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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 7: Risk factors for stroke
• Kit 8: Genetic risk for coronary heart disease
• Kit 9: Homocysteine, heart disease and stroke
• Kit 10: Cardiovascular risk factors in women

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 7: Risk factors for stroke

• Slide 1: Major risk factors for ischemic stroke
• Slide 2: Major risk factors for hemorrhagic stroke
• Slide 3: Major recognized mechanisms for ischemic stroke
• Slide 4: Statins reduce stroke incidence
• Slide 5: Investigation of the causes of stroke. The Prospective Studies Collaboration
• Slide 6: The Prospective Studies Collaboration
• Slide 7: The Prospective Studies Collaboration
• Slide 8: The Prospective Studies Collaboration
• Slide 9: The Prospective Studies Collaboration
• Slide 10: Baseline characteristics of stroke cases and controls in the PROCAM study
• Slide 11: The PROCAM coronary risk algorithm also predicts the incidence of stroke
• Slide 12: Number of strokes per 100.000 per year during 7.2 years of follow-up in the PROCAM study
• Slide 13: Major risk factors for both ischemic and hemorrhagic stroke in 7.2 years of follow-up in the PROCAM study
• Slide 14: Distribution of prothrombotic risk factors in children with stroke and controls
• Slide 15: Odds ratio of thromboembolic events in children according to quartiles of Lp(a) levels and quartiles of the estimated numbers of apo(a) Kringle IV repeats
• Slide 16: Candidate genes for heritable disorders of blood coagulation
• Slide 17: Characteristics of the major statin trials
• Slide 18: Effects of cholesterol-lowering on stroke. Results of meta-analysis
• Slide 19: Risk reduction of non-fatal and fatal stroke in randomized statin trials

Download Slide Kit 7 (slidekit7.zip, Microsoft Office 97, 1164 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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