PRIMARY PREVENTION OF ATHEROSCLEROTIC VASCULAR DISEASE
|
|
|
- Kelley Preston
- 5 years ago
- Views:
Transcription
1 ATHEROSCLEROSIS PRIMARY PREVENTION OF ATHEROSCLEROTIC VASCULAR DISEASE Preventing atherosclerosis before it leads to death and disability should now be possible using lifestyle modification and drugs where necessary. L J Burgess MB BCh, MMed, Dip Int Research Ethics, PhD Professor N U Sulzer BA (HMS) BSc (Med) (Hons), MSc (Med) Biokineticist A F Doubell MB ChB, MMed, FCP (SA), BSc Hons, PhD Professor and Head TREAD Research/Cardiology Unit Tygerberg Hospital, and Stellenbosch University Lesley Burgess is currently managing a large clinical trial unit (TRAED Research). She is an associate professor in the Department of Cardiology at Stellenbosch University and is actively involved in lecturing and mentoring academic research projects in the fields of chemical pathology, GCP and cardiology. Nicole Sulzer specialised in the treatment of cardiac and chronic diseases. She is currently involved with clinical and academic reasearch at TREAD Research and the Cardiology Unit at Stellenbosch University. Her main areas of research interest are chronic diseases of lifestyle. Anton Doubell's research interests include endothelial dysfunction, coronary restenosis following angioplasty, inflammatory heart disease (including valvular disease, infective endocarditis and pericarditis) and second messengers in the cardiovascular system (the MAP kinase family in particular). Professor Doubell is the current editor of SAHeart, the official journal of the South African Heart Association. Atherosclerosis is one of the most common causes of death and disability throughout the world. Cardiovascular diseases are expected to be the main cause of death glob ally within the next 15 years owing to a rapidly increasing prevalence in developing countries and Eastern Europe and the rising incidence of obesity and diabetes in the Western world. Coronary artery atherosclerosis has been a major focus for clinical investigation and considerable strides have been made in the development of programmes to prevent and treat the clinical manifestations of this disease. However atherosclerosis is a systemic disease with important sequelae in many other regional circulations including those supplying the brain, kidneys, mesentery and limbs. Predisposition to atherosclerosis begins in childhood. Atherosclerosis is a process that starts early in life and progresses silently and slowly for decades, usually only manifesting clinically in middle age. Since childhood risk factors persist into adulthood, the lifelong burden of a dyslipidaemic trait and concomitant conditions such as obesity and hypertension has a major impact on the silent phase of this disease. The main objectives of primary prevention are to reduce morbidity, to improve quality of life and to increase life expectancy. There is growing evidence that lifestyle changes and primary risk factor modification can reduce both morbidity and mortality. TRADITIONAL RISK FACTORS The major risk factors for atherosclerosis are age, family history, dyslipidaemia, cigarette smoking, hypertension and diabetes. These risk factors rarely occur in isolation. The Framingham study demonstrates the importance of multiple risk factors for coronary artery disease (CAD) events. Asymptomatic individuals are classified into low risk (0-1 risk factor), intermediate risk ( 2 risk factors but < 10% risk of CAD over 10 years), moderately high risk ( 2 risk factors and 10-20% risk of CAD over 10 years), or high risk ( 2 risk factors and > 20% risk of CAD over 10 years). Risk is calculated by adding the points from each risk category and the absolute 10-year risk is derived from the total score. The Framingham risk scoring (Table I, p.203) can be used to determine the 10-year risk for developing CAD. To calculate risk, add the points of each category. The absolute 10-year risk is derived from the total score. 200 CME April 2006 Vol.24 No.4 Atherosclerosis.indd 200 3/29/06 3:46:30 PM
2 Atherosclerosis.indd 201 3/29/06 3:46:30 PM
3 ATHEROSCLEROSIS Table II. LDL cholesterol and cut-off points for therapeutic lifestyle changes and drug therapy the NCEP III guidelines and proposed modifications (in italics) based on recent clinical trial evidence. Risk category LDL goal (mmol/l) Therapeutic lifestyle changes Drug therapy to be initiated (mmol/l) to be initiated (mmol/l) High risk: CAD or CAD < 2.59 > 2.59 > 3.36 ( : drug optional) risk equivalents (10-year Optional goal is 1.80 > 2.59 (<2.59 consider drug options)* risk > 20%) Moderately high risk: < 3.36 > 3.36 > 3.36 > 2 risk factors (10-year : consider drug options risk 10-20%) Lower risk: 0-1 risk < 4.14 > 4.14 > 4.92 ( : drug optional) factor (< 10% 10-year risk) * If baseline LDL cholesterol is < 2.59mmol/l, institution of an LDL-lowering drug is a therapeutic option on the basis of available clinical trial results. For moderately high-risk persons, when LDL cholesterol level is mmol/l, at baseline or on lifestyle therapy, initiation of an LDL-lowering drug to achieve an LDL cholesterol level < 2.59 mmol/l is a therapeutic option based on available clinical trial results. The current National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) report includes diabetes mellitus (as well as peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease) as a CAD risk equivalent. A low level of HDL cholesterol is an independent risk factor for future cardiovascular events. Low HDL is defined as less than 1.03 mmol/l in men and less than 1.30 mmol/l in women. Epidemiological studies have indicated that each increase in baseline HDL cholesterol of 0.03 mmol/l is associated with a 6% decrease in the risk of death from coronary disease or myocardial infarction. See Table II for cut off points for lifestyle changes and drug treatment. The effect of multiple risk factors seems to accelerate the extent of atherosclerosis in both the aorta and coronary arteries and cardiovascular risk factors become additive in their effect on cardiovascular disease events in adults. There is a need for a treatment paradigm shift from the diagnosis and treatment