From Aging/Disease to Youth/Health Economic, Scientific...

New York, Dec 9, 2016 No Disclosures

From Aging/Disease to Youth/Health

Economic, Scientific, Educational

The Three Upcoming Challenges

NHLBI Strategic Agenda - 2025

M Lauer, GH Gibbons et. al. JACC 2015; 65: 1130 - Environment


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

Interheart - PURE Inv. (S Yusuf et. al.) NEJM 2014; 371: 818

CV Risk-Factor Burden in HML I Countries

CV Case Fatality Rates in HML I Countries

PARADOX

PARADOX

LJ Laslett et. al. JACC 2012;60:S1 –

Age-Adjusted Deaths for CVD, CAD & Stroke

US 1980 to 2008 – The 50% / 50%

Projected Direct Costs of Total CVD

by Type of Cost (in Billions) - / 50%

ACC BOT’ ESWG Members (L Laslett et. al.) JACC 2015; 66 (suppl D).

Value of Primordial and Primary Prevention

for Cardiovascular Disease

A Policy Statement From the American Heart Association

Public policy, community efforts, and pharmacological

interventions are all likely to be cost-effective and often cost

saving compared with common benchmarks. The high

direct medical care and indirect costs of cardiovascular

disease—approaching $450 billion a year in 2010 and

projected to rise to over $1 trillion a year by 2030—make this

a critical medical and societal issue. Prevention of CVD will

also provide great value in developing a healthier, more

productive society.

WS Weintraub et al., Circulation 2011; 124:967


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

Minimizing Modifiable CV RFrs (7) & Life Style

c

c 1

3

2


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

T Münzel et al. Eur Heart J 2015;36:1777

KE Cosselman et. al. Nat. Rev. Cardiol. 2015;12:627

Pulmonary. Oxidative Stress

Proposed Cardiovascular Side Effects

Of Noise & Air Pollution - ROS

A

B


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

Primordial

Secondary

Primary

50/50

Translation Studies Towards

Promoting Healthy Aging

5) SHE

HARLEM

MEXICO

3)1)

2)

4) IIIP

HRP

Surg.Interv.

PESA

AWHS

TANSNIP

1). Risk Factors of CV Disease

White Matter & Lacunar Lesions (DBD)

MA Lim et. al. Clin Geriatr Med. 2009;25:191.

JC Kovacic, V Fuster et. al. Circulation. 2011;123:1900

1B

Cerebral Microcirculation - 6 Studies

1.V Novak, I Hajjar. Nat. Rev. Cardiol. 2010; 7:686 – A’sD

2. HW Querfurth et al NEJM 2010;362:329 - Ischemia 60-90% A’sD

3. JT O’Brien et. al. Lancet. 2015;386:1698 - Autopsy

4. CARDIA (K Yaffe et al) Circ 2014;129:1560 - CV RFrs , Cognitive

5.JI Friedman et al. JACC CV Imag. 2014;7:1039 - Imaging

6. FINGER (T Ngandu et al)., Lancet 2015; 385:2255 - Intervention

Impact of Hypertension on Cognitive Function

A Scientific Statement From the AHA

Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function. Observational studies demonstrated a cumulative effect of hypertension on cerebrov. damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive.

C Iadecola et al., Hypertension 2016 (In Press)

BP Lowering in Key Subgroups

-5 0Cand/HCTZ

better

Placebo

better

5

Age-years

72 (Mean=71.0)

72-75 (Mean=73.3)

>75 (Mean=78.1)

SBP-mmHg

133.0 (Mean=123.8)

133.0-140.0 (Mean=139.1)

>145.0 (Mean=156.3)

HOPE-3 Investigators (J Bosch et. al.) 2016 (AHA)

ROSUVASTATIN IN KEY SUBGROUPS

Age-years

72 (Mean=71.0)

72-75 (Mean=73.3)

>75 (Mean=78.1)

LDL-mg/dl

112 (Mean=88.7)

112-140 (Mean=125.7)

>140 (Mean=164.9)

-5 0Rosu

better

Placebo

better5

HOPE-3 Investigators (J Bosch et. al.) 2016 (AHA)

DBD & Alzheimer’s Disease

Increasing evidence suggests that many lifestyle-related factors, including diabetes, obesity, physical and mental inactivity, depression, smoking, low educational attainment, and diet have a role in dementia, and the potential for primary prevention related to such modifiable risk factors is huge but yet to be fully explored. On the basis of the Rotterdam study, it has been modelled that elimination of the seven most important modifiable risk factors would lead to a 30% reduction in dementia incidence.

