Objectives. Having completed the learning activities, the participant will be able to: Dyslipidemia: The latest treatment recommendations
|
|
- Silas Lyons
- 6 years ago
- Views:
Transcription
1 Objectives Dyslipidemia: The latest treatment recommendations Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC President, Fitzgerald Health Education Associates, Inc. North Andover, MA Family Nurse Practitioner, Greater Lawrence (MA) Family Health Center Editorial Board, The Nurse Practitioner Journal, Medscape Nursing, The Prescriber s Letter, American Nurse Today Member, Pharmacy and Therapeutics Committee Neighborhood Health Plan, Boston, MA 1 Having completed the learning activities, the participant will be able to: Identify the most current recommendations for dyslipidemia therapy. Describe the process of arriving at a lipid lowering goal for a given patient. Discuss the role of non LDL treatment goals in contemporary dyslipidemia therapy. 2 Objectives Having completed the learning activities, the participant will be able to: (cont.) Discuss select considerations in prescribing lipid-lowering therapies. Dyslipidemia Treatment Recommendations Stone NJ, Robinson J, Lichtenstein AH, et al. ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol Available at ATP3 vs. ACC/AHA Guidelines Moderate- or high-intensity statin therapy Individuals who fall into 4 categories No specific LDL cholesterol goals Rather degree of LDL cholesterol reduction with statin therapy Measure lipids during follow-ups Not to assess achievement of given LDL goal but rather adherence to therapy Comparing the Guideline: How many adults are eligible for treatment? ATP-3=48.5 million adults ACC/AHA=56.7 million adults 5 6 1
2 ACC/AHA Dyslipidemia Guidelines High- and moderateintensity statin treatment emphasized Low-intensity statin therapy nearly eliminated ACC/AHA Dyslipidemia Guidelines Atherosclerotic cardiovascular disease (ASCVD) broadly defined Includes stroke, coronary heart disease and peripheral arterial disease 7 8 ACC/AHA Dyslipidemia Guidelines Nonstatin therapies deemphasized No guidelines provided for treating high triglyceride levels This program will cite separate recommendations on this issue later in program. Individuals From Four Major Statin Benefit Groups 1. Established ASCVD 2. Pretreatment LDL>190 mg/dl (4.9 mmol/l) 9 10 Individuals From Four Major Statin Benefit Groups 3. T1DM or T2DM, age years with LDL mg/dl ( mmol/l) and without clinical ASCVD 4. Without clinical ASCVD or DM but with LDL mg/dl ( mmol/l) and calculated estimated 10-year ASCVD risk=>7.5% Potential Limitations of ACC/AHA Guidelines Potential for overtreatment, particularly in elder Potential for undertreatment, particularly in elevated LDL-C whose 10-year ASCVD risk is less than 7.5% because of younger age
3 Potential Limitations of ACC/AHA Guidelines Does not address patients younger than age 40 or older than 75 years Family history of ASCVD, triglyceride levels not considered 13 AHA/ACC Disclaimer The results and recommendations provided by this application are intended to inform but do not replace clinical judgment. Therapeutic options should be individualized and determined after discussion between the patient and their care provider. 14 CVD Risk Estimator Calculator from ACC/AHA Guidelines Available at 15 Specific LDL C and/or Non-HDL C Treatment Goals The Expert Panel was unable to find RCT evidence to support continued use of specific LDL C and/or non- HDL C treatment targets. The appropriate intensity of statin therapy should be used to reduce ASCVD risk in those most likely to benefit. Specific LDL C and/or Non-HDL C Treatment Goals Nonstatin therapies do not provide acceptable ASCVD risk reduction benefits compared to their potential for adverse effects in the routine prevention of ASCVD. 3
4 Safety Recommendations This guideline used RCTs to identify important safety considerations in individuals receiving treatment of blood cholesterol to reduce ASCVD risk. Using RCTs to determine statin adverse effects facilitates understanding of the net benefit from statin therapy. HMG CoA Reductase Inhibitors: The Statins Simvastatin (Zocor ), atorvastatin (Lipitor ), pravastatin (Pravachol ), pitavastatin (Livalo ), others 20 Mechanism of Action HMG-CoA Reductase Inhibitor: The Statins Inhibitor of HMG-CoA reductase Enzyme responsible for conversion of HMG-CoA to mevalonate, and decreases hepatic biosynthesis of cholesterol As a result Hepatocytes compensate by increasing the number of LDL surface receptors to increase LDL reuptake from the circulation. End result is reduction of HMG CoA Reductase Inhibitor Check hepatic enzymes prior to initiation to establish baseline. No further routine hepatic enzyme monitoring warranted during statin use. Serious liver injury due to statins is usually idiosyncratic and not prevented with routine monitoring. serum LDL concentration HMG CoA Reductase Inhibitor T2DM risk is slightly increased with statin use, particularly with more potent statin in higher dose. Cardiovascular benefit outweighs small risk. Cognitive impairment while on statin rarely reported. If occurs, consider lowering dose or try another statin. Clinical Scenarios
