Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer
|
|
- Chrystal Walker
- 5 years ago
- Views:
Transcription
1 Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer
2 Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32, waist circumference 110 cm HTN: well controlled with ACE-I and β-blocker IFG (fasting glucose 108 mg/dl, HbA1c 6.3%) Dyslipidemia treated with simvastatin 20 mg
3 Case Presentation Lipid profile TC 188 mg/dl LDL 90 mg/dl HDL 34 mg/dl TG 320 mg/dl CK, GOT, GPT normal. No myalgia.
4 Case Presentation Treatment options (+TLC) Atorvastatin 80 mg instead of simva Add fibrate o` l e dyrz dn?jlz Add niacin ER Add Omega 3
5 Risk of death in patients with CHD is greatest early after an ACS Deaths/100 patients/month Acute MI Unstable angina Stable angina Time (months after hospital admission) Braunwald (1996)
6 MIRACL: Primary efficacy measure Cumulative incidence (%) 15 Placebo Atorvastatin 17.4% 14.8% Time to first occurrence of composite endpoint of: Death (any cause) Non-fatal MI Resuscitated cardiac arrest Worsening angina with new objective evidence and urgent rehospitalisation RRR = 16% p= % CI = NNT = Time since randomisation (weeks) JAMA. 2001;285:1711
7 PROVE IT-TIMI TIMI 22: Early benefit with intensive lipid lowering N = 4162 with ACS 16% RRR at 2 years 30 (p = 0.005) Death or major CV event (%) mg Pravastatin P = 0.03 at 4 mos 80 mg Atorvastatin NNT = Follow-up (months) Ray KK and Cannon CP Am J Cardiol. 2005;96(suppl):54F-60F. Adapted from Cannon CP et al. N Engl J Med. 2004;350:
8 A to Z: Primary Endpoint Composite CV Death, MI, ACS or Stroke KM Rate (%) HR 0.89 CI primary events p = 0.14 P/S20 Rate = 16.7% S40/80 Rate = 14.4% Month from Randomization JAMA. 2004;292:1307
9 CRP - EFFECT ONLY IN ACS? LDL-C, CRP, and Early Clinical Benefit in A to Z, MIRACL, and PROVE IT TIMI TIMI 22 A-to-Z MIRACL PROVE IT Number of patients randomized Early* LDL achieved on treatment, mg/dl Early* LDL cholesterol differential, mg/dl CRP differential, % 0/ Early event reduction, % 0* 16* 18 * Measured 120 days after randomization. Measured 90 days after randomization. Adapted from Nissen. JAMA. 2004;292:1365, with permission.
10 High-Dose Statin Treatment Rreduces Ox-LDL Markers MIRACL study subgroup analysis, N = 2341 with ACS, atorvastatin 80 mg for 16 weeks ApoB-100 Atorvastatin Placebo Total apob-oxpl Atorvastatin Placebo Total apob-ic IgG Atorvastatin Placebo Total apob-ic IgM Atorvastatin Placebo Mean 95% CI , , , , , , , , 17.3 OxPL = oxidized phospholipids IC-IgG, -IgM = immune complexes with IgG and IgM, respectively Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering % change Tsimikas S et al. Circulation. 2004;110:
11 Case Presentation Treatment options Atorvastatin 80 mg instead of simva Add fibrate Add niacin ER Omega 3
12 TG Level Is Significant CVD Risk Factor: Meta-Analysis of 29 Studies Groups CHD Cases Duration of follow-up 10 years 5902 <10 years 4256 Sex Male 7728 Female 1994 Fasting status Fasting 7484 Nonfasting 2674 Adjusted for HDL Yes 4469 No 5689 *Individuals in top vs. bottom third of usual log-tg values; adjusted for at least age, sex, smoking status, and lipid concentrations; also adjusted for BP (in most studies). 1 N = 262, ( ) 2 CHD Risk Ratio* (95% CI) Circulation. 2007;115:
13 TG Level Remains CVD Risk Factor in Patients On Statins: TNT Adjusted HRs of death, MI, and recurrent ACS between 30 days and 2 years of follow-up* TG<150 mg/dl TG>150 mg/dl LDL<70 mg/dl LDL>70 mg/dl *Adjusted for age, gender, low HDL-C, smoking, HTN, obesity, DM, prior statin therapy, prior ACS, PVD, treatment effect JACC 2008;51:724 30
14 Diet for Metabolic Dyslipidemia NEJM 2008;359:229-41
15 Outcomes in Fibrate Trials: Diabetes / Metabolic Syndrome Trial N Control Drug Primary Prevention Rel. RR HHS* % 3.9% 71%.005 Secondary Prevention Major CVD Event Rate BIP % 14.1% 25%.03 VA-HIT % 21.2% 32%.004 Rel. RR indicates relative risk reduction *Patients with triglycerides >204 mg/dl and an LDL/HDL >5 Patients with the metabolic syndrome; baseline HDL-C, 33 mg/dl; triglycerides, 170 mg/dl Patients with diabetes; baseline HDL-C, 31 mg/dl; triglycerides, 164 mg/dl * Circulation. 1992;85: Arch Intern Med. 2005;165: Arch Intern Med. 2002;162: P