P Scheltens et al., The Lancet 2016; 388:507

Primordial

Secondary

Primary

50/50



5) SHE

HARLEM

MEXICO

3)1)

2)

4) IIIP

HRP

Surg.Interv.

PESA

AWHS

TANSNIP

2). CV Drugs – Underuse

Risk Factors - Proportion of Participants at Goal % – 1 year

Trials L SBP DBP Hb A1C Meet Goals

BARI-2D 75 56 70 52 14 20

COURAGE 51 55 55 59 12 19

FREEDOM 55 63 53 55 12 20

Freedom, Bari-2D, Courage Investigators, JACC 2013;61:1607

PURE (S Yusuf et al.) Lancet 2011; Aug 28 - Poor Countries,7% !!!

NHANES, AHA, NHLBI-JNC-7, NHLBI-NCEP – < Adherence

P Muntner, V Fuster et al., AHJ 2011; 161: 719 – 49 seconds !!!!

CABG Versus PCI -Impact of Adherence to Medical

Therapy on Comparative Outcomes

All non-STEMI patients undergoing revascularization in an 8-hospital network were followed for up to 8 years. Among the 973 CABG and 2255 PCI patients. There was a significant benefit for antiplatelet, lipid-lowering, and -blocker therapy in both the CABG and PCI groups. Compliance with optimal medical therapy as a more powerful predictor of major adverse cardiac event-free survival than choice of therapy.Among comparable patients who adhere to optimal medical therapy, outcomes of PCI and CABG may not differ; however, among nonadherent patients, CABG affords better major adverse cardiac event-free survival.

P Kurlansky, M Mack et al., Circulation 2016; 134:1238

CV Drugs Underuse - Polypill, 2ary Prevention*

Am. H J 2011;162:811 Semin.Thor.Cardiov.Surg 2011;23:24JACC, 2014; 64:2071 JACC. 2016; 68:789 Approved in 27 Countries

* Valentín Fuster (inventor)

FOOD INTERACTION

PHARMACOKINETIC INTERACTION WITH ASPIRIN

PHARMACOKINETIC INTERACTION WITH

SYMVASTATIN

PHARMACOKINETIC INTERACTION WITH RAMIPRIL

PHARMACODYNAMIC INTERACTION WITH ASPIRIN

PHARMACODYNAMIC INTERACTION WITH

SYMVASTATIN

PHARMACODINAMIC INTERACTION WITH RAMIPRIL

BIO-EQUIVALENCE

ASA, Statin, ACE-Inhibitor

ArgentinaBrazilParaguayItalySpain

FOCUS 1 & 2

FREEDOM

AETNA-DIABETES

SECURE-EC 2016


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

Primordial

Secondary

Primary

50/50



5) SHE

HARLEM

MEXICO

3)1)

2)

4) IIIP

HRP

Surg.Interv.

PESA

AWHS

TANSNIP

3). Plaque Burden (N=12,000)

Carotid 3D-US, Coronary Calcification

PI: Valentin Fuster, Mobile Units - AHJ 2010;160:49

H Sillesen, P Muntendam, E Falk, V Fuster et.al JACC Imag. 2012;7:681.

U Baber, R Mehran, V Fuster, et al. J. Am. Coll. Card. 2015; 65: 1065

Upcoming 8 Year Follow up

3a).Three Year All-Cause MACE Rates (N=216)

by Carotid and Coronary Atherosclerosis

Reclassification: CAC 24% - cPB 18%

3b). Distribution Of The Systemic Extent

Of Subclinical Atherosclerosis

PESA (L Fernandez-Friera, A Fernandez-Ortiz, V Fuster et.al) Circulation 2015;131:2104

3c). Framingham, When Positive Coronary Artery

Calcification Score and Ultrasound are Added

Variables included in the prediction model Variables included in the prediction model

0.665 0.689 0.706 0.719 0.743 0.778 0.810 0.827

AWHS - M Lacaustra, V Fuster et al. JACC 2016; 67: 1263

Tarkin JM, Dweck M, Fayad ZA et al. Circ Research 2016 (in Press)

CT / PET–Carotid and CxCA Plaques / Inflammation

Culprit Plaque Identified In Acute MI

Coronary Angiogram Fused 18F-NaF PET CT

Joshi N, Dweck M, Vesey A, Rudd JHF, Newby DE et al Lancet 2014

Primordial

Secondary

Primary

50/50



5) SHE

HARLEM

MEXICO

3)1)

2)

4) IIIP

HRP

Surg.Interv.

PESA

AWHS

TANSNIP

c

?

4ab). A Health Center

In The Adult Brain (?)

