THE LIPID DEBATE: WHAT S NEW? Dr Detloff Rump
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1 THE LIPID DEBATE: WHAT S NEW? Dr Detloff Rump
2 Agenda The Statin debate The TChol/LDL/HDL/Trig debate The ratio debate Conclusions 2
3 Statins 3
4 There is an academic debate and it is not concluded 4
5 ..and the debate is about. 5
6 ..and the debate is about. 6
7 Firstly: How effective are statins? 7
8 How does this stack up? 8
9 So there are benefits, but they seem limited 9
10 Secondly: Are statins safe? There are doubts 10
11 Firstly: Are statins safe? There are doubts 11
12 but there appear to be non-doubters 12
13 and he is referring to. Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm (ASCOT- LLA): a randomised double-blind placebo-controlled trial 13
14 but there appear to be non-doubters 14
15 JAMA recommendations for 2017 ASCVD=Atherosclerotic Cardiovascular Disease 15
16 JAMA recommendations for 2017 ASCVD=Atherosclerotic Cardiovascular Disease 16
17 TChol / LDL / HDL / Trig ratios 17
18 Cholesterol elevation and heart disease are not very well correlated 18
19 Could high cholesterol (incl LDL) have positive effects? It would seem so 19
20 Many heart attack patients have normal LDL cholesterol 20
21 The discussion shifts towards small dense LDL 21
22 What is it about small dense LDL? 22
23 Trigs seem to cause increase in small dense LDL particles 23
24 And Trigs also have an effect on HDL 24
25 HDL the higher the better? Not true 25
26 Triglycerides fluctuate 26
27 Lipid ratios 27
28 There are a few lipid ratios (atherogenic indices) that are commonly used to optimise the predictive capacity of the lipid profile 28
29 What is a good option? If small dense LDL is the culprit..then we want to know how many small dense LDL particles there are (it is understood that testing for small dense LDL is expensive) TChol tells us, how many LDL particles are there (appr. 2/3 of all cholesterol) Triglycerides correlate with small dense LDL (but fluctuate) HDL doesn t fluctuate so much, but is inversely correlated to Trigs So how about using TChol/HDL as a ratio to gauge the number of small dense LBL particles? and therefore CVD risk? (But keep in mind the possible distortion through ultra-high Trigs and the detrimental effect of ultra-high HDL) 29
30 Conclusions The Statin debate is a heated one..let s keep an eye on it! Our attention is being drawn to small dense LDL particles The TChol/HDL ratio may at this stage be the most reasonable tool to gauge CVD risk 30
31 31
32 32
33 Legal notice 2017 Swiss Re. All rights reserved. You are not permitted to create any modifications or derivative works of this presentation or to use it for commercial or other public purposes without the prior written permission of Swiss Re. The information and opinions contained in the presentation are provided as at the date of the presentation and are subject to change without notice. Although the information used was taken from reliable sources, Swiss Re does not accept any responsibility for the accuracy or comprehensiveness of the details given. All liability for the accuracy and completeness thereof or for any damage or loss resulting from the use of the information contained in this presentation is expressly excluded. Under no circumstances shall Swiss Re or its Group companies be liable for any financial or consequential loss relating to this presentation. 33
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