5 59-year-old Woman of European Ancestry with HTN and T2DM Total cholesterol: 185 mg/dl (4.8 mmol/l) HDL cholesterol: 35 mg/dl (0.9 mmol/l) Systolic blood pressure: 139 mm Hg Smoker: No 10-year ASCVD risk=11.5% 25 Fitzgerald Health Education Associates, Inc. 26 High-intensity statin therapy examples LDL-C reduction approx. 50% Daily dose Atorvastatin (40 )-80 mg Rosuvastatin mg Moderate-intensity statin therapy examples LDL-C reduction approx % Daily dose Atorvastatin mg Rosuvastatin 5-10 mg Simvastatin mg Pravastatin mg Lovastatin 40 mg Fitzgerald Health Education Associates, Inc. Low-intensity statin therapy examples LDL-C reduction approx. <30% Daily dose Pravastatin mg Lovastatin 20 mg *Individual responses to statin therapy varied in the RCTs and should be expected to vary in clinical practice. Biologic basis for a less-than-average response possible. Evidence from 1 RCT only: Down-titration if unable to tolerate atorvastatin 80 mg in IDEAL (Incremental decrease through Aggressive Lipid Lowering study) year-old Woman with HTN and DM of Other Ancestry 10-year ASCVD risk=11.5% Unchanged from white designation Might underestimate risk for persons from some race/ethnic groups, Native American, south Asian ancestry, and some Latinos (Puerto Ricans), and might overestimate risk for others, including east Asian ancestry and Mexican Americans year-old Man of European Ancestry with HTN, T2DM Race: White/other Total cholesterol: 220 mg/dl (5.7 mmol/l) HDL cholesterol: 51 mg/dl (1.3 mmol/l) Systolic blood pressure: 122 mm Hg Smoker: Yes 10-year ASCVD risk=31.8% 29 Fitzgerald Health Education Associates, Inc. 30 5
6 68-year-old African American Man, no DM, nonsmoker Total cholesterol: 180 mg/dl (4.7 mmol/l) HDL cholesterol: 28 mg/dl (0.7 mmol/l) SBP: 148 mm Hg Hypertension treatment: No 10-year ASCVD risk=16.1% High intensity statin therapy recommended With a 68-year-old African American Man Add smoking 16.1% risk becomes 26.2% risk Take away smoking, add DM 16.1% becomes 28.4% risk Add smoking and DM 16.1% becomes 43.9% risk year-old white woman with HTN, no DM, non smoker Total cholesterol: 230 mg/dl (6 mmol/l) HDL: 55 mg/dl (1.4 mmol/l) SBP: 146 mm Hg, on meds Calculated 10 yr risk of ASCVD: 4% 33 Fitzgerald Health Education Associates, Inc. 34 Additional Factors Considered in Dyslipidemia Therapy Moderate intensity statin therapy advised In individuals for whom after quantitative risk assessment a riskbased treatment decision is uncertain, additional factors may be considered to inform treatment decision making. Additional Factors Considered in Dyslipidemia Therapy LDL-C 160 mg/dl (4.1 mmol/l) Evidence of genetic hyperlipidemias Family history of premature ASCVD Onset <55 years of age in a first degree male relative or <65 years of age in a first degree female relative
7 Additional Factors Considered in Dyslipidemia Therapy hs-c-reactive protein 2 mg/l CAC score 300 Agatston units or 75 th %tile for age, sex, ethnicity CAC=Coronary Artery Calcium Ankle-brachial index<0.9 Elevated lifetime risk of ASCVD Male, GFR=84 ml/min/1.73 m2, BMI=27 kg/m2 Two 73-year-olds with Established ASCVD Female, GFR=48 ml/min/1.73 m2, BMI=22 kg/m Individuals at Risk for Statin Adverse Effects Multiple or serious comorbidities, including impaired renal or hepatic function History of previous statin intolerance or muscle disorders History of hemorrhagic stroke Fitzgerald Health Education Associates, Inc Individuals at Risk for Statin Adverse Effects Unexplained ALT elevations>3 times ULN >75 years of age Asian ancestry Drug Comparative Efficiency and Pharmacology of the Statins Reduction in LDL-C (%) Increase in HDL-C (%) Reduction Reduction in TG (%) in TC (%) T ½ (h) Metabolism Hydrophilic Atorvastatin CYP3A No Lovastatin CYP3A4 2 4 No Simvastatin CYP3A4 1 3 No Rosuvastatin CYP2C9 19 Yes Pravastatin No CYP 2 3 Yes
8 Definitions National Lipid Association (NLA) Myopathy=Symptoms of myalgia in addition to an elevation in serum creatine kinase (CK) greater than 10 times the upper limit of normal (CK >10 ULN) Also known as myositis Statin-induced Myopathy Risk >50% FDA Reported=Drug-drug Interaction Risk Statins alone Usually in higher doses in advancing age (>75 years), particularly with renal impairment Select statins and interacting medications All due to CYP450 3A4 inhibition Lova-, simva-, atorvastatin=cyp450 3A4 substrates Cyclosporine Select oral antifungals Itraconazole, ketoconazole Statin-induced Myopathy Risk >50% FDA Reported=Drug-drug Interaction Risk Select statins w interacting medications Macrolides Erythromycin, clarithromycin but not azithromycin Select HIV protease inhibitors Select calcium channel blockers Amiodarone Grapefruit juice ingestion Simvastatin: When Compared to Ingestion with Water as Control With grapefruit juice C max and AUC increased 12.0-fold (P<0.001) and 13.5-fold (P<0.001) 24 hours after last grapefruit juice C max and AUC increased 2.4-fold (P<0.01) and 2.1-fold (P<0.001) 7 days after last grapefruit juice dose No change Source: CYP450 Substrates CYP450 3A4 Atorvastatin Lovastatin Simvastatin CYP450 2C9 Pitavastatin Rosuvastatin Not metabolized by CYP450 Pravastatin Recommendations for Managing Common Difficulties During Statin Therapy Per ACC/AHA Dyslipidemia Guidelines