of individual risk factors to the assessment and management of total cardiovascular disease risk. Clustering of CAD risk factors such as hypertension and dyslipidaemia may begin in childhood, indicating a need for screening for cardiovascular risk early in life. There is also a need for educational measures to improve the level of awareness among the general population about adopting healthy lifestyle options early on in life. Individuals with co-existing hypertension and dyslipidaemia are particularly likely to develop atherosclerosis and the physiological interplay of these two diseases results in a marked increase in CAD risk. A recent study showed that the prevalence of CAD was more than doubled in patients with concomitant hypertension and dyslipidaemia. Clinically meaningful reductions in blood pressure and serum cholesterol concentrations can be achieved by lifestyle modifications which include weight loss, dietary intervention and regular aerobic exercise. Evidence from research indicates that atherosclerosis is, at least partially, genetically determined. Carotid artery intimal-medial thickness, a surrogate marker of atherosclerosis, is highly heritable. Independent from the major risk factors, no major gene has yet been identified for atherosclerosis. Research efforts are now focused on discovering genes that contribute to the intermediate traits that are more proximal on the pathway leading to atherosclerosis. METABOLIC SYNDROME Obesity increases the prevalence and persistence of multiple risk factor clustering. Childhood obesity has been shown to be the driving force related to the metabolic syndrome. The term metabolic syndrome refers to a specific collection of disorders and the diagnosis of this syndrome is based on the presence of 3 or more stipulated risk factors. These include abdominal obesity, atherogenic dyslipidaemia (elevated triglycerides, small LDL particles, low HDL cholesterol), raised blood pressure, insulin resistance (with or without glucose intolerance), and prothrombotic and proinflammatory states. These risk factors enhance the risk for CAD at any given level of LDL cholesterol. CAD has been shown to be more prevalent in those individuals with the metabolic syndrome than those without (13.9% versus 8.7%). The current NCEP ATP III report acknowledges the importance of this syndrome as a secondary therapeutic target. The recently proposed amendments to these guidelines suggest that the metabolic syndrome should be considered as a factor favouring LDL-lowering drug therapy as a therapeutic option for patients at moderately high risk. THERAPY Aggressive statin therapy Clinical trial evidence supports the benefits of cholesterol reduction in the presence of atherosclerosis or multiple risk factors even if LDL cholesterol is not elevated. The results of these trials indicate that lipid-lowering 202 CME April 2006 Vol.24 No.4 Atherosclerosis.indd 202 3/29/06 3:46:30 PM
4 R ATHEROSCLEROSIS Table I. The Framingham Risk Scoring System Total cholesterol (TC) TC (mmol/l) Age Age Age Age Age Male Female Male Female Male Female Male Female Male Female < > Smoking status Age Age Age Age Age Male Female Male Female Male Female Male Female Male Female Non-smoker Smoker Systolic BP Systolic BP (mmhg) Untreated Treated Male Female Male Female < HDL HDL (mmol/l) Male Female < Age Age Male Female Total points Total points 10-year risk Total points 10-year risk Male Male Female Female < 0 < 1 < 9 < N/A N/A Safety-Coated The miracle of made safer. It's the shell that makes safer. 81mg Aspirin ph Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767 Pharmafrica (Pty) Ltd, 33 Hulbert Road, New Centre, Johannesburg 2001 Under licence from Goldshield Pharmaceuticals Ltd. U.K. R April 2006 Vol.24 No.4 CME 203 Atherosclerosis.indd 203 3/29/06 3:46:33 PM
5 ATHEROSCLEROSIS The major risk factors for atherosclerosis are age, family history, dyslipidaemia, cigarette smoking, hypertension and diabetes. These risk factors rarely occur in isolation. There is a need for a treatment paradigm shift from the diagnosis and treatment of individual risk factors to the assessment and management of total cardiovascular disease risk. therapy should be administered to all patients with hypertension regardless of their lipid levels. Previously it was considered optimal to lower the LDL cholesterol level to less than 2.59 mmol/l (Table I). That axiom has now been called into question because clinical trials have shown that atherosclerotic progression and clinical outcomes will be lessened by much more aggressive use of statins. To date, 6 large primary prevention trials with cholesterol-lowering agents have been published. The most important of these in terms of their clinical application are the West of Scotland Coronary Prevention Study Group (WOSCOPS), the AFCAPS and ASCOT-LLA trials. The major finding of all these trials is an early and dramatic reduction in clinical events in treated patients who have a baseline LDL cholesterol > 4.0 mmol/l or an LDL cholesterol level that was previously considered normal that did not warrant drug therapy. More aggressive care of patients with multiple risk factors is the major focus of updated treatment guidelines. In addition, it is now accepted that patients who have no overt CAD but who have multiple risk factors are at risk and should receive treatment for these risk factors to reduce later development of CAD. A study that evaluated aggressive treatment of elevated blood sugar, blood pressure, LDL cholesterol and triglycerides showed a 53% decrease in CAD events compared with a conventional approach and supports the concept of intensive concomitant risk factor modification in patients at high risk for CAD. Recent calculations indicate that patients at moderate risk should have risk factor modification implemented years earlier than suggested by conventional algorithms. Recent data also indicate that the Framingham risk function significantly underestimates the 10- year absolute risk of CAD. In Europe, the recommendations of the Third Joint Task Force of European and Other Societies on the Prevention of CAD in Clinical Practice have adopted the European