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Integrating Aggressive CV Risk Management in Primary Care High prevalence of multiple CV risk factors in US adultsBehavioral Risk Factor Surveillance System, 200327.0%–32.9%33.0%–35.9%36.0%–39.9%40.0%–46.2%≥2 of hypertension, hypercholesterolemia, diabetes, smoking, physical inactivity, obesityCDC. MMWR. 2005;54:113-40.INTERHEART: Exponential rise in CV disease with added risk factors?26-fold?3-fold3.313.042.368.5182.9333.751225612864Odds ratio for1st MI* (99% CIll 9 riskfactors1+2+3All 4Smk(1)DM(2)HTN(3)ApoB/A1 ratio (4)All 4+ ObesAll 4+ PsSmk = smoking; DM = diabetes; HTN = hypertension; Obes = obesity; Ps = psychosocial factors*Plotted on a doubling scale Yusuf S et al. Lancet. 2004;364:937-52.INTERHEART: Any smoking increases CV riskN = 27,098 from 52 countries84Odds ratio for first MI*21-0.75Never1–23–45–67–89–1011–1213–1415–1617–1819–20≥21Cigarettes smoked (n/day)*vs never smokedTeo KK et al. Lancet. 2006;368:647-58.Lifetime CVD risk estimate and risk factor burdenMen(n = 3564)Women(n = 4362)707069606050505050Adjusted cumulative incidence of CVD(%)463940403630302720201010850050607080905060708090Attained age (years)≥2 Major RFs≥1 Elevated RFAll optimal RFs1 Major RF≥1 Not optimal RFLloyd-Jones DM et al. Circulation. 2006;113:791-8.Additive risk of age with hypertension + hypercholesterolemia52.743.126.521.4NHANES 2001-2002; N = 2864?2-fold in higher age group Wong ND et al. Am J Cardiol. 2006;98:204-8.Clinical manifestations of obesityType 2 diabetes and glycemic disorders?FFAsDyslipidemiaLow HDLSmall, dense LDLHypertriglyceridemiaHypertensionEndothelial dysfunction/inflammation (hsCRP) Impaired thrombolysis?PAI-1InsulinresistanceGlucotoxicityLipotoxicity?Adiponectin?LeptinAtherosclerosisCourtesy of Selwyn AP, Weissman PN. 2006.Metabolic consequences of visceral obesityVisceral/abdominal obesity Correlates more strongly with insulin resistance than lower body obesityIs associated with ?plasma levels of fatty acids and accompanying ?TG ?Insulin resista