9 Statin Therapy During Mild to Moderate Muscle Symptoms Mild to moderate muscle symptoms develop during statin therapy In absence of clinically significant increase in serum creatine kinase Discontinue statin until the symptoms can be evaluated. Statin Therapy with Mild to Moderate Muscle Symptoms Evaluate for other conditions that increase the risk for muscle symptoms. Hypothyroidism Reduced renal or hepatic function Rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy Vitamin D deficiency Primary muscle diseases Statin Therapy with Mild to Moderate Muscle Symptoms If muscle symptoms resolve off statin and no contraindication Start lower dose of same statin. Monitor for return of symptoms. Statin Therapy with Mild to Moderate Muscle Symptoms If symptoms return Discontinue current statin. Start low dose of another statin. Titrate up dose slowly to goal, monitoring for symptom recurrence Statin Therapy with Mild to Moderate Muscle Symptoms Persistent symptoms for =>2 months post discontinuation of statin therapy Myalgia and/or elevated CK levels Consider cause other than statininduced myopathy. Therapeutic Options in Statin Intolerance in the Absence of Myopathy/ Myositis An Update on Statin Alternatives and Adjuncts, Matthew J Sorrentino, Clin Lipidology. 2012;7(6):
10 Options in Statin-Intolerance Consider following options Every-other-day statin therapy Anecdotal evidence of helpfulness Aim for weekly total dose vs. getting some rather than no statin on board? Favors longer T½ statins Atorvastatin, rosuvastatin Options in Statin-Intolerance Most commonly reported Myalgia without CK rise Use of more hydrophilic/ less lipophilic statin Rosuvastatin, pravastatin most hydrophilic Simvastatin, lovastatin most lipophilic Health Education Associates, Inc Statins in liver disease? Contraindications to statin use Cholestasis, active liver disease Not been shown to worsen outcomes Chronic hepatitis B or C w/ enz elevation No specific evidence that statin use exacerbates liver disease Source: Detail-Document, Prescriber's Letter; 9(9):180924, available at Effects of Selected Drugs on Triglyceride and Cholesterol Levels Drug Triglyceride LDL Cholesterol HDL Cholesterol Alcohol Increased No effect Increased Estrogens, Increased Decreased Increased estradiol Androgens, Increased Increased Decreased testosterone Progestins Decreased Increased Decreased Alcohol, estrogens, estradiol, glucocorticoids, thiazide diuretics, beta-blockers, sertraline protease inhibitors, valproate and related drugs, and isotretinoin can cause severe hypertriglyceridemia and the chylomicronemia syndrome in patients with a familial form of hypertriglyceridemia. LDL denotes lowdensity lipoprotein, and HDL high-density lipoprotein. 57 Source: Brunzell JD. N Engl J Med 2007;357: Effects of Selected Drugs on Triglyceride and Cholesterol Levels Drug Triglyceride LDL Cholesterol HDL Cholesterol Glucocorticoids Increased No effect Increased Cyclosporines Increased Increased Increased Tacrolimus Increased Increased Increased Thiazide diuretics Increased Increased Decreased Beta-blockers Increased No effect Decreased Sertraline Possible increase Increased No effect Alcohol, estrogens, estradiol, glucocorticoids, thiazide diuretics, beta-blockers, sertraline protease inhibitors, valproate and related drugs, and isotretinoin can cause severe hypertriglyceridemia and the chylomicronemia syndrome in patients with a familial form of hypertriglyceridemia. LDL denotes low-density lipoprotein, and HDL high-density lipoprotein. Source: Brunzell JD. N Engl J Med 2007;357: Effects of Selected Drugs on Triglyceride and Cholesterol Levels Drug Triglyceride LDL Cholesterol HDL Cholesterol Protease Increased No effect No effect inhibitors Valproate and Increased No effect Decreased related drugs Isotretinoin Increased No effect Decreased Alcohol, estrogens, estradiol, glucocorticoids, thiazide diuretics, beta-blockers, sertraline protease inhibitors, valproate and related drugs, and isotretinoin can cause severe hypertriglyceridemia and the chylomicronemia syndrome in patients with a familial form of hypertriglyceridemia. LDL denotes lowdensity lipoprotein, and HDL high-density lipoprotein. Source: Brunzell JD. N Engl J Med 2007;357:
11 Niacin: AIM-HIGH The AIM-HIGH Investigators. The role of niacin in raising high-density lipoprotein cholesterol to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease and optimally treated lowdensity lipoprotein cholesterol rationale and study design. The Atherothrombosis Intervention in Metabolic syndrome with low HDL/high triglycerides: Impact on Global Health outcomes (AIM-HIGH). Am Heart J 2011; 161: PL Detail-Document, Niacin: Who needs it? Pharmacist s Letter/Prescriber s Letter. February The AIM-HIGH study goal To determine if a niacin/statin combination could further reduce the risk of cardiovascular events in patients with cardiovascular disease and wellcontrolled LDL but low HDL and high triglycerides vs a statin alone 62 AIM-HIGH Primary outcome measure Time from randomization to first CHD death, nonfatal MI, ischemic stroke, acute coronary syndrome hospitalization, or symptoms requiring coronary or cerebral revascularization (exclusive of revascularization of restenosis) AIM-HIGH Interim analysis Demonstrated lack of benefit of simva/niacin vs simva alone Small increase in ischemic stroke in the combination group (1.6% vs 0.7%) 1/3 of individuals in stroke group had DC niacin=>2 mo prior to stroke. 9 of the 28 stroke patients in the combination group had stopped taking niacin 2 months to 4 years prior to stroke What to make of AIM-HIGH results? Coronary Drug Project study Pre-statin study where most of niacin s advantage was seen AIM-HIGH Subjects with LDL well-controlled on and HPS2-THRIVE studies had well-controlled What to make of AIM-HIGH results? Statin non-ldl benefits Decreased inflammation Inability to lower CV risk further Beyond known reduction from statins HDL often have to be very low to get a benefit from niacin
12 Future Updates to the Blood Cholesterol Guideline This is a comprehensive guideline for the evidence-based treatment of blood cholesterol to reduce ASCVD risk. Future updates will build on this foundation to provide expert guidance on the management of complex lipid disorders and incorporate refinements in risk stratification based on critical review of emerging data. End of Presentation Thank you for your time and attention. Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC cs@fhea.com 68 References John F. Keaney, Jr., M.D., Gregory D. Curfman, M.D., And John A. Jarcho, M.D. A Pragmatic View Of The New Cholesterol Treatment Guidelines. N Engl J Med 2014; 370: References Stone Nj, Robinson J, Lichtenstein Ah, Bairey Merz Cn, Lioyd-jones Dm, Blum Cb, Mcbride P, eckel Rh, Schwartz Js, Goldberg Ac, Shero St, Gordon D, Smith Sc Jr, Levy D, Watson K, Wilson Pw ACC/AHA Guideline On The Treatment Of Blood Cholesterol To Reduce Atherosclerotic Cardiovascular Risk In Adults: A Report Of The American College Of Cardiology/American Heart Association Task Force On Practice Guidelines. J Am Coll Cardiol Nov 7. Pii: S All websites listed active at the time of publication
13 Fitzgerald Health Education Associates, Inc
Acute Coronary Syndromes (ACS)
Sally A. Arif, Pharm.D., BCPS (AQ Cardiology) Assistant Professor of Pharmacy Practice Midwestern University, Chicago College of Pharmacy Cardiology Clinical Specialist, Rush University Medical Center
More informationPharmacy Drug Class Review
Pharmacy Drug Class Review January 22, 2014 Authored By: Christina Manciocchi, Pharm.D. BCACP Disclaimer: Specific agents may have variations Edited By: Richard J. Kraft, Pharm.D.BCPS NEW CHOLESTEROL GUIDELINES
More information4/24/15. AHA/ACC 2013 Guideline Key Points
Review of the ACC/AHA 2013 Guidelines Anita Ralstin, MS, CNS, CNP Next Step Health Consultant, LLC 1! Discuss the rationale for the change in lipid guidelines and how that affects the decision to implement
More informationIt is the policy of health plans affiliated with PA Health & Wellness that Vytorin is medically necessary when the following criteria are met:
Clinical Policy: Ezetimibe and Simvastatin (Vytorin) Reference Number: PA.CP.PMN.77 Effective Date: 02.01.17 Last Review Date: 07.18 Revision Log Description Ezetimibe/simvastatin (Vytorin ) contains ezetimibe,
More informationConflict of Interest Disclosure. Learning Objectives. Learning Objectives. Guidelines. Update on Lifestyle Guidelines
Conflict of Interest Disclosure Updates for the Ambulatory Care Pharmacist: Dyslipidemia and CV Risk Assessment No conflicts of interest to disclose 2014 Updates to the Updates in Ambulatory Care Pharmacy
More information2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD
2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD How do you interpret my blood test results? What are our targets for these tests? Before the ACC/AHA Lipid Guidelines A1c:
More informationNew 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
More information2.3 CONTACT HOURS. Managing. By Kristine Anne Scordo, PhD, RN, ACNP-BC, FAANP
2.3 CONTACT HOURS 2.3 CONTACT HOURS Managing hyperlipidemia The updated cholesterol treatment guidelines Abstract: The ACC/AHA 2013 cholesterol treatment guidelines focus on lowering the risk of heart
More informationLearning Objectives. Patient Case
Joseph Saseen, Pharm.D., FASHP, FCCP, BCPS Professor and Vice Chair, Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Learning Objectives Identify the 4 patient populations
More informationDyslipidemia 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
More informationConflicts of interest. What's the Skinny on the Lipid Guidelines? Key Differences. Are you applying the new ACC/AHA Lipid guidelines in your practice?
