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International Task Force for Prevention of Coronary Heart Disease

Slide Kits

• Kit 1: PROCAM (Münster Heart Study): Design and principal results
• Kit 2: PROCAM (Münster Heart Study): Body mass index and cardiovascular risk factors
• Kit 3: PROCAM (Münster Heart Study): Lipoprotein (a) and risk of cardiovascular disease
• Kit 4: PROCAM (Münster Heart Study): Determinants of mortality
• Kit 5: PROCAM (Münster Heart Study): Diabetes mellitus
• Kit 6: PROCAM (Münster Heart Study): HDL cholesterol and myocardial infarction
• Kit 7a: Ethiology and epidemiology of Stroke
• Kit 7b: Primary prevention of stroke
• Kit 8: Genetic risk for coronary heart disease
• Kit 9: Homocysteine, heart disease and stroke
• Kit 10: Cardiovascular risk factors in women
• Kit 11: Intestinal cholesterol absorption as a drug target for primary and secondary prevention of CHD
• Kit 12: PROCAM (Münster Heart Study): The PROCAM Risk Score

Kit 1: PROCAM (Münster Heart Study):
Design and principal results of the Prospective Cardiovascular Münster (PROCAM) study

• Slide 1: Recruitment area
• Slide 2: Design
• Slide 3: Outcome
• Slide 4: Prevalence of risk factors in groups with and without myocardial infarction
• Slide 5: Incidence of myocardial infarction according to HDL-cholesterol and cholesterol
• Slide 6: Distribution of cholesterol to HDL-cholesterol ratio and incidence of myocardial infarction
• Slide 7: The lipid triad and risk of myocardial infarction
• Slide 8: Incidence of myocardial infarction in 8 years in quintiles of the PROCAM algorithm and
    Annual percentage incidence of myocardial infarction in quintiles of the PROCAM algorithm
• Slide 9: PROCAM coronary risk algorithm predicts stroke incidence
• Slide 10: Risk factors included in standard PROCAM algorithm and neural network analysis
• Slide 11: Incidence of myocardial infarction in deciles of risk predictors
• Slide 12: Receiver Operated Characteristics curves for various risk predictors

Download Slide Kit 1 (slidekit1.zip, Microsoft Office 97, 1002 kB )

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Kit 2: PROCAM (Münster Heart Study):
Body mass index and cardiovascular risk factors
The slides in this slide kit show the relationship between various risk markers and body mass index in each age group of men and women. Note that certain variables such as systolic and diastolic blood pressure both increase with age and with Body Mass Index, whereas other variables such as the cholesterol/HDL-cholesterol ratio increase only with Body Mass Index.

• Slide 1: LDL-cholesterol (mg/dl)
• Slide 2: HDL-cholesterol (mg/dl)
• Slide 3: Total cholesterol (mg/dl)
• Slide 4: Cholesterol/HDL-cholesterol ratio
• Slide 5: LDL-cholesterol/HDL-cholesterol ratio
• Slide 6: Triglycerides (median, mg/dl)
• Slide 7: Diastolic blood pressure (mm Hg)
• Slide 8: Systolic blood pressure (mm Hg)
• Slide 9: Fasting blood glucose (mg/dl)
• Slide 10: Body Mass Index according to age
• Slide 11: CHD risk according to Body Mass Index in the PROCAM study
• Slide 12: Age-standardized death rates and body weight in PROCAM
• Slide 13: Age-standardized death rates and body weight among non-smoking men in PROCAM
• Slide 14: Age-standardized death rates and body weight among smoking men in PROCAM

Download Slide Kit 2 (slidekit2.zip, Microsoft Office 97, 1364 kB )

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Kit 3: PROCAM (Münster Heart Study):
Lipoprotein (a) and risk of cardiovascular disease

• Slide 1: Relation between LDL-cholesterol, Lp(a) and age in men in the PROCAM study.
• Slide 2: Distribution of Lp(a) levels in survivors of myocardial infarction and controls from the PROCAM study.
• Slide 3: Relation between LDL-cholesterol, Lp(a) and risk of nonfatal myocardial infarction in men
• Slide 4: Incidence of major coronary events at various Lp(a) levels in middle-aged men in the PROCAM study
• Slide 5: Relation between LDL-cholesterol, Lp(a) and age in women in the PROCAM study.
• Slide 6: Relation between Lp(a), age and Body Mass Index in women in the PROCAM study.
• Slide 7: Relation between Lp(a) and fibrinogen in men and women in the PROCAM study.

