Vulnerable or High Risk Plaque Multimodality Plaque Imaging 1. Plaque Progression - Nomenclature, 1990 -1995 2. Plaque Imaging - Invasive / Non-Invasive 1995 -2010 3. HRP Bioimage Study - Disease Burden 2010 -2012 4. The Two Extreme Paradox 2012 -2020
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Vulnerable or High Risk Plaque Multimodality Plaque Imaging · Vulnerable or High Risk Plaque Multimodality Plaque Imaging ... Mario Garcia, MD ... Vulnerable or High Risk Plaque
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Vulnerable or High Risk Plaque Multimodality Plaque Imaging
– Largest industry funded biomarker initiative ever
– Unique structure of collective funding, design, oversight, and interpretation, while study execution is done by a third-party
– HRP Initiative extended through • Copenhagen Heart Studies (CCHS and
CGPS)• Framingham Heart Study under
NIH/NHLBI CRADA
PI: V. Fuster, Co-PI: E. Falk, P. Muntendam - AHJ 2010;160:49
HRP - Bioimage Iniciative - Steering Committee
Valentin Fuster, MD, PhD (Chair) Carol McCall, FSA, MAAAErling Falk, MD, PhD (Co-Chair) Pedro R. Moreno, MDJuan José Badimon, PhD B.G. Nordestgaard, MD, PhDMat Daemen, MD, PhD James H.F. Rudd, MD, PhDZahi A. Fayad, PhD Prediman K. Shah, MDMario Garcia, MD Henrik Sillesen, MDGeoffrey S. Ginsburg, MD Anton van der Steen, PhDStanley L. Hazen, MD, PhD Prof. Sir Magdi M. YacoubSpencer B. King, III, MD Chun Yuan, PhD
BG Medicine (Peter Muntendam) & Humana (Carol McCall)
1. MEETING TARGETS FOR RISK FACTOR CONTROL?Risk Factors - Proportion of Participants at Goal % – 1 yearTrials LDL SBP DBP Hb A1C
Meet Goals
Base FUBARI-
2D 75 56 70 5214 20
COURAGE 51 55 55 5912 19
FREEDOM 55 63 53 5512 20
Freedom, Bari-2D, Courage Investigators, 2012 (Subm.)PURE (S Yusuf et al.) Lancet 2011; Aug 28 - Poor Countries,7% !!!NHANES, AHA, NHLBI-JNC-7, NHLBI-NCEP P Muntner, V Fuster et al., AHJ 2011; 161: 719 – 49 seconds !!!!
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
FOCUS 1General
Adherence
FOCUS 2Polypill
Adherence
ArgentinaBrazilParaguay
ItalySpain
ASA, Statin, ACE-Inhibitor
1. POLYPILL CNIC-FERRER: ADHERENCE – ECONOMICS
G Sanz, V Fuster Am. H J 2011;162:811 – Semin. Thor. Cardiov 2011;23:24
Molecular Imaging – PEN – 2011-2015NIH Program of Excellence in Nanotechnology
HHSN2682010000045C$16,447,515 – 5 years
Zahi Fayad, MSSM Valentin Fuster, MSSM Roger Hajjar, MSSM Martin Schwarz, MSSMRobert Langer, MITOmid Farokhzad, BrighamEdward A. Fisher, NYUIra Tabas, Columbia
Sj Nicholis et al JACC 2006;47:992 M Lobatto, V Fuster, ZA Fayad, W Mulder. Molec Pharmac 2010;7:20.Liposome encapsulated Prednisolone M Lobatto, V Fuster, ZA Fayad, W Mulder. Nat Rev Drug Discov 2011;10:963.rHDL Nanoparticles Statin Loaded
Biological Imaging & Local Treatment
Rx
Vulnerable or High Risk Plaque Multimodality Plaque Imaging