Conflicts of interest What's the Skinny on the Lipid Guidelines? The presenter has no relevant conflicts of interest to disclose. Kathleen Vest, PharmD, CDE, BCACP At the end of this presentation, pharmacist
More informationNew Cholesterol Guidelines What the LDL are we supposed to do now?!
New Cholesterol Guidelines What the LDL are we supposed to do now?! Michael D. Shapiro Assistant Professor of Medicine and Radiology Knight Cardiovascular Institute Oregon Health & Science University 2013
More information2013 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
More informationIntroduction. 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:
More informationNew 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
More information2013 ACC/AHA Cholesterol Guidelines JULIE HAMMOND, D.O. PGY-2 MATTHEW PAOLI, D.O. PGY-2
2013 ACC/AHA Cholesterol Guidelines JULIE HAMMOND, D.O. PGY-2 MATTHEW PAOLI, D.O. PGY-2 GOALS ACC/AHA as publisher of guidelines Determining which patients are appropriate for statin therapy The treatment
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
MANAGEMENT OF HYPERLIPIDEMIA AND CARDIOVASCULAR RISK IN WOMEN: Balancing Benefits and Harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu
More information2013 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
More informationUnderstanding US Lipid Guidelines-2013:
Presentation to NLA Symposium: May 3 2014 Understanding US Lipid Guidelines-2013: Neil J. Stone MD, MACP, FACC Bonow Professor of Medicine Feinberg School of Medicine Northwestern University Chicago, Il
More informationCholesterol Management Roy Gandolfi, MD
Cholesterol Management 2017 Roy Gandolfi, MD Goals Interpreting cholesterol guidelines Cholesterol treatment in diabetics Statin use and side effects therapy Reporting- Comparison data among physicians
More information4/7/ 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
More informationPREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN
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
More informationTHE 2013 ACC/AHA GUIDELINES ON THE TREATMENT OF BLOOD CHOLESTEROL
THE 2013 ACC/AHA GUIDELINES ON THE TREATMENT OF BLOOD CHOLESTEROL Anne Carol Goldberg, MD, FACP, FAHA, FNLA Associate Professor of Medicine Washington University School of Medicine National Lipid Association
More informationUpdate 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
More informationHighlights 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
More informationLipids What s new? Meera Jain, MD Providence Portland Medical Center
Lipids 2016- What s new? Meera Jain, MD Providence Portland Medical Center 1 Can I trust the ASCVD risk calculator? Do harms outweigh benefits in primary prevention? Is there anything besides a statin?
More informationLipid 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
More informationHYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016
HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016 NOTHING TO DISCLOSE I, Nicole Slater, have no actual or potential conflict
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Vytorin) Reference Number: CP.PMN.77 Effective Date: 02.01.17 Last Review Date: 02.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the end of this policy
More informationPlacebo-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
More informationWhat do the guidelines say about combination therapy?
What do the guidelines say about combination therapy? Christie M. Ballantyne, MD Center for Cardiovascular Disease Prevention Methodist DeBakey Heart & Vascular Center Baylor College of Medicine Houston,
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS: WHERE DO WE STAND WITH THE NEW PRACTICE GUIDELINES? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant financial relationships
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
PREVENTING CARDIOVASCULAR DISEASE IN WOMEN: Current Guidelines for Hypertension, Lipids and Aspirin Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationTreating Hyperlipidemias in Adults. Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine, University of Kentucky Lexington KY VAMC
Treating Hyperlipidemias in Adults Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine, University of Kentucky Lexington KY VAMC Disclosures Conflicts: None Talk will address off-label
More information4 th and Goal To Go How Low Should We Go? :
4 th and Goal To Go How Low Should We Go? : Evaluating New Lipid Lowering Therapies Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor Disclosure The presenter has nothing to disclose
More informationReview current guideline recommendations for lipid-lowering therapy
Breakout Session #3 New Paradigms in the Management of Dyslipidemia Review current guideline recommendations for lipid-lowering therapy Dr Meral KAYIKCIOGLU Ege University Medical School, Cardiology Dept,
More informationMajor recommendations for statin therapy for ASCVD prevention
2013 A/AHA Guidelines holesterol Rx to Reduce ASVD Risk in Adults Major recommendations for statin therapy for ASVD prevention *% in LDL can be used as indication of response & adherence to Rx but is not
More informationNEW GUIDELINES FOR CHOLESTEROL
NEW GUIDELINES FOR CHOLESTEROL NEW CHOLESTEROL GUIDELINES 2013 Recently updated guidelines for the treatment of high blood cholesterol levels is a major update since 2002. The news media have trumpeted
More informationDisclosures No relationships (not even to an employer) No off-label uses. Cholesterol Lowering Guidelines: What now?
