderate High Very-high
OBS14286 – ICLPS 9 May 2017
11.6
34.4
38.1
15.9
45.7
30.0
18.2
6.5
5.2
26.3
43.7
24.8
2.9
21.7
34.8
40.6
Physician-estimated CV risk:
![Page 43: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/43.jpg)
Algeria
Physician-Estimated versus ESC/EAS Assessment of Patient CV Risk
0
10
20
30
40
50
60
70
80
90
100
Low (n=3) Moderate (n=42) High (n=39) Very-high (n=281)
Ph
ysic
ian
-est
imat
ed C
V r
isk
(%)
ESC/EAS cardiovascular risk level1
Low Moderate High Very-high
15,4
48,8
17,9
17,9
70,8
18,9
7,5 2,8
4,7
42,9
35,7
16,7
33,3
33,3
33,3
Physician-estimated CV risk:
![Page 44: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/44.jpg)
HF Algérie
Etiologie de
l’hyperchole
stérolémie
Effectif 3 42 39 279 120 483 DLCN
Familiale 0 3 1 6 1 11 7
Risque bas Risque
modéré
Risque
élevé
Risque très
élevé
Risque non
évalué
Total
36% des HF diagnostiquées par les médecins n’ont pas de HF selon DCLN
![Page 45: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/45.jpg)
HF Algérie
Etiologie de
l’hyperchole
stérolémie
Effectif 3 42 39 279 120 483 DLCN
Familiale 0 3 1 6 1 11 7
Risque bas Risque
modéré
Risque
élevé
Risque très
élevé
Risque non
évalué
Total
36% des HF diagnostiquées par les médecins n’ont pas de HF selon DCLN
![Page 46: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/46.jpg)
Physician Assessment of FH versus DLCN Criteria Assessment
• 16.3% of patients with FH diagnosed by physicians did not actually have FH according to DLCN criteria (Kappa coefficient 0.222, 95% CI 0.175–0.268)
Pro
po
rtio
n o
f p
atie
nts
(%
)
FH diagnosis by physician
OBS14286 – ICLPS 9 May 2017. DLCN, Dutch Lipid Clinic Network diagnostic criteria
4.4% also had FH by DLCN
76.0% also did not have FH by DLCN
20.7% of patients had FH according to physician assessment
79.3% of patients did not have FH according to physician assessment
■ Agreement between physician assessment and DLCN diagnosis
■ Disagreement between physician assessment and DLCN diagnosis
3.3% had FH by DLCN
Nordestgaard BG et al. Eur Heart J. 2013;34:3478–90a
0
10
20
30
40
50
60
70
80
90
100
No Yes
16.3% did not have FH by DLCN
![Page 47: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/47.jpg)
Intolérance aux statines
Palestine
![Page 48: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/48.jpg)
Causes d’intolérance
Symptômes musculaires
0 1 1 5 2 9
Symptômes Gastro-intes
0 0 1 6 3 10
Autres raisons
1 0 0 0 0 1
NP 0 0 0 2 0 2
Modalités Risque bas Risque modéré Risque élevé Risque très élevé Risque non évalué Total
Intolérance aux statines
![Page 49: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/49.jpg)
Intolérance aux statines, controverses, résistance, reluctance
Toth PP. Am J Cardiovas Drugs 2018
![Page 50: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/50.jpg)
Quelles recommandations ?
Palestine
![Page 51: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/51.jpg)
Physician-Estimated Target Assessment versus ESC/EAS Guideline-Assessed Target
• On average, the LDL-C target assessed by the physician was significantly higher than the target assessed using ESC/EAS guidelines1 (P<0.0001)
– Mean difference between these assessments was higher for physicians who did not follow any guidelines or who followed other international guidelines compared with those who followed ESC/EAS1 or ACC/AHA2 guidelines
52
Guideline followed by investigator
Difference (%) between LDL-C target value assessed by the investigator and target value defined by ESC/EAS guidelines (n=6138)
Overall Mean (SD)
Median (IQR)
12.3 (27.8)
0.7 (0.0, 43.9) Investigator did not follow any guidelines
Mean (IQR) 3.6 (–13.7, 43.9)
Investigator followed other international guidelines
Mean (IQR) 38.9 (0.7, 43.9)
Investigator followed ESC/EAS guidelines
Mean (IQR) 0.7 (0.0, 29.5)
Investigator followed ACC/AHA guidelines
Mean (IQR) 0.7 (0.0, 46.9)
OBS14286 – ICLPS 9 May 2017.