16 Fibrate Trials: Diabetic or Metabolic Syndrome Subanalyses % HHS* -71 BIP** -25 RRR in MACE VA- HIT*** -32 *Patients with triglycerides >204 mg/dl and an LDL/HDL >5 * * Patients with the metabolic syndrome; baseline HDL-C, 33 mg/dl; triglycerides, 170 mg/dl * * * Patients with diabetes; baseline HDL-C, 31 mg/dl; triglycerides, 164 mg/dl
17 FIELD: Primary End Point Nonfatal MI, or CHD Death 8 11% Reduction P=.16 Event Rate, % % Placebo 5% Fenofibrate Lancet. 2005;366:
18 ACCORD: Fibrates: What s s in Store? Fenofibrate+statin vs. statin in 9750 patients with DM2 Due 2011
19 Case Presentation Treatment options Atorvastatin 80 mg instead of simva Add fibrate Add niacin ER Omega 3
20 Change from Baseline (%) Lipid Effects of Niacin Extended- Release Most potent agent for HDL: 20%+; nonlinear Favorable effects on LDL-particle density LDL (linear), TG, and Lp(a) mg HDL-C LDL-C Lp(a) TG Am J Cardiol 1998;82:74U-81U.
21 Coronary Drug Project Long-Term Mortality Benefit of Niacin in Post-MI Patients Survival (%) years: 4% absolute reduction in mortality NNT = 25 Placebo Niacin P = Years of follow-up J Am Coll Cardiol 1986;8:
22 NIACIN: Clinical Events ARBITER 2 HATS Patients with Event (%) Statin + Placebo RR = 0.4 P = Statin + Niacin ER % Free of Event Simvastatin Niacin All placebos RR = 0.10 P =.03 97% % YEARS Composite End Point (MI, UAP, CVA, Sudden Death, Coronary or peripheral revascularization) Circulation 2004;110: Composite End Point (Death from Coronary Causes, Nonfatal MI, Stroke, or Revascularization for Worsening Ischemia) NEJM 2001;345:
23 ARBITER-HALTS 6 Study 363 CHD/equivalent patients with low HDL-C (<50 mg/dl men, <55 mg/dl women) All on statin with LDL-C<100 mg/dl Primary end point: change in cimt after 14 months The trial was terminated early, on the basis of efficacy N Engl J Med 2009;361.
24 ARBITER-HALTS 6 study Lipids with niacin (mg/dl) LDL-C HDL-C N Engl J Med 2009;361.
25 ARBITER-HALTS 6 Study N Engl J Med 2009;361.
26 Oxford Niaspan Study 71 statin-treated patients with HDL-C<40 mg/dl and DM2 + CHD or carotid/peripheral atherosclerosis. 2 g daily modified-release NA vs. placebo Primary end point: change in carotid artery wall area quantified by MRI, after 1 year. J Am Coll Cardiol 2009;54:
27 Oxford Niaspan Study Lipids in niacin group LDL-C mg/dl (-19%) HDL-C mg/dl (+23%) J Am Coll Cardiol 2009;54:
28 Oxford Niaspan Study Inverse relationship between the HDL-C and wall area, and no relationship between the LDL-C and wall area. Increases in HDL-C may be beneficial Flow-mediated dilation of the brachial artery showed a favorable trend with niacin. Aortic distensibility and glyceryl-trinitrate-mediated brachial reactivity did not change significantly with niacin. J Am Coll Cardiol 2009;54:
29 NIA Plaque study 145 patients with clinically evident atherosclerosis, treated with a statin to ATP III LDL-C targets. Randomized to 1500 mg extended-release niacin or placebo. Both arms improved No significant difference between the two treatment arms in MRI outcomes, including carotid arterial wall volume and measurements of the lipid core. Sibley et al. AHA 2009
30 NIA Plaque: Change in lipid parameters Lipid measure (mg/dl) Statin + placebo, baseline Statin + placebo, 18 mo Statin+ER niacin, baseline Statin+ER niacin, 18 mo p (between groups) LDL-C HDL-C <0.001 TG Sibley et al. AHA 2009
31 Niacin: What s in Store? HPS2-THRIVE: Niacin and a blocker of PG D2 on top of statin therapy in 20,000 patients AIM-HIGH: Simvastatin+Niaspan vs. Simvastatin in 3300 patients with CVD, low HDL and high TG Due 2012
32 Case Presentation Treatment options Atorvastatin 80 mg instead of simva Add fibrate Add niacin ER Omega 3
33 Omega-3 3 and Lipids in Patients with TG >500 mg/dl Baseline (mg/dl) 60% 40% 20% 0% -20% TG 816 P< HDL-C 22 P= Non- HDL-C 27 P= Chol 296 P= VLDL-C 175 P< LDL-C 89 P< % -60% Placebo Omega-3 Acid Ethyl Esters (4 g/day) Pooled analysis: Harris WS et al. J Cardiovasc Risk 1997;4: Pownall HJ et al. Atherosclerosis 1999;143:
34 Omega-3 3 and Lipids in Patients with TG >500 mg/dl Baseline (mg/dl) 60% 40% 20% 0% -20% TG 816 P< HDL-C 22 P= Non- HDL-C 27 P= Chol 296 P= VLDL-C 175 P< LDL-C 89 P< % -60% Placebo Omega-3 Acid Ethyl Esters (4 g/day) Pooled analysis: Harris WS et al. J Cardiovasc Risk 1997;4: Pownall HJ et al. Atherosclerosis 1999;143:
35 Dietary Supplementation With Omega-3 3 Fatty Acids After MI GISSI-Prevenzione Event Rate (%) % Reduction P = % Reduction P =.008 Placebo (n = 2828) Omega-3 fatty acids 1 g (n = 2836) 0 Death/ Nonfatal MI/ Nonfatal Stroke CVD Death/ Nonfatal MI/ Nonfatal Stroke Lancet. 1999;354:
36 GISSI-Prevenzione: Effects of EPA+DHA on Serum Lipids No Difference 5% Difference mg/dl HDL Cholesterol n-3 Control Months mg/dl Triglycerides n-3 Control Months Circulation 2002;105:
37 Case Presentation Treatment options Atorvastatin 80 mg instead of simva Add fibrate Add niacin ER Omega 3
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
More informationJanet B. Long, MSN, ACNP, CLS, FAHA, FNLA Rhode Island Cardiology Center
Primary and Secondary Prevention of Coronary Artery Disease: What is the role of non statin drugs (fenofibrates, fish oil, niacin, folate and vitamins)? Janet B. Long, MSN, ACNP, CLS, FAHA, FNLA Rhode
More informationLDL 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
More informationHyperlipidemia: Lowering the Bar on the Lipid Limbo. Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH
Mark slides Hyperlipidemia: Lowering the Bar on the Lipid Limbo Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH Hyperlipidemia is a common problem Nearly 50% of men in the
More informationUpdate on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient
Update on Dyslipidemia and Recent Data on Treating the Statin Intolerant Patient Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical
More informationUpdate On Diabetic Dyslipidemia: Who Should Be Treated With A Fibrate After ACCORD-LIPID?
Update On Diabetic Dyslipidemia: Who Should Be Treated With A Fibrate After ACCORD-LIPID? Karen Aspry, MD, MS, ABCL, FACC Assistant Clinical Professor of Medicine Warren Alpert Medical School of Brown
More informationCVD Risk Assessment. Lipid Management in Women: Lessons Learned. Conflict of Interest Disclosure
Lipid Management in Women: Lessons Learned Conflict of Interest Disclosure Emma A. Meagher, MD has no conflicts to disclose Emma A. Meagher, MD Associate Professor, Medicine and Pharmacology University
More informationCardiovascular 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
More informationAdvances in Lipid Management
Advances in Lipid Management Kavita Sharma, MD Assistant Professor of Medicine, Division of Cardiology Clinical Director of the Lipid Management Clinics, The Ohio State University Wexner Medical Center
More informationThe 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
More informationDecline in CV-Mortality
Lipids id 2013 What s Changed? Christopher Granger, MD Disclosure Research contracts: AstraZeneca, GSK, Merck, Sanofi- Aventis, BMS, Pfizer, The Medicines Company, Medtronic Foundation, and Boehringer
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 informationLandmark 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
More informationIn-Ho Chae. Seoul National University College of Medicine
The Earlier, The Better: Quantum Progress in ACS In-Ho Chae Seoul National University College of Medicine Quantum Leap in Statin Landmark Trials in ACS patients Randomized Controlled Studies of Lipid-Lowering
More informationLessons 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
More informationIs Lower Better for LDL or is there a Sweet Spot
Is Lower Better for LDL or is there a Sweet Spot ALAN S BROWN MD, FACC FNLA FAHA FASPC DIRECTOR, DIVISION OF CARDIOLOGY ADVOCATE LUTHERAN GENERAL HOSPITAL, PARK RIDGE, ILLINOIS DIRECTOR OF CARDIOLOGY,
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 informationThere are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk?