Society of Cardiology SCORE risk prediction system. This allows physicians to estimate the 10- year risk of fatal CAD in asymptomatic subjects with the aim of adjusting the intensity of preventive therapy. Only a fraction of the patients who should be treated with a statin are currently receiving such therapy. It is estimated that worldwide more than 200 million people meet the criteria for treatment but fewer than 25 million receive statins. One of the main reasons for this degree of undertreatment is cost related. This is especially pertinent in a country such as South Africa, where health care resources are limited. Lifestyle interventions Lifestyle interventions are crucially important in the control of obesity, dyslipidaemia and diabetes. Such interventions have also been shown to raise HDL levels. Recently, large prospective studies have shown that healthy diet, exercise and low serum cholesterol as well as normal blood pressure together with smoking abstinence is associated with low risk for CAD. Recommendations for diet, weight loss and exercise offer little or no risk to the patient but have been shown to yield significant long-term benefits. In addition, health education programmes aimed at school children are vital and sorely lacking in this country. Health education is an important tool in setting the stage to encourage children to take care of their own health and be responsible for their well-being. This is a major component of preventive cardiology. novel risk factors CAD events have been predicted using various equations that include the traditional risk factors as variables. Novel risk factors are emerging, however, which may prove to be the key to improving the current risk estimation approach which is lacking in certain respects. Cholesterol screening, for instance, fails to identify almost 50% of the 1.3 million individuals who develop myocardial infarctions in America every year. In addition, much of the total incidence of CAD occurs in individuals with belowaverage plasma levels of cholesterol. The compelling evidence for the role of inflammation in atherosclerotic disease has motivated research into the role of other new, risk factors. Atherosclerosis is not solely a disease of lipid deposits, and systemic inflammation plays a crucial role in atherosclerotic inception and progression. Triggers of this inflammatory response may include oxidised lipoproteins, hypertension, diabetes and obesity. Measurement of inflammatory markers may enhance the current risk evaluation. C-reactive protein One of the most researched novel markers is C-reactive protein (CRP). Plasma CRP has a long half-life, exhibits stable levels in individuals and has negligible circadian variation. It is easily measured and inexpensive standardised high-sensitivity assays provide similar results in fresh, stored or frozen plasma. Data from prospective studies demonstrate that plasma CRP levels predict the likelihood of CAD events in apparently well people. These data also indicate that high-sensitivity CRP (hs-crp) measurements add to the predictive ability of plasma lipid risk factors. Elevated plasma CRP levels have been 204 CME April 2006 Vol.24 No.4 Atherosclerosis.indd 204 3/29/06 3:46:34 PM
6 Atherosclerosis.indd 205 3/29/06 3:46:34 PM
7 ATHEROSCLEROSIS Lifestyle interventions are crucially important in the control of obesity, dyslipidaemia and diabetes. Such interventions have also been shown to raise HDL levels. The knowledge that atherosclerosis is an inflammatory disease offers exciting new opportunities for the future prediction, prevention and treatment of CAD. associated with increased relative risk of initial myocardial infarction at every level of the plasma total cholesterol to HDL cholesterol ratio in apparently healthy men. Plasma hs- CRP level at baseline predicted risk for first CAD events better than baseline plasma LDL cholesterol. Plasma hs-crp measurement also aided risk prediction in individuals with the metabolic syndrome. An accumulation of components of the metabolic syndrome (central obesity, elevated triglycerides, low levels of HDL, hypertension, elevated blood glucose) were also associated with increased plasma hs- CRP levels. In 2003 the American Heart Association and the Centers for Disease Control and Prevention published a joint scientific statement recommending the measurement of plasma hs-crp for assessing absolute risk for coronary disease primary prevention. The current recommended plasma hs-crp cut-off points are < 1.0 mg/l for low risk, mg/l Fig. 1. Direct comparison of CRP to several other lipid and nonlipid risk factors for CAD (HDL-C = HDL cholesterol; LDL-C = LDL cholesterol; TC = total cholesterol). for average risk and > 3.0 mg/l for high risk. In order to assess risk of future first coronary events, each patient is classified into a quintile of risk, depending on the hs-crp concentration. The reporting of hs-crp results focuses on the quintile of risk and not the actual mass concentration. Models containing both hs-crp and total cholesterol or the total cholesterol to HDL ratio are better able to predict future first coronary events than those containing hs-crp alone (Fig. 1). The computed relative risk does not vary significantly between men and women and so there is a single risk assessment algorithm for both genders (Table III). Although there are no specific therapies to decrease hs-crp and there is no direct evidence that risk of future cardiovascular events is reduced by decreasing hs-crp, studies have shown that aspirin and pravastatin are effective in decreasing the incidence of future coronary events in those with increased hs-crp (> 2.1 mg/l). Clinical trials are currently ongoing to further explore the interaction between pravastatin, aspirin and the inflammatory response in primary and secondary settings. Future investigations will determine whether plasma hs-crp can identify individuals who are apparently at low risk but may still benefit from lipid-lowering therapy. A large-scale randomised clinical trial (JUPITER) will evaluate the effects of statin therapy in subjects who have both plasma LDL cholesterol levels below those currently used to target therapy and plasma hs-crp levels that indicate heightened risk of a CAD event. The rationale and design of this trial have been Table III. Relative risk estimates for future coronary events in men and women associated with quintiles of hs-crp and TC:HDL cholesterol ratio. Quintile of TC: Men Women hs-crp quintile hs-crp quintile hs-crp quintile hs-crp quintile hs-crp quintile HDL-C ratio (< 0.7mg/l) 2 ( mg/l) 3 ( mg/l) 4 ( mg/l) 5 ( mg/l) 1 < 3.4 < > 5.5 > CME April 2006 Vol.24 No.4 Atherosclerosis.indd 206 3/29/06 3:46:34 PM