1. Reiner Z et al. Eur Heart J, 2011;32:1769–818; 2. Stone NJ et al. J Am Coll Cardiol, 2014;63:2889–934.
![Page 52: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/52.jpg)
Facteurs associés à la non atteinte de l’objectif LDL -C
![Page 53: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/53.jpg)
Variable Modalités Atteinte cible LDL
Non atteinte
Diabète Pas de diabète
Nombre ECG
Effectif 156 206 316 169
n 136 189 278 157
Nombre d’écho
n 93 128 180 107
Delta +28% +43%
Consommation des ressources en soins
![Page 54: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/54.jpg)
Consommation des ressources en soins
Variable Modalités Atteinte cible LDL
Non atteinte Diabète Pas de diabète
Effectif 156 206 316 169
Nbre sujets hospitalisés 27 23 32 23
Durée des 3 hospitalisations les plus récentes
Effectif 26 19 27 22
M ± ET 13 ±23 5,1 ± 3,7 13,3 ± 22,5 5 ± 2,9
Val extr 1 à 105 1 à 15 1 à 105 1 à 10
Nombre de consultations en urgence
Effectif 134 176 271 146
0 118 157 237 135
1 12 11 24 6
>1 4 8 10 5
Nombre de consultations vers un généraliste
Effectif 111 142 227 109
0 61 85 116 71
1 11 17 25 12
>1 39 40 86 26
Nombre de consultations vers un cardiologue
Effectif 151 199 303 168
0 28 40 71 11
1 11 13 32 10
>1 112 146 200 147
Nombre de consultations vers un autre spécialiste
Effectif 117 155 253 113
0 44 49 57 73
1 8 16 20 12
>1 65 90 176 28
Delta +33% +49%
Vs delta LDL 45% Diabète Global 39%
![Page 55: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/55.jpg)
ICLPS
Palestine
![Page 56: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/56.jpg)
Synthèse
• This registry of 9049 patients receiving LMT in 18 non-Western countries shows that the rate of LDL-C control is suboptimal, particularly in patients at high or very-high CV risk
• An estimated 37.2% (95% CI 36.0–38.4%) of patients achieved LDL-C goals according to ESC/EAS guidelines.
– Rate of patients achieving LDL-C goal decreases with increasing level of CV risk
• Non-achievement of goals was more common in women than men and when other risk factors, excluding diabetes, were present or poorly controlled
• High-dose statins are insufficient to achieve LDL-C goals in many instances
• There is a discrepancy between risk as assessed by physicians and score-calculated risk.
57
OBS14286 – ICLPS 9 May 2017.
![Page 57: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/57.jpg)
Do we reached the LDL target?
• In clinical trials:
meta-analysis (Boekholdt, JACC 2014): 40.4% did not reached an LDL target < 70 mg/dl (1.81 mmol/l)
• In real-life:
DYSIS study (Leiter LA. Diabet Med 2011): 41.3% of statin-treated patients were not at LDL-C goal (> 2.5 mmol/l)
EUROASPIRE III 2006–2007 (n=6588)
• 79% of patients with diabetes were (n=1541) on a statin
• Overall, only 53% of patients with prevalent diabetes reached
the LDL-C target of <100 mg/dl (2.5 mmol/l)
Gyberg V et al. Eur J Prev Cardiol. 2015, 22: 753-61
% of patients achieving LDL-C target:
<1.8 mmol/L
<2.5 mmol/L 0
20
40
60
80
100
No Diabetes (n=4295)
Incident Diabetes (n=752)
Prevalent Diabetes (n=1541)
<3.0 mmol/L
![Page 58: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/58.jpg)
Les Recommandations évoluent, les pratiques…
N= 3x500
![Page 59: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/59.jpg)
Contrôle optimal vs sous optimal
![Page 60: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/60.jpg)
Réponse aux statines : Différences raciales
![Page 61: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/61.jpg)
The Myocardial Infarction Genetics Consortium Investigators. N Engl J Med 2014;371:2072-2082
Naturally occurring mutations that disrupt NPC1L1 function were found to be associated with reduced plasma LDL cholesterol levels (12mg/dl) and a reduced risk of coronary heart disease (53%) (heterozygous).
Inactivating Mutations in NPC1L1 and Protection from Coronary Heart Disease
Preuves génétiques: Inactivating mutations in NPC1L1 and protection from CHD
![Page 62: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/62.jpg)
LDL Cholesterol and Coronary Heart Disease among Subjects by PCSK9142X or PCSK9679X Allele
PCSK9142X or PCSK9679X
Cohen NEJM 2006; 354:1264-72
Co
ron
ary
Heart
Dis
ease (
%)
No Yes
P=0.008
12
8
4
0
88%
![Page 63: 21ème congrès SADIAB 2019 - sadiab-dz.comPeripheral artery disease 430 (4.8) 0 0 0 430 (8.9) 0 Stroke (any) 567 (6.3) 0 0 0 567 (11.7) 0 OBS14286 – ICLPS 9 May 2017. ACS, acute](https://reader034.fdocuments.us/reader034/viewer/2022050501/5f9385c21c2ce46d2675335d/html5/thumbnails/63.jpg)
Feuille de route