ONTARGET Slide - Boehringer Ingelheim
ONTARGET Slide - Boehringer Ingelheim
ONTARGET Slide - Boehringer Ingelheim
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<strong>ONTARGET</strong> Study and<br />
Cardiovascular Diseases<br />
Prevention and Treatment<br />
Beijing Fuwai Cardiovascular Hospital<br />
Prof. Lisheng Liu
Content<br />
�The role of ACEI/ARB on prevention and<br />
treatment of cardiovascular diseases<br />
�The implication to public clinical practice and<br />
of <strong>ONTARGET</strong>
The role of ACEI/ARB on prevention and<br />
treatment of cardiovascular diseases
The Cardiovascular Continuum<br />
� The process of CVD, from the onset to end-stage heart<br />
disease, can be regarded as a continuum.<br />
� It starts with the risk factors, e.g. hypertension, low-density<br />
lipoproteins (LDL) ↑, diabetes, etc.<br />
� Progression to atherosclerosis, CAD, myocardial infarction,<br />
remodelling and heart failure is the consequence.<br />
� Angiotensin II (AII), acting through the AT 1-receptor, is<br />
involved in every single step in this process.<br />
� Blocking the AT 1-receptor can be expected to significantly<br />
reduce cardiovascular morbidity and mortality by retarding the<br />
progression of CVD.<br />
Unger T., Am J Cardiol 2002;89(suppl):3A–10A<br />
adapted from Dzau, Braunwald, Am Heart J 1991;121:1244–1263
The Role of AngII in Cardiovascular Diseases<br />
artherosclerosis<br />
endothelial<br />
dysfunction<br />
risk factors<br />
Hypertension<br />
DM<br />
CAD<br />
Angiotensin II<br />
Plaque rupture<br />
HF<br />
MI<br />
remodelling<br />
Cardio-Cerebrovascular events
RAAS Inhibition<br />
Adapted from: Chung, Unger., Am J Hypertens 1999;12:150S–156S
Content<br />
�The role of ACEI/ARB on prevention and<br />
treatment of cardiovascular diseases<br />
�The implication to public clinical practice and<br />
of <strong>ONTARGET</strong>
The evidence of RAS Inhibitor on<br />
cardiovascular protection<br />
� Outcome trials have clearly demonstrated the beneficial role of ACE<br />
inhibition in patients with heart failure (SOLVD), and recently in<br />
arterial hypertension (ANBP-2) and nephropathy.<br />
� These findings were extended by the results of the Heart Outcome<br />
Prevention Evaluation (HOPE). In this landmark cardiovascular<br />
outcome study the risk for MI, stroke or death from cardiovascular<br />
causes was reduced by ramipril compared to placebo.<br />
� HOPE showed that ramipril is effective in preventing major CV<br />
events in high-risk patients with and without hypertension.<br />
The SOLVD Investigators, NEJM 1992;327:685-91<br />
Lindon MH., NEJM 2003;348:583-592<br />
The HOPE Study Investigators, NEJM 2000;342:e145-53<br />
Lewis EJ., NEJM 1993;329:1456-1462
<strong>ONTARGET</strong> Results<br />
1. Telmisartan has been tested in the following high-risk<br />
patients "head to head“ with ramipril, which is regarded<br />
as gold standard of cardiovascular protection<br />
� CAD<br />
� Stroke<br />
� PAOD<br />
� DM<br />
� CKD<br />
2. Telmisartan is as effective as ramipril for high risk<br />
patients cardiovascular protection<br />
3. Telmisartan is better tolerated than ramipril<br />
• Less cough and angioneurotic edema
The implications of <strong>ONTARGET</strong> Study<br />
1. In high-risk cardiovascular patients, the cardiovascular<br />
mortality every 10 years is 5-8%. The secondary<br />
prevention of cardiovascular disease is extremely<br />
significant to the public.<br />
2. <strong>ONTARGET</strong>/TRANSCEND Trial tests and re-confirms the<br />
role of different RAS inhibition in cardiovascular protection.<br />
3. Telmisartan has been proved as effective as ramipril and<br />
better tolerated. The physicians now have more flexible<br />
choice for high-risk cardiovascular protection.
Thanks
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