8 R ATHEROSCLEROSIS published. These results should provide important information regarding the use of plasma hs-crp values to guide initiation of lipid-lowering therapy in a primary prevention population deemed to be at low cardiovascular risk by means of current criteria. This trial will supply the first findings regarding the clinical application of the biology of inflammation in atherosclerosis. conclusion The field of atherosclerotic vascular disease has been advancing at an increasing pace as the importance of the disease and its early recognition is better appreciated by the medical community. The family doctor s office is the ideal location to implement behavioural change strategies which are an integral part of primary prevention. Health care providers should be reminded that a holistic approach is necessary for any primary prevention programme to be successful and no risk factor should be viewed in isolation. The knowledge that atherosclerosis is an inflammatory disease offers exciting new opportunities for the future prediction, prevention and treatment of CAD. This knowledge will hopefully lead to the discovery of new treatments for this life-threatening disease which is the second most common cause of death in South Africa. A commitment to continued education is vital to ensure that South African practitioners remain informed of current trends and new therapeutic options in order that we continue to offer patients the best in clinical care. Further reading Anonymous. Randomised trial of cholesterol lowering in patients with coronary heart disease: the Scandinavian simvastatin survival study (4S). Lancet 1994; 344: Berenson GS, Srinivasan S. Cholesterol as a risk factor for early atherosclerosis: the Bogalsa Heart Study. Progress in Pediatric Cardiology 2003; 17: Boudik F, Reissigova J, Hrach K, et al. Primary prevention of coronary artery disease among middle aged men in Prague: Twenty-year followup results. Atherosclerosis 2006; 184: Faxon DP, Creager MA, Smith SC, et al. Atherosclerotic Vascular Disease Conference Proceedings. Circulation 2004; 109: Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352: Okrainec K, Banerjee DK, Eisenberg MJ. Coronary artery disease in the developing world. Am Heart J 2004; 148: Rifai N, Ridker PM. High-sensitivity C-reactive protein: A novel and promising marker of coronary heart disease. Clinical Chemistry 2001; 47: Shepard J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland coronary prevention study group. N Engl J Med 1995; 333: IN A N UTSHELL Atherosclerosis is a process that starts early in life and progresses silently and slowly for decades, usually only manifesting clinically in middle age. The main objectives of primary prevention are to reduce morbidity, to improve quality of life and to increase life expectancy. There is growing evidence that lifestyle changes and primary risk factor modification can reduce both morbidity and mortality. The major risk factors for atherosclerosis are age, family history, dyslipidaemia, cigarette smoking, hypertension and diabetes. These risk factors rarely occur in isolation. A low level of HDL cholesterol is an independent risk factor for future cardiovascular events. Low HDL is defined as less than 1.03 mmol/l in men and less than 1.30 mmol/l in women. Clustering of CAD risk factors such as hypertension and dyslipidaemia may begin in childhood, indicating a need for screening for cardiovascular risk early in life. The major finding of prevention trials with cholesterol-lowering agents is an early and dramatic reduction in clinical events in treated patients who have a baseline LDL-cholesterol > 4.0 mmol/l; an LDL cholesterol level that was previously considered normal that did not warrant drug therapy. Lifestyle interventions are crucially important in the control of obesity, dyslipidaemia and diabetes. Novel risk factors are emerging which may prove to be the key to improving the current risk estimation approach which is lacking in certain respects. Safety-Coated The miracle of made safer. It's the shell that makes safer. 81mg Aspirin ph Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767 Pharmafrica (Pty) Ltd, 33 Hulbert Road, New Centre, Johannesburg 2001 Under licence from Goldshield Pharmaceuticals Ltd. U.K. R April 2006 Vol.24 No.4 CME 207 Atherosclerosis.indd 207 3/29/06 3:46:37 PM
How would you manage Ms. Gold
How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56
4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for
+ Update on Lipid Management Stacey Gardiner, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin + The stats on heart disease Over the past 10 years for which statistics
Review of guidelines for management of dyslipidemia in diabetic patients
2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University
Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION
2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL
Changing lipid-lowering guidelines: whom to treat and how low to go
European Heart Journal Supplements (2005) 7 (Supplement A), A12 A19 doi:10.1093/eurheartj/sui003 Changing lipid-lowering guidelines: whom to treat and how low to go C.M. Ballantyne Section of Atherosclerosis,
MOLINA HEALTHCARE OF CALIFORNIA
MOLINA HEALTHCARE OF CALIFORNIA HIGH BLOOD CHOLESTEROL IN ADULTS GUIDELINE Molina Healthcare of California has adopted the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel
2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary
2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Becky McKibben, MPH; Seth
PIEDMONT ACCESS TO HEALTH SERVICES, INC. Guidelines for Screening and Management of Dyslipidemia