Disclosures No relationships (not even to an employer) No off-label uses Cholesterol Lowering Guidelines: What now?, FACP 1 2 65-year-old white woman Total cholesterol 175mg/dL HDL 54 mg/dl LDL 96 mg/dl
More informationPlacebo-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
More informationClinical Policy: Lomitapide (Juxtapid) Reference Number: ERX.SPA.170 Effective Date:
Clinical Policy: (Juxtapid) Reference Number: ERX.SPA.170 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationTreatment of Cholesterol in 2018: Time to Level Up. Most Important Slide. Three Things Learned that Will be Applied
Treatment of Cholesterol in 2018: Time to Level Up 1. Most Important Slide Three Things Learned that Will be Applied 2. 3. 2013 Top Ten Points 1. Expert committee. Evidence used. 2. Four groups identified
More informationDisclosures. Choosing a Statin/New Therapies. Case. How else would you do to treat him? LDL-C Reduction with Different Statin Strategies
Disclosures I have no disclosures relevant to this talk Choosing a Statin/New Therapies Aryan Aiyer, MD Assistant Professor of Medicine University of Pittsburgh School of Medicine UPMC Heart and Vascular
More informationAn 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
More informationPlacebo-Controlled Statin Trials Prevention Of CVD in Women"
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
More informationLong-Term Complications of Diabetes Mellitus Macrovascular Complication
Long-Term Complications of Diabetes Mellitus Macrovascular Complication Sung Hee Choi MD, PhD Professor, Seoul National University College of Medicine, SNUBH, Bundang Hospital Diabetes = CVD equivalent
More informationDavid Y. Gaitonde, MD, FACP Endocrinology DDEAMC, Fort Gordon
David Y. Gaitonde, MD, FACP Endocrinology DDEAMC, Fort Gordon I have no actual or potential conflicts of interest in relation to this program or presentation. Raphael School of Athens, 1509-1511 Apply
More informationManagement of Post-transplant hyperlipidemia
Management of Post-transplant hyperlipidemia B. Gisella Carranza Leon, MD Assistant Professor of Medicine Lipid Clinic - Vanderbilt Heart and Vascular Institute Division of Diabetes, Endocrinology and
More informationLipid Management: The Next Level How Will the New ACC/AHA Guidelines Change My Practice
Lipid Management: The Next Level How Will the New ACC/AHA Guidelines Change My Practice Vera Bittner, MD, MSPH Professor of Medicine Section Head, Preventive Cardiology Medical Director, Cardiac Rehabilitation
More informationHow to Handle Statin Intolerance in the High Risk Patient
How to Handle Statin Intolerance in the High Risk Patient Thomas D. Conley, MD FACC FSCAI Disclosures: None 1 Definition of High Risk Primary Prevention ASCVD Risk Calculator Adults >21 yrs, LDL 190 mg/dl
More informationObjec ves To discuss the process of formulation of guidelines and how this may differ among professional societies 5/14/15
Kellie McLain, NP- C, CLS Medical University of South Carolina Cardiology Division Seinsheimer Cardiovascular Prevention and Lipid Program May 29 th, 2015 Objecves To discuss the process of formulation
More informationAssessment and Primary Prevention of CAD. Tuan D. Nguyen, M.D. Non-Invasive Cardiology Seton Heart Institute
Assessment and Primary Prevention of CAD Tuan D. Nguyen, M.D. Non-Invasive Cardiology Seton Heart Institute Objectives Identify risk factors for CV disease Identify populations that likely benefit from
More informationPharmacology Challenges: Managing Statin Myalgia
Clinical Case: RM is a 50 year-old African American woman with a past medical history of type diabetes, dyslipidemia, hypertension and peripheral arterial disease. She had been prescribed simvastatin 80
More informationCase Studies The Role of Non-Statin Therapies for LDL-C Lowering in the Management of ASCVD Risk
Case Studies The Role of Non-Statin Therapies for LDL-C Lowering in the Management of ASCVD Risk Kim K. Birtcher, PharmD, MS, AACC Clinical Professor University of Houston College of Pharmacy Houston,
More informationDisclosures. Overview 9/30/ ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults 2014 AAHP Fall Seminar Sherry Myatt, PharmD, BCPS Assistant Director of Pharmacy for
More informationFORTH VALLEY. LIPID LOWERING GUIDELINE v5 2016
FORTH VALLEY LIPID LOWERING GUIDELINE v5 2016 This guideline applies to people over 16 years of age. This guideline is not intended to serve as a standard of medical care or be applicable in every situation.