Download Slide Kit 3 (slidekit3.zip, Microsoft Office 97, 514 kB )

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Kit 4: PROCAM (Münster Heart Study):
Determinants of mortality in the PROCAM Study, Data were derived in 10,856 men aged 35 to 64 Years. Mean follow-up period 8.1 years, Range 5 to 18 years.
Cullen P, Schulte H, Assmann G. Circulation 1997; 96:2128-2136.

• Slide 1: Age standardized death rate in men according to LDL-cholesterol
• Slide 2: Age standardized death rate in smokers and non-smokers according to LDL-cholesterol
• Slide 3: Age standardized death rate in men according to HDL-cholesterol
• Slide 4: Age standardized death rate in smokers and non-smokers according to HDL-cholesterol
• Slide 5: Age standardized death rate in men according to cholesterol / HDL-cholesterol ratio
• Slide 6: Age standardized death rate in smokers and non-smokers according to total cholesterol / HDL-cholesterol ratio
• Slide 7: Age standardized death rate in men according to LDL- / HDL-cholesterol ratio
• Slide 8: Age standardized death rate according to LDL- / HDL-cholesterol ratio in smokers and non-smokers
• Slide 9: Age standardized death rate in men according to triglycerides
• Slide 10: Age standardized death rate in men according to cigarette smoking
• Slide 11: Age standardized death rates in men according to quintiles of the PROCAM algorithm

Download Slide Kit 4 (slidekit4.zip, Microsoft Office 97, 712 kB )

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Kit 5: PROCAM (Münster Heart Study):
Diabetes mellitus as a risk factor for myocardial infarction

• Slide 1: Mean values of age-standardized factors in middle aged men with and without diabetes
• Slide 2: Mean values of age-standardized risk factors in middle aged men with and without diabetes
• Slide 3: Lipid levels in diabetic and non-diabetic middle aged men in the PROCAM study
• Slide 4: The lipid triad in diabetic subjects
• Slide 5: Obesity and hypertension in diabetes
• Slide 6: Mortality, coronaary events and stroke in diabetics
• Slide 7: Risk factors for type 2 diabetes mellitus in PROCAM
• Slide 8: Risk factors for development of type 2 diabetes mellitus in PROCAM
• Slide 9: Risk factors for development of type 2 diabetes mellitus in PROCAM; HDL and BMI
• Slide 10: Risk factors for development of type 2 diabetes mellitus in PROCAM
• Slide 11 + 12: Development of type 2 diabetes mellitus in PROCAM; establishment of a multiple logistic function
• Slide 13: Prediction of diabetes mellitus in PROCAM; performance of individual risk factors and a multiple logistic function

Download Slide Kit 5 (slidekit5.zip, Microsoft Office 97, 888 kB )

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Kit 6: PROCAM (Münster Heart Study):
HDL cholesterol and myocardial infarction
Clinical guidelines usually recommend that the level of high density lipoprotein cholesterol (HDL-C) should be measured. It is frequently argued that HDL-C levels below 35 mg/dl are causally associated with an increased risk of atherosclerosis. The information provided in this slide kit shows that this assumption is too simplistic and that the clinical interpretation of low HDL-C levels often requires expert knowledge.

• Slide 1: Possible relationship between low HDL-cholesterol and coronary heart disease
• Slide 2: The incidence of myocardial infarction according to the HDL cholesterol and Apo A-I levels in the PROCAM study
• Slide 3: Prevalence of risk factors in male participants in the PROCAM study with low HDL cholesterol levels
• Slide 4: Estimated risk of coronary events in middle aged men in the PROCAM study according to the level of HDL cholesterol
• Slide 5: Metabolic consequences of insulin-resistance
• Slide 6: The relationship between testosterone, adipose tissue, insulin sensitivity and lipoprotein metabolism in men
• Slide 7: Relationship between insulin and HDL cholesterol in the PROCAM study:
• Slide 8: The lipid triad
• Slide 9: Results of the Veterans' Administration low HDL cholesterol intervention (VA-HIT) trial
• Slide 10: The relationship between low HDL cholesterol and coronary heart disease becomes weaker with time
• Slide 11: Relationship between HDL cholesterol, Apo A-I levels, and coronary heart disease in the ECAT Angina Pectoris Study
• Slide 12: Mechanisms of the anti-atherogenic effects of HDL
• Slide 13: Metabolism of HDL
• Slide 14: Lipid efflux from cell membranes
• Slide 15: Cholesterol efflux from cells
• Slide 16: Genetics of low HDL cholesterol
• Slide 17: Mutations in pivotal genes of HDL metabolism
• Slide 18: Transgenic animal models of HDL metabolism
• Slide 19: Mutations in the ATP binding cassette transporter gene (ABC1) causes Tangier disease
• Slide 20: Main clinical features of Tangier disease