PIEDMONT ACCESS TO HEALTH SERVICES, INC. Policy Number: 01-09-021 SUBJECT: Guidelines for Screening and Management of Dyslipidemia EFFECTIVE DATE: 04/2008 REVIEWED/REVISED: 04/12/10, 03/17/2011, 4/10/2012,
Dyslipidaemia. Is there any new information? Dr. A.R.M. Saifuddin Ekram
Dyslipidaemia Is there any new information? Dr. A.R.M. Saifuddin Ekram PhD,FACP,FCPS(Medicine) Professor(c.c.) & Head Department of Medicine Rajshahi Medical College Rajshahi-6000 New features of ATP III
RECOGNITION OF THE METABOLIC SYNDROME
THE METABOLIC SYNDROME IN CLINICAL PRACTICE Michael H. Davidson, MD* ABSTRACT Patients with the metabolic syndrome remain at significantly elevated risk of morbidity and mortality associated with coronary
Comparison of Original and Generic Atorvastatin for the Treatment of Moderate Dyslipidemic Patients
Comparison of Original and Generic Atorvastatin for the Treatment of Moderate Dyslipidemic Patients Cardiology Department, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok, Thailand Abstract
Guidelines on cardiovascular risk assessment and management
European Heart Journal Supplements (2005) 7 (Supplement L), L5 L10 doi:10.1093/eurheartj/sui079 Guidelines on cardiovascular risk assessment and management David A. Wood 1,2 * 1 Cardiovascular Medicine
CLINICAL OUTCOME Vs SURROGATE MARKER
CLINICAL OUTCOME Vs SURROGATE MARKER Statin Real Experience Dr. Mostafa Sherif Senior Medical Manager Pfizer Egypt & Sudan Objective Difference between Clinical outcome and surrogate marker Proper Clinical
Introduction. Objective. Critical Questions Addressed
Introduction Objective To provide a strong evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in women and men Critical Questions Addressed CQ1:
Nearly 62 million people in the. ... REPORTS... New Therapeutic Options in the National Cholesterol Education Program Adult Treatment Panel III
... REPORTS... New Therapeutic Options in the National Cholesterol Education Program Adult Treatment Panel III Robert L. Talbert, PharmD Abstract Coronary heart disease (CHD) is a common, costly, and undertreated
Assessing Cardiovascular Risk to Optimally Stratify Low- and Moderate- Risk Patients. Copyright. Not for Sale or Commercial Distribution
CLINICAL Viewpoint Assessing Cardiovascular Risk to Optimally Stratify Low- and Moderate- Risk Patients Copyright Not for Sale or Commercial Distribution By Ruth McPherson, MD, PhD, FRCPC Unauthorised
1. Which one of the following patients does not need to be screened for hyperlipidemia:
Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:
ATP IV: Predicting Guideline Updates
Disclosures ATP IV: Predicting Guideline Updates Daniel M. Riche, Pharm.D., BCPS, CDE Speaker s Bureau Merck Janssen Boehringer-Ingelheim Learning Objectives Describe at least two evidence-based recommendations
Dyslipidemia in the light of Current Guidelines - Do we change our Practice?
Dyslipidemia in the light of Current Guidelines - Do we change our Practice? Dato Dr. David Chew Soon Ping Senior Consultant Cardiologist Institut Jantung Negara Atherosclerotic Cardiovascular Disease
CVD Risk Assessment. Michal Vrablík Charles University, Prague Czech Republic
CVD Risk Assessment Michal Vrablík Charles University, Prague Czech Republic What is Risk? A cumulative probability of an event, usually expressed as percentage e.g.: 5 CV events in 00 pts = 5% risk This
Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions in hs-crp
Página 1 de 5 Return to Medscape coverage of: American Society of Hypertension 21st Annual Scientific Meeting and Exposition Val-MARC: Valsartan-Managing Blood Pressure Aggressively and Evaluating Reductions
New Features of the National Cholesterol Education Program Adult Treatment Panel III Lipid-Lowering Guidelines
Clin. Cardiol. Vol. 26 (Suppl. III), III-19 III-24 (2003) New Features of the National Cholesterol Education Program Adult Treatment Panel III Lipid-Lowering Guidelines H. BRYAN BREWER, JR, M.D. Molecular
Data Alert. Vascular Biology Working Group. Blunting the atherosclerotic process in patients with coronary artery disease.
1994--4 Vascular Biology Working Group www.vbwg.org c/o Medical Education Consultants, LLC 25 Sylvan Road South, Westport, CT 688 Chairman: Carl J. Pepine, MD Eminent Scholar American Heart Association
New Guidelines in Dyslipidemia Management
The Fourth IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 2018 New Guidelines in Dyslipidemia Management Dr. Khalid Al-Waili, MD, FRCPC, DABCL Senior Consultant Medical
Diabetic Dyslipidemia
Diabetic Dyslipidemia Dr R V S N Sarma, M.D., (Internal Medicine), M.Sc., (Canada), Consultant Physician Cardiovascular disease (CVD) is a significant cause of illness, disability, and death among individuals
Cardiovascular Complications of Diabetes
VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary
Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals
European Heart Journal Supplements (2004) 6 (Supplement A), A12 A18 Reducing low-density lipoprotein cholesterol treating to target and meeting new European goals University of Sydney, Sydney, NSW, Australia
Lipid Panel Management Refresher Course for the Family Physician
Lipid Panel Management Refresher Course for the Family Physician Objectives Understand the evidence that was evaluated to develop the 2013 ACC/AHA guidelines Discuss the utility and accuracy of the new
Established Risk Factors for Coronary Heart Disease (CHD)
Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland
Young high risk patients the role of statins Dr. Mohamed Jeilan
Young high risk patients the role of statins Dr. Mohamed Jeilan KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures
LIST OF ABBREVIATIONS
Diabetes & Endocrinology 2005 Royal College of Physicians of Edinburgh Diabetes and lipids 1 G Marshall, 2 M Fisher 1 Research Fellow, Department of Cardiology, Glasgow Royal Infirmary, Glasgow, Scotland,
LIPID GUIDELINES: 2015
LIPID GUIDELINES: 2015 D P Mikhailidis BSc MSc MD FCPP FCP FRSPH FFPM FRCP FRCPath Academic Head Dept. of Clinical Biochemistry (Vascular Disease Prevention Clinics) Royal Free campus University College
2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc.