More informationLipid Management 2013 Statin Benefit Groups
Clinical Integration Steering Committee Clinical Integration Chronic Disease Management Work Group Lipid Management 2013 Statin Benefit Groups Approved by Board Chair Signature Name (Please Print) Date
More information9/18/2017 DISCLOSURES. Consultant: RubiconMD. Research: Amgen, NHLBI OUTLINE OBJECTIVES. Review current CV risk assessment tools.
UW MEDICINE UW MEDICINE UCSF ASIAN TITLE HEALTH OR EVENT SYMPOSIUM 2017 DISCLOSURES Consultant: RubiconMD ESTIMATING CV RISK IN ASIAN AMERICANS AND PREVENTION OF CVD Research: Amgen, NHLBI EUGENE YANG,
More informationCardiovascular Risk and Dyslipidemia Management Clinician Guide SEPTEMBER 2017
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Cardiovascular Risk and Dyslipidemia Management Clinician Guide SEPTEMBER 2017 Introduction This Clinician Guide is based on the 2017 KP National
More informationManagement of Lipid Disorders and Hypertension: Implications of the New Guidelines
Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine
More informationHow 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
More informationLipids & Hypertension Update
Lipids & Hypertension Update No financial disclosures Michael W. Cullen, MD, FACC Senior Associate Consultant, Assistant Professor of Medicine Mayo Clinic Department of Cardiovascular Diseases 34 th Annual
More informationJoshua Shepherd PA-C, MMS, MT (ASCP)
Joshua Shepherd PA-C, MMS, MT (ASCP) None What is Cholesterol? Why cholesterol is it important? Review the National Cholesterol Education Programs guidelines (NCEP-ATPIII) Discuss New guidelines from the
More informationDiabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018
Diabetes: Use of Adjunctive Therapy ACEs, ARBs, ASA & STATINs --Oh My! Veronica J. Brady, PhD, FNP-BC, BC-ADM, CDE Project ECHO April 19, 2018 Points to Ponder ASCVD is the leading cause of morbidity
More information2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation,
More informationATP 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
More informationSpeaker Disclosure. Pharmacist Objectives. Path to New Hypertension (HTN) Guidelines. Overview of New HTN Guidelines 8/21/2014
Speaker Disclosure Erica Pearce, Pharm.D. declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants,
More informationVincent J. Caracciolo, MD FACC FOMA May 2014
Vincent J. Caracciolo, MD FACC FOMA May 2014 Goals of the Guidelines National Heart, lung and Blood Institute ( NHLBI) collaborated with ACC/AHA to develop guidelines a.) assess CV risk, b.) lifestyle
More informationApproach to Dyslipidemia among diabetic patients
Approach to Dyslipidemia among diabetic patients Farzad Hadaegh, MD, Professor of Internal Medicine & Endocrinology Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences
More informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More informationPREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN
1980 to 2000: Death rate fell from: 542.9 to 266.8 per 100K men 263.3 to 134.4 per 100K women 341,745 fewer deaths from CHD in 2000 Ford ES, NEJM, 2007 47% from CHD treatments, 44% from risk factor modification
More informationCLINICAL 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
More informationClinical Policy: Alirocumab (Praluent) Reference Number: CP.CPA.268 Effective Date: Last Review Date: 11.17
Clinical Policy: (Praluent) Reference Number: CP.CPA.268 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for
More informationDyslipidemia and Combination Therapy: A Framework for Clinical Decision Making
Dyslipidemia and Combination Therapy: A Framework for Clinical Decision Making Shashank Sinha, MD Pamela B. Morris, MD, FACC 8 October 2016 Mexico City Introduction: Pamela B. Morris, MD, FACC COMING TO
More informationPrevention of Heart Disease: The New Guidelines
Prevention of Heart Disease: The New Guidelines Nisha I. Parikh MD MPH Assistant Professor of Medicine Division of Cardiology Department of Medicine University of California San Francisco May 18 th 2015
More information2/10/2016. Patient-Centered Management of Dyslipidemia. No disclosures. What is Patient-Centered Management?
Patient-Centered Management of Dyslipidemia Carl E. Orringer, MD, FACC, FNLA Associate Professor of Medicine University of Miami Miller School of Medicine President, National Lipid Association 1 No disclosures
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Statin Therapy Page 1 of 10 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Statin Therapy Prime Therapeutics will review Prior Authorization requests. Prior Authorization
More informationNew Measure Recommended for Endorsement by PQA
New Measure Recommended for Endorsement by PQA Measure: Statin Use in Persons with Diabetes Description: The percentage of patients ages 40 75 years who were dispensed a medication for diabetes that receive
More informationCPE Session 7. Update on Clinical Practice Guidelines and Best Evidence in the Management of Hyperlipidemia and Cardiovascular Risk Reduction
CPE Session 7 Update on Clinical Practice Guidelines and Best Evidence in the Management of Hyperlipidemia and Cardiovascular Risk Reduction Saturday, April 25, 2015 ACPE UAN 0128-0000-15-027-L01-P 1.0
More informationDisclosures. Prevention of Heart Disease: The New Guidelines. Summary of Talk. Four guidelines. No relevant disclosures.