Download Slide Kit 6 (slidekit6.zip, Microsoft Office 97, 20380 kB )

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Kit 7a: Ethiology and epidemiology of Stroke

• Slide 1: Definition of stroke
• Slide 2: Major recognized mechanisms for ischemic stroke
• Slide 3: Incidence of stroke and coronary events in 14 WHO MONICA populations
• Slide 4: Incidence of stroke and coronary events in 14 WHO MONICA populations
• Slide 5: Incidence of pathological types of stroke
• Slide 6: Major risk factors for ischemic stoke
• Slide 7: Major risk factors for hemorrhagic stroke
• Slide 8: Investigation of the causes of stroke. The Prospective Studies Collaboration
• Slide 9: The Prospective Studies Collaboration
• Slide 10: The Prospective Studies Collaboration
• Slide 11: Mortality from different pathological types of stroke by cholesterol levels
• Slide 12: Non-hemorrhagic and hemorrhagic stroke in eastern Asia by diastolic blood pressure
• Slide 13: Non-hemorrhagic and hemorrhagic stroke in eastern Asia by total cholesterol
• Slide 14: Protective effect of HDL-cholesterol on ischemic stroke
• Slide 15: Baseline characteristics of stroke cases and controls in the PROCAM Study
• Slide 16: The PROCAM Coronary Risk Algorithm also predicts the incidence of stroke
• Slide 17: Number of strokes per 100.000 per year during 7.2 years of follow-up in the PROCAM Study
• Slide 18: Major risk factors for both ischemic and hemorrhagic stroke in 7.2 years of follow-up in the PROCAM Study
• Slide 19: Midlife blood pressure and cholesterol predict development of Alzheimer's disease
• Slide 20: Distribution of prothrombotic risk factors in children with stroke and controls
• Slide 21: Candidate genes for heritable disorders of blood coagulation based on sub-set analysis from the PROCAM Study

Download Slide Kit 7a (slidekit7a.zip, Microsoft Office 97, 1287 kB )

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Kit 7b: Primary prevention of stroke

• Slide 1: Primary prevention of ischemic stroke. Recommendations for risk factor management
• Slide 2: Effects of ACE-inhibitors and calcium-antagonists on stroke, coronary heart disease and total mortality
• Slide 3: Effects of ACE-inhibitors on stroke and cardiovascular outcomes in people with diabetes
• Slide 4: Primary prevention of ischemic stroke in patients with atrial fibrillation
• Slide 5: Aspirin for primary prevention of stroke and other major vascular events
• Slide 6: Primary prevention of ischemic stroke: recommendations for management of serum lipids
• Slide 7: Genetic susceptibility and LDL-cholesterol in lacunar stroke
• Slide 8: Effects of statins on stroke: Meta-analysis of CHD prevention trials
• Slide 9: Risk reduction in major statin trials
• Slide 10: Effects of statins on stroke type. Prospective Pravastatin Pooling Project
• Slide 11: Effects of statins on stroke and coronary events in older patients - the CARE trial
• Slide 12: Protective effects of statins on ischemic stroke
• Slide 13: Statins and prevalence of Alzheimer's disease
• Slide 14: Statins and risk of dementia
• Slide 15: Effects of fibrates on stroke types in men with CHD and low HDL-cholesterol

Download Slide Kit 7b (slidekit7b.zip, Microsoft Office 97, 863 kB )

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Kit 8: Genetic risk for coronary heart disease:

• Slide 1: Pathways in which mutations or polymorphisms have been shown to modify the risk of coronary artery disease
• Slide 2: Relative hazard for death due to coronary heart disease
• Slide 3: Mutations and polymorphisms in genes affecting lipoprotein metabolism
• Slide 4: Polymorphisms in genes affecting blood pressure
• Slide 5: Mutations and polymorphisms in genes affecting glucose metabolism
• Slide 6: Mutations and polymorphisms in genes affecting hemostasis
• Slide 7: Mutations and polymorphisms in genes affecting the inflammatory response
• Slide 8: Mutations and polymorphisms in genes affecting mediators of oxidation
• Slide 9: Mutations and polymorphisms in genes affecting cellular adhesion
• Slide 10: Mutations and polymorphisms in transcription factors

Download Slide Kit 8 (slidekit8.zip, Microsoft Office 97, 45 kB )

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Kit 9: Homocysteine, heart disease and stroke
In recent years homocysteine has been identified as a potential risk factor for coronary heart disease and stroke. This slide kit summarises major findings.