2013 Cholesterol Guidelines Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc. Disclosures Speaker Gilead Sciences NHLBI Charge to the Expert Panel Evaluate higher quality
rosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd.
rosuvastatin, 5mg, 10mg, 20mg, film-coated tablets (Crestor ) SMC No. (725/11) AstraZeneca UK Ltd. 09 September 2011 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
Current Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD
Current Cholesterol Guidelines and Treatment of Residual Risk J. Peter Oettgen, MD Associate Professor of Medicine Harvard Medical School Director, Preventive Cardiology Beth Israel Deaconess Medical Center
JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study
Panel Discussion: Literature that Should Have an Impact on our Practice: The Study Kaiser COAST 11 th Annual Conference Maui, August 2009 Robert Blumberg, MD, FACC Ralph Brindis, MD, MPH, FACC Primary
Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden
Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD
The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009
The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain
2014/10/20. Management of Lipid Disorders Eric Klug Sunninghill, Sunward Park and CM JHB Academic Hospitals
Management of Lipid Disorders Eric Klug Sunninghill, Sunward Park and CM JHB Academic Hospitals Sudden and unexpected deaths in an adult population, Cape Town, South Africa, 2001-2005 1 Sudden and unexpected
Term-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY
MCC-006 POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PGDCC) 00269 Term-End Examination December, 2009 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY Time : 2 hours Maximum Marks : 60 Note : There will be multiple
Welcome and Introduction
Welcome and Introduction This presentation will: Define obesity, prediabetes, and diabetes Discuss the diagnoses and management of obesity, prediabetes, and diabetes Explain the early risk factors for
Treatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center
Treatment of Cardiovascular Risk Factors Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center Disclosures: None Objectives What do risk factors tell us What to check and when Does treatment
The Framingham Coronary Heart Disease Risk Score
Plasma Concentration of C-Reactive Protein and the Calculated Framingham Coronary Heart Disease Risk Score Michelle A. Albert, MD, MPH; Robert J. Glynn, PhD; Paul M Ridker, MD, MPH Background Although
Chronic Benefit Application Form Cardiovascular Disease and Diabetes
Chronic Benefit Application Form Cardiovascular Disease and Diabetes 19 West Street, Houghton, South Africa, 2198 Postnet Suite 411, Private Bag X1, Melrose Arch, 2076 Tel: +27 (11) 715 3000 Fax: +27 (11)
Dyslipidemia 울산의대서울아산병원심장병원심장내과이철환
Dyslipidemia 울산의대서울아산병원심장병원심장내과이철환 Presentation General LDL cholesterol HDL cholesterol Future Summary A top healthcare priority 사망 / 인구 10 만 Causes of Death Worldwide, 2008 140 120 2008 년 한국인 5 대사망원인
Familial hypercholesterolaemia in children and adolescents
Familial hypercholesterolaemia in children and adolescents Rationale and recommendations for early identification and treatment European Atherosclerosis Society Consensus Panel Slide deck adapted from:
Disclosures. Pediatric Dyslipidemia Casey Elkins, DNP, NP C, CLS, FNLA. Learning Objectives. Atherogenesis. Acceptable Values
39 th National Conference on Pediatric Health Care Pediatric Dyslipidemia Casey Elkins, DNP, NP C, CLS, FNLA March 19-22, 2018 CHICAGO Disclosures Speakers Bureau Sanofi and Regeneron Learning Objectives
Diabetes Mellitus: A Cardiovascular Disease
Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular
Threshold Level or Not for Low-Density Lipoprotein Cholesterol
... SYMPOSIA PROCEEDINGS... Threshold Level or Not for Low-Density Lipoprotein Cholesterol Based on a debate between Philip J. Barter, MD, PhD, FRACP, and Frank M. Sacks, MD Debate Summary As drugs, such
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM OSHP 2014 Annual Meeting Oklahoma City, OK April 4, 2014 1 Objectives
Risk Factors for Heart Disease
Risk Factors for Heart Disease Risk Factors we cannot change (Age, Gender, Family History) Risk Factors we can change (modifiable) Smoking Blood pressure Cholesterol Diabetes Inactivity Overweight Stress
JOSHUA K. KAYIMA INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY
INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY JOSHUA K. KAYIMA ASSOCIATE PROFESSOR DEPT. OF CLINICAL MEDICINE AND THERAPEUTICS UNIVERSITY OF NAIROBI Introduction According to
Page 1. Disclosures. Background. No disclosures
Population-Based Lipid Screening in the Era of a Childhood Obesity Epidemic: The Importance of Non-HDL Cholesterol Assessment Brian W. McCrindle, Cedric Manlhiot, Don Gibson, Nita Chahal, Helen Wong, Karen
Weintraub, W et al NEJM March Khot, UN et al, JAMA 2003
Global risk hscrp Should not be included in a Global Cardiovascular Risk Assessment. Jodi Tinkel, MD Assistant Professor Director of Cardiac Rehabilitation Associate Program Director, Cardiovascular Medicine
LDL cholesterol and cardiovascular outcomes?