Disclosures Prevention of Heart Disease: The New Guidelines No relevant disclosures Nisha I. Parikh MD MPH Assistant Professor of Medicine Division of Cardiology Department of Medicine University of California
More informationADULT CARDIOVASCULAR CLINICAL PRACTICE GUIDELINES
ADULT CARDIOVASCULAR CLINICAL PRACTICE GUIDELINES Risk Intervention Lifestyle Interventions Hypertension Cholesterol Management Recommendations 1. Smoking cessation 2. Maintain ideal weight or weight reduction
More informationRISK FACTORS AND DRUG TO STATIN-INDUCED MYOPATHY
RISK FACTORS AND DRUG INTERACTION PREDISPOSING TO STATIN-INDUCED MYOPATHY Assist. Prof. Dr. Verawan Uchaipichat Clinical Pharmacy Department Khon Kaen University Advanced Pharmacotherapy 2012 Updated d
More informationLipid Management C. Samuel Ledford, MD Interventional Cardiology Chattanooga Heart Institute
Lipid Management 2018 C. Samuel Ledford, MD Interventional Cardiology Chattanooga Heart Institute Disclosures No Financial Disclosures Disclosures I am an Interventional Cardiologist I put STENTS in for
More informationAPPENDIX 2F Management of Cholesterol
Patients with established CVD: Coronary heart disease Cerebrovascular disease Peripheral vascular disease APPEDIX 2F Management of Cholesterol Patients at high risk of cardiovascular events: Chronic kidney
More informationPraluent. Praluent (alirocumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.06 Subject: Praluent Page: 1 of 10 Last Review Date: September 20, 2018 Praluent Description Praluent
More informationDrug Class Monograph
Drug Class Monograph Class: Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitor Drugs: Praluent (alirocumab), Repatha (evolocumab) Line of Business: Medi-Cal Effective Date: February 17, 2016
More informationTreating dyslipidemia
Treating dyslipidemia in patients with type 2 diabetes mellitus 18 The Nurse Practitioner Vol. 40, No. 18 www.tnpj.com 2.0 CONTACT HOURS 1.0 CONTACT HOURS Abstract: Type 2 diabetes mellitus is associated
More informationQuality ID #438: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease National Quality Strategy Domain: Effective Clinical Care
Quality ID #438: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS F INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE
More informationPCSK9 Agents Drug Class Prior Authorization Protocol
PCSK9 Agents Drug Class Prior Authorization Protocol Line of Business: Medicaid P & T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review of medical
More informationToday s Recommendations
Today s Recommendations 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk (45 pages) 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults (14 pages)
More informationUpdate on Cholesterol Management: The 2013 ACC/AHA Guidelines
Update on Cholesterol Management: The 2013 ACC/AHA Guidelines Ola Akinboboye MD MPH MBA Medical Director, Queens Heart institute Rosedale. Associate Professor of Clinical Medicine, Weill Medical College
More informationConfusion about guidelines: How should we treat lipids?
Confusion about guidelines: How should we treat lipids? Anne Carol Goldberg, MD, FACP, FAHA, FNLA Professor of Medicine Washington University School of Medicine American College of Physicians Missouri
More informationStatin Intolerance. Jason Evanchan DO, FACC April 20 th, 2018
Statin Intolerance 2 nd Annual CV Course for Trainees and Early Career Physicians: Current Concepts in the Diagnosis and Management of Coronary Artery Disease Jason Evanchan DO, FACC April 20 th, 2018
More informationReview 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
More informationPharmacy Management Drug Policy
SUBJECT: ; Praluent (alirocumab), Repatha (evolocumab) POLICY NUMBER: Pharmacy-61 EFFECTIVE DATE: 8/15 LAST REVIEW DATE: 9/22/2017 If the member s subscriber contract excludes coverage for a specific service
More informationHyperlipidemia: Past and Present. Rebecca Khaimova, PharmD The Brooklyn Hospital Center
Hyperlipidemia: Past and Present Rebecca Khaimova, PharmD The Brooklyn Hospital Center Rkhaimova@tbh.org Conflicts of Interest None to disclose Learning Objectives for Pharmacist Describe the pathophysiology
More informationRepatha. Repatha (evolocumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.08 Subject: Repatha Page: 1 of 9 Last Review Date: September 15, 2017 Repatha Description Repatha
More informationRepatha. Repatha (evolocumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.08 Subject: Repatha Page: 1 of 9 Last Review Date: November 30, 2018 Repatha Description Repatha (evolocumab)
More informationThe 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
More information