• Slide 1: Risk of coronary heart disease associated with an increase of homocysteine
• Slide 2: Estimated survival among patients with coronary artery disease according to plasma homocysteine levels
• Slide 3: The role of homocysteine as an independent cardiovascular risk factor
• Slide 4: Relationship between vitamins and homocysteine
• Slide 5: Relative risks of coronary heart disease associated with baseline levels of homocysteine and vitamin B6
• Slide 6: Risk of stroke associated with homocysteine plasma levels
• Slide 7: Risk of coronary heart disease associated with an increase of homocysteine
• Slide 8: Therapeutic effects of treatment with folic acid according to quintiles of homocysteine
• Slide 9: Should hyperhomocysteinemia be treated? (part 1)
• Slide 10: Should hyperhomocysteinemia be treated? (part 2)
• Slide 11: Homocysteine and cardiovascular disease: Recommendations of the International Task Force for the Prevention of Cardiovascular Disease
• Slide 12: Treatment algorithm
• Slide 13: Food rich in Folic acid, Vitamin B6, and Vitamin B12

Download Slide Kit 9 (slidekit9.zip, Microsoft Office 97, 777 kB )

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Kit 10: Cardiovascular risk factors in women:

• Slide 1: Effect of menopause as opposed to age on lipid risk factors in the PROCAM study.
• Slide 2: Lipids and body weight in women
• Slide 3: Metabolic syndrome in women
• Slide 4: LDL cholesterol and Lp(a) in women
• Slide 5: Menopause and hemostatic risk factors in 45 to 55 year old women
• Slide 6: Results of the Heart and Estrogen/Progestin Replacement Study (HERS)
• Slide 7: Side effects of the Heart and Estrogen/Progestin Replacement Study (HERS)
• Slide 8: Lp(a) as a coronary risk factor in postmenopausal women (HERS)
• Slide 9: Mean change in Lp(a) at 1 year of follow-up among women randomly assigned to estrogen and progestin or placebo (HERS)
• Slide 10: Effect of estrogen and progestin on outcomes of myocardial infarction and coronary heart disease death according to Lp (a) (HERS)
• Slide 11: Effects of Hormone Replacement Therapy (HRT) vs. Simvastatin on Lipid Levels in Hypercholesterolemic Postmenopausal Women
• Slide 12: Intervention studies aimed at the prevention of coronary heart disease (subgroups of women)

Download Slide Kit 10 (slidekit10.zip, Microsoft Office 97, 784 kB )

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Kit 11: Intestinal cholesterol absorption as a drug target for primary and secondary prevention of CHD

• Slide 1: Risk of myocardial infarction according to plasma total cholesterol concentration.
• Slide 2: Effect of lowering total cholesterol concentration on CHD events.
• Slide 3: Net cholesterol balance in humans.
• Slide 4: The liver regulates the concentration of LDL cholesterol.
• Slide 5: Effect of blocking bile acid absorption.
• Slide 6: Effect of blocking cholesterol absorption.
• Slide 7: Effect of combined therapy.
• Slide 8: Steps involved in cholesterol absorption.
• Slide 9: Inhibition of cholesterol absorption.
• Slide 10: Inhibition of cholesterol absorption by Rexinoids.
• Slide 11: Role of ABC1 and CYP7A1 in reverse cholesterol transport.
• Slide 12: ABC transporter with function in cholesterol metabolism.
• Slide 13: Role of ABC transporters in cholesterol absorption.

Download Slide Kit 11 (slidekit11.zip, Microsoft Office 97, 1623 kB )

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Kit 12: PROCAM (Münster Heart Study): The PROCAM Risk Score

• Slide 1: PROCAM Score
• Slide 2: PROCAM Score - Corresponding global risks
• Slide 3: The PROCAM Algorithm
• Slide 4: PROCAM Score - Estimated and observed risk of myocardial infarction

Download Slide Kit 12 (slidekit12.zip, Microsoft Office 97, 328 kB )

Kit 12 in Deutsch: Der PROCAM Risiko Score

• Slide 1: PROCAM Score für einzelne Risikofaktoren
• Slide 2: PROCAM Score - Zuordnung des Herzinfarktrisikos zur Punktzahl
• Slide 3: Der PROCAM Algorithmus
• Slide 4: PROCAM Score - geschätztes und beobachtetes Herzinfarktrisiko

Download Diasatz 12 in Deutsch (diasatz12.zip, Microsoft Office 97, 466 kB )

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