LDL cholesterol and cardiovascular outcomes? Prof Kausik Ray, BSc (hons), MBChB, FRCP, MD, MPhil (Cantab), FACC, FESC Professor of Cardiovascular Disease Prevention St Georges University of London Honorary
Lipoprotein Particle Profile
Lipoprotein Particle Profile 50% of people at risk for HEART DISEASE are not identified by routine testing. Why is LPP Testing The Most Comprehensive Risk Assessment? u Provides much more accurate cardiovascular
Five chapters 1. What is CVD prevention 2. Why is CVD prevention needed 3. Who needs CVD prevention 4. How is CVD prevention applied 5. Where should CVD prevention be offered Shorter, more adapted to clinical
Of the 1.5 million heart attacks
CARDIOLOGY PATIENT PAGE CARDIOLOGY PATIENT PAGE C-Reactive Protein A Simple Test to Help Predict Risk of Heart Attack and Stroke Paul M Ridker, MD, MPH Of the 1.5 million heart attacks and 600 000 strokes
Modern Lipid Management:
Modern Lipid Management: New Drugs, New Targets, New Hope Kirk U. Knowlton, M.D Director of Cardiovascular Research Co Chief of Cardiology Why lower LDL C in those without evidence of CAD (primary prevention)
An update on lipidology and cardiovascular risk management. Lipids, Metabolism & Vascular Risk Section - Royal Society of Medicine
An update on lipidology and cardiovascular risk management Lipids, Metabolism & Vascular Risk Section - Royal Society of Medicine National and international lipid modification guidelines: A critical appraisal
Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines
Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines Paul Mahoney, MD Sentara Cardiology Specialists Lipid Management in Cardiovascular Disease
Lessons from Recent Atherosclerosis Trials
Lessons from Recent Atherosclerosis Trials Han, Ki Hoon MD PhD Asan Medical Center Seoul, Korea Change of concept Primary vs. secondary prevention Low risk vs. High risk High Risk CHD and equivalents CHD
How to Reduce Residual Risk in Primary Prevention
How to Reduce Residual Risk in Primary Prevention Helene Glassberg, MD Assistant Professor of Medicine Section of Cardiology Hospital of the University of Pennsylvania Philadelphia, PA USA Patients with
Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk
Metabolic Syndrome Update 21 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes University of Colorado Denver Denver Health Medical Center The Metabolic
Andrejs Kalvelis 1, MD, PhD, Inga Stukena 2, MD, Guntis Bahs 3 MD, PhD & Aivars Lejnieks 4, MD, PhD ABSTRACT INTRODUCTION. Riga Stradins University
CARDIOVASCULAR RISK FACTORS ORIGINAL ARTICLE Do We Correctly Assess the Risk of Cardiovascular Disease? Characteristics of Risk Factors for Cardiovascular Disease Depending on the Sex and Age of Patients
Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE
Metabolic Syndrome and Chronic Kidney Disease
Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference
Preventing Myocardial Infarction in the Young Adult in the First Place: How Do the National Cholesterol Education Panel III Guidelines Perform?
Journal of the American College of Cardiology Vol. 41, No. 9, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Inc. doi:10.1016/s0735-1097(03)00187-6
Eyes on Korean Data: Lipid Management in Korean DM Patients
Eyes on Korean Data: Lipid Management in Korean DM Patients ICDM Luncheon Symposium Sung Rae Kim MD PhD Division of Endocrinology and Metabolism The Catholic University of Korea Causes of Death in People
Since the release of the National Cholesterol PROCEEDINGS FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT
FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT Since the National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP III) guidelines, 3 large
Cardiovascular Risk Factors: Distribution and Prevalence in a Rural Population of Bangladesh
"Insight Heart" is also available at www.squarepharma.com.bd Cardiovascular Risk Factors: Distribution and Prevalence in a Rural Population of Bangladesh Coronary heart disease has been emerging as an
GUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES
GUIDELINES FOR DYSLIPIDEMIA MANAGEMENT AND EDUCATION THROUGH NOVA SCOTIA DIABETES CENTRES Prepared by DCPNS Action Committee Dr. Lynne Harrigan Brenda Cook Peggy Dunbar Bev Harpell with the assistance
The Clinical Debates
The Clinical Debates Speakers: Round 2: Statins for Primary Prevention of Cardiovascular Disease Matthew Cantrell, PharmD, BCPS, is a 2000 graduate of Mt. Mercy College and 2005 graduate from the University
New Guidelines in Dyslipidemia Management
The Third IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 2017 New Guidelines in Dyslipidemia Management Dr. Khalid Al-Waili, MD, FRCPC, DABCL Senior Consultant Medical
Managing Dyslipidemia in Disclosures. Learning Objectives 03/05/2018. Speaker Disclosures
Managing Dyslipidemia in 2018 Glen J. Pearson, BSc, BScPhm, PharmD, FCSHP, FCCS Professor of Medicine (Cardiology) Co-Director, Cardiac Transplant Clinic; Associate Chair, Health Research Ethics Boards;
EuroPRevent Risk assessment models: what is to come? Risk Assessment Models: Applications in Clinical Practice
EuroPRevent 2010 Risk assessment models: what is to come? Risk Assessment Models: Applications in Clinical Practice G. De Backer Ghent University Ghent, Belgium May 5-8 2010, Prague Czech Republic G. De
Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review.
