UPDATE IN THE MANAGEMENT OF DYSLIPIDEMIA 2013 RESDISUAL CV RISK AND SUBOPTIMAL LDL-C REDUCTION BEYOND STATINS J. Antonio G.

Transcription

1 UPDATE IN THE MANAGEMENT OF DYSLIPIDEMIA 2013 RESDISUAL CV RISK AND SUBOPTIMAL LDL-C REDUCTION BEYOND STATINS J. Antonio G. López, MD FACC, FAHA, FACP, FACA, FCCP, FASE, FASA, FNLA, FASH Fellow, Council on Clinical Cardiology, American Heart Association Fellow, Council on Arteriosclerosis, Thrombosis, and Vascular Biology, American Heart Association Fellow, Council on Epidemiology and Prevention, AHA Overseas Fellow, Royal Society of Medicine Specialist in Clinical Hypertension, American Society of Hypertension Diplomate, American Board of Clinical Lipidology Director, Preventive Cardiology and Cardiovascular Rehabilitation, Saint Alphonsus Regional Medical Center Director, Lipid Clinic and LDL Apheresis Program, Saint Alphonsus Regional Medical Center Chair, Department of Cardiology, Saint Alphonsus Regional Medical Center Chair Cardiovascular Research and Education, Saint Alphonsus Regional Medical Center President, Pacific Lipid Association SAINT ALPHONSUS MEDICAL GROUP HEART CARE

2 Presenter Disclosure Information J. Antonio G. López, M.D., F.A.C.C., F.A.H.A.,F.A.C.P., F.A.C.A., F.C.C.P., F.A.S.E., F.A.S.A., F.N.L.A. DISCLOSURE INFORMATION: The following relationships exist related to this presentation (consultant and/or speakers bureau): Abbott Laboratories Aegerion Pharmaceuticals Amarin AstraZeneca Boerhringer Ingelheim Pharmaceuticals, Inc. Bristol-Myers Squibb Company Daiichi Sankyo, Inc. Diadexus Forest Pharmaceuticals Gilead GlaxoSmithKline Kowa Pharmaceuticals America, Inc. Preventive Diagnostics Takeda Pharmaceuticals ZonaHealth

3 Objectives Discuss the importance of intensive LDL-C lowering strategy for addressing residual Cardiovascular(CV) risk despite current optimal medical therapy Review the current pathophysiologic rationale for PSCK( inhibition in hypercholesterolemia via a discussion of the mechanism of action and an analysis of emerging clinical data. Describe the potential impact of emerging LDL-C targeted therapies in patients who require additional LDL-C reduction, such as, those with familial hypercholesterolemia and statin intolerance. Provide Recommendations

4

5

6

7

8

9

10

11

12 What Is Desirable Cholesterol? Cholesterol Levels Among Different Human Populations Hazda Inuit!Kung Pygmy San Adult American Huntergatherer humans Mean total cholesterol, mg/dl Adapted from O Keefe JH Jr et al. J Am Coll Cardiol. 2004;43:

13

14 TREATMENT GOALS IN PATIENTS WITH CMR AND LIPOPROTEIN ABNORMALITIES HIGHEST RISK HIGH-RISK LDL <70 <100 NON-HDL <100 <130 APO B <80 <90 JACC 2008:51:

15 Change in Relative Risk of CHD Event Robinson, J. G. et al. J Am Coll Cardiol 2009;53: Copyright 2009 American College of Cardiology Foundation. Restrictions may apply.

16 CHD Event Associations of NMR LDL Particle Number (LDL-P) versus LDL Cholesterol (LDL-C) Probability of Event-free Survival Low LDL-C Low LDL-P (n=1249) High LDL-C Low LDL-P (n=284) High LDL-C High LDL-P (n=1251) Low LDL-C High LDL-P (n=282) Years of Follow-up Cromwell WC et al: J Clinical Lipidology 2007;1:

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77 Copyright 2007 Elsevier Ltd Terms and Conditions Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis Mitsuhiro Yokoyama, MD, Hideki Origasa, PhD, Masunori Matsuzaki, MD, Yuji Matsuzawa, MD, Yasushi Saito, MD, Yuichi Ishikawa, MD, Shinichi Oikawa, MD, Jun Sasaki, MD, Hitoshi Hishida, MD, Hiroshige Itakura, MD, Toru Kita, MD, Akira Kitabatake, MD, Noriaki Nakaya, MD, Toshiie Sakata, MD, Kazuyuki Shimada, MD, Kunio Shirato, MD and for the Japan EPA lipid intervention study (JELIS) Investigators The Lancet Volume 369, Issue 9567, Pages (March 2007) DOI: /S (07)

78

79

80 Predictions for ATP-IV 1. The goals for LDL-C in primary prevention will be lowered. 2. There will be a stronger statement on hscrp, but routine use in risk stratification or use as secondary target will not be specifically endorsed. 3. Non-HDL-C will remain the secondary lipid target, but optional use of apo B or LDL-P will be endorsed. 4. A new risk calculator providing lifetime risk estimates will be provided.

81 Questions?