To Stimulate / Motivate

2B

4a). AMPATH Centers In Kenya

BP Control / Non MD / High Technology

R Vedanthan, V Fuster, NHLBI / Kenya Model (2012-2016)

86

69

96

104

127

70

86

N=552

4b). The Seven Community Study

Spain - E. Gomez, V Fuster et al JACC 2016; 67:476

Cardona Integral – “Fifty-fifty” - 2014

Global Demonstration Project – GHP – 2013


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

Primordial

Secondary

Primary

50/50



5) SHE

HARLEM

VILLAGE

MEXICO

3)1)

2)

4) IIIP

HRP

Surg.Interv.

PESA

AWHS

TANSNIP

JN Giedd. Scientific American 2015;312:32

5). Child’s Brain Development

Less Networking Brings Atention

3B

GENERAL

PUBLIC

3-5CHILDREN 6-8 9-14

EDUCATIVE GOAL: HEALTHY HABITS FOR CHILDREN BETWEEN 3 & 5 YRS

COLOMBIA – CHILDREN’S PROGRAM

CHILDREN’S – BOGOTA, SPAIN, NEW YORK – N = 50,000

The Amer J of Med 2013;126:1122 - J. Amer. Coll. Card. 2015;65:1065J. Amer. Coll. Card. 2016 (In Press)

Primordial

Secondary

Primary

50/50



5) SHE

HARLEM

VILLAGE

MEXICO

3)1)

2)

4) IIIP

HRP

Surg.Interv.

PESA

AWHS

TANSNIP

BARRIERS TO IMPLEMENTATION OF A HEALTH

PROMOTION PROGRAM IN HARLEM, NY

THE FAMILIA STUDYAn AHA Strategically Focused Research Network Study

Sameer Bansilal, MD, MS, Rajesh Vedanthan, MD, MPH, Risa Jaslow, MS, RDN,

Martha Hadley, PhD, Amy Siskind, PhD, Carmina Marcial, MA, Ana Victoria Soto,

MD, Claire Kofler, BS, Zahi A Fayad, PhD, Valentin Fuster, MD,PhD

O

Start

Start

Children

3 Groups

Caregivers

3 Groups

P

P

P

P

P

P

Teachers

O

I

I

I

O

O

O

O O

O

O

O

O

O

KAH-BEA

Mol. Genomics KAH-BEAS-KAH-BEA

BEWAT

Point of Care.

3D-US

Mol. Genomics

O

IP

II II

O

IP

Contr./Interv.

S-BEWAT

Point of Care

BEWAT

Point of Care

3D-US

Mol. Genomics

1st

Yr 2nd

Yr 3rd

Yr 4th

Yr

Intervention.

Intervention

Control

IIIP

PPPI

KAH-BEA = Knowledge, Attitude, Habit, -BMI, Exercise, Alimentation ; FUSTER-BEWAT = BP, Exercise, Weight, Alimentation, Tobacco; S=Sustained

(1)

(2)

(3)

(3)

(1)

(2)

IT & Lifestyle: A Systematic Evaluation of Internet

and Mobile Interventions for Improving Diet, Physical

Activity, Obesity, Tobacco, & Alcohol Use

224 relevant reports were identified. Internet

interventions improved diet (N=20 studies), physical

activity (N=33), adiposity (N=35), tobacco (N=22),

and excess alcohol (N=47). Internet and mobile

interventions improve important lifestyle behaviors

up to 1 year. This systematic review supports the

need for long-term interventions to evaluate

sustainability.

A Afshin et al., J Am Heart Assoc 2016; 5:e003058

46Confidential, for Internal and Investigator use only

Lanzamiento de la versión internacional THE CIRCLE OF HEALTH

Actividades previstas

Interactive “Circle of Health” - App

www.thecircleofhealth.org

HEALTH

ENVIRONMENT

SCIENCE

EDUCATION

EDUCATION (7)

CARDONA - MEXICO

HARLEM

SPAIN

GRENADA

KENYA

SPAIN

BOGOTA

Co

ntin

uity

Village (1)

Family (1)

Adults (2)

Children (2)

CONCEPTS, SCIENTIFIC STUDIES , NPOs


B

B

B

Prom.

Health

Subcl.

Disease

Stable

Disease

Window

Young

Our Future

Behav.

Change

Simplicity

Adherence

25 50 100

25 50 100

A

Present

Too Late Earlier

1. Economic

A

A0

2. Scientific

V Fuster, JACC 2015; 66: 1627

Environment

Health Policy

3. Educational

0

New York, Dec 9, 2016 No Disclosures


Economic, Scientific, Educational

The Three Upcoming Challenges

From Aging/Disease to Youth/Health Economic, Scientific...

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