ISPUB.COM The Internet Journal of Cardiovascular Research Volume 7 Number 1 Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review. C ANYANWU, C NOSIRI Citation C ANYANWU, C NOSIRI.
Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES
MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest
Supplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Cholesterol Treatment Trialists Collaboration.
Arteriosclerosis & Atherosclerosis
Arteriosclerosis & Atherosclerosis Arteriosclerosis = hardening of arteries = arterial wall thickening + loss of elasticity 3 types: -Arteriolosclerosis -Monckeberg medial sclerosis -Atherosclerosis Arteriosclerosis,
The New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk
The New Gold Standard for Lipoprotein Analysis Advanced Testing for Cardiovascular Risk Evolution of Lipoprotein Testing The Lipid Panel Total Cholesterol = VLDL + LDL + HDL Evolution of Lipoprotein Testing
Introduction. Risk factors of PVD 5/8/2017
PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental
Association between arterial stiffness and cardiovascular risk factors in a pediatric population
+ Association between arterial stiffness and cardiovascular risk factors in a pediatric population Maria Perticone Department of Experimental and Clinical Medicine University Magna Graecia of Catanzaro
2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc.
2013 Cholesterol Guidelines Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc. Disclosures Speaker Gilead Sciences NHLBI Charge to the Expert Panel Evaluate higher quality
Pharmaceutical Help to Control Cholesterol
Pharmaceutical Help to Control Cholesterol Catherine E. Cooke, PharmD, BCPS, PAHM President, PosiHealth, Inc. Clinical Associate Professor, Univ. of Maryland This program has been brought to you by PharmCon
POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PG DCC) Term-End Examination June, 2016 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY
No. of Printed Pages : 12 MCC-006 POST GRADUATE DIPLOMA IN CLINICAL CARDIOLOGY (PG DCC) 00484 Term-End Examination June, 2016 MCC-006 : CARDIOVASCULAR EPIDEMIOLOGY Time : 2 hours Maximum Marks : 60 Note
Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies
Low-density lipoproteins cause atherosclerotic cardiovascular disease (ASCVD) 1. Evidence from genetic, epidemiologic and clinical studies A Consensus Statement from the European Atherosclerosis Society
The American Diabetes Association estimates
DYSLIPIDEMIA, PREDIABETES, AND TYPE 2 DIABETES: CLINICAL IMPLICATIONS OF THE VA-HIT SUBANALYSIS Frank M. Sacks, MD* ABSTRACT The most serious and common complication in adults with diabetes is cardiovascular
Total risk management of Cardiovascular diseases Nobuhiro Yamada
Nobuhiro Yamada The worldwide burden of cardiovascular diseases (WHO) To prevent cardiovascular diseases Beyond LDL Multiple risk factors With common molecular basis The Current Burden of CVD CVD is responsible
Supplementary Online Content
Supplementary Online Content Kavousi M, Leening MJG, Nanchen D, et al. Comparison of application of the ACC/AHA guidelines, Adult Treatment Panel III guidelines, and European Society of Cardiology guidelines
The Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam
Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention
TABLE 1. Cardiovascular Disease Management Guidelines for the Primary Prevention of CAD a Risk category b LDL-C goal (mg/dl) c Moderately high risk (
REVIEW PRIMARY PREVENTION OF CAD Intensive Lowering of Low-Density Lipoprotein Cholesterol Levels for Primary Prevention of Coronary Artery Disease DEAN G. KARALIS, MD Coronary artery disease (CAD) is
KEY COMPONENTS. Metabolic Risk Cardiovascular Risk Vascular Inflammation Markers
CardioMetabolic Risk Poor blood sugar regulation and unhealthy triglyceride and lipoprotein levels often present long before the diagnosis of type 2 Diabetes. SpectraCell s CardioMetabolic and Pre-Diabetes
Landmark Clinical Trials.
Landmark Clinical Trials 1 Learning Objectives Discuss clinical trials and their role in lipid and lipoprotein treatment in cardiovascular prevention. Review the clinical trials of lipid-altering drug
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Briefing paper QOF indicator area: Primary prevention of CVD Potential output:
Serum levels of galectin-1, galectin-3, and galectin-9 are associated with large artery atherosclerotic
Supplementary Information The title of the manuscript Serum levels of galectin-1, galectin-3, and galectin-9 are associated with large artery atherosclerotic stroke Xin-Wei He 1, Wei-Ling Li 1, Cai Li
Dyslipidemia in women: Who should be treated and how?
Dyslipidemia in women: Who should be treated and how? Lale Tokgozoglu, MD, FACC, FESC Professor of Cardiology Hacettepe University Faculty of Medicine Ankara, Turkey. Cause of Death in Women: European
Metabolic Syndrome Is A Key Determinant Of Coronary Microvascular Function In Patients With Stable Coronary Disease Undergoing PCI
Metabolic Syndrome Is A Key Determinant Of Coronary Microvascular Function In Patients With Stable Coronary Disease Undergoing PCI Narbeh Melikian*, Ajay M Shah*, Martyn R Thomas, Roy Sherwood, Mark T
Statins in the elderly : Is there a rationale?
Statins in the elderly : Is there a rationale? Pr B Boland After a communication by Dr. Manfred Gogol EAMA, Sion, June, 2006 1 RCTs with Statins Meta-Analysis, 1999 182 abstracts or research papers 29