There are many ways to lower triglycerides in humans: Which are the most relevant for pancreatitis and for CV risk? Michael Davidson M.D. FACC, Diplomate of the American Board of Lipidology Professor,
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 informationMacrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?
Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists
More informationCholesterol Treatment Update
Cholesterol Treatment Update Patrick E. McBride, M.D., M.P.H. Professor of Medicine, Cardiovascular Medicine Associate Director, Preventive Cardiology Program UW School of Medicine and Public Health Disclosure:
More informationHow 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
More informationJUPITER 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
More informationWhat have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline?
What have We Learned in Dyslipidemia Management Since the Publication of the 2013 ACC/AHA Guideline? Salim S. Virani, MD, PhD, FACC, FAHA Associate Professor, Section of Cardiovascular Research Baylor
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 information2016 ESC/EAS Guideline in Dyslipidemias: Impact on Treatment& Clinical Practice
2016 ESC/EAS Guideline in Dyslipidemias: Impact on Treatment& Clinical Practice Nattawut Wongpraparut, MD, FACP, FACC, FSCAI Associate Professor of Medicine, Division of Cardiology, Department of Medicine
More informationHyperlipidemia and Cardiovascular Disease. Kathmandu November 2010 Harold E. Lebovitz, MD, FACE
Hyperlipidemia and Cardiovascular Disease Kathmandu November 21 Harold E. Lebovitz, MD, FACE Diabetes and Lifetime Risk for CHD Adjusted cummula ative incidence.7.6.5 Men 67% 3%.7.6.5 Women Diabetes No
More informationAmerican Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida
The 21 st Century Paradigm Shift: Prevention Rather Than Intervention for the Treatment of Stable CHD The Economic Burden of Cardiovascular Diseases Basil Margolis MD, FACC, FRCP Director, Preventive Cardiology
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 informationThe updated guidelines from the National
BEYOND NCEP ATP III: LESSONS LEARNED AND FUTURE DIRECTIONS * Benjamin J. Ansell, MD, FACP ABSTRACT The National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP III) guidelines provide
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 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 informationCVD risk assessment using risk scores in primary and secondary prevention
CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities
More informationLipid Management: A Case-Based Approach. Overview. Simple Lipid Therapy Approach. Patients have lipid disorders of:
Lipid Management: A Case-Based Approach Patrick E. McBride, M.D., M.P.H. Professor of Medicine, Cardiovascular Medicine Associate Director, Preventive Cardiology Program UW School of Medicine and Public
More informationDyslipidemia: Lots of Good Evidence, Less Good Interpretation.
Dyslipidemia: Lots of Good Evidence, Less Good Interpretation. G Michael Allan Evidence & CPD Program, ACFP Associate Professor, Dept of Family, U of A. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure
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 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 informationNon-Statin Lipid-Lowering Agents M Holler - Last updated: 10/2016
Drug/Class Cholestyramine (Questran) Bile acid sequestrant Generic? Lipid Effects Y/N (monotherapy) Y LDL : 9% (4 g to 8 ; 21% (16 g to 20 ; 23% to 28% (>20 HDL : 4% to 8% (16 to 24 TG : 11% to 28% (4
More information10/15/2012. Lessons Learned from Tim Russert: Investigating Residual Risk. Tim Russert: Residual CV Risk?
Lessons Learned from Tim Russert: Investigating Residual Risk Peter H. Jones, MD, FACP Associate Professor Methodist DeBakey Heart and Vascular Center Baylor College of Medicine Houston, Texas Tim Russert:
More informationRikshospitalet, University of Oslo
Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular
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 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 informationJohn 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
More informationRecent Advances & Emerging Data in the Treatment of Hypertriglyceridemia. Michael Miller, MD, FACC, FAHA, FNLA
Recent Advances & Emerging Data in the Treatment of Hypertriglyceridemia Michael Miller, MD, FACC, FAHA, FNLA Professor of Medicine, Epidemiology & Public Health University of Maryland School of Medicine
More informationCopyright 2017 by Sea Courses Inc.
Diabetes and Lipids Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic, electronic, or
More informationCardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes
Cardiovascular Risk Reduction and Other Co-morbidities in Type 2 Diabetes Following this presentation, you will be able to: Describe the relationship between major CV risk factors and CVD outcomes Select
More informationStatins for Cardiovascular Disease Prevention in Women: Review of the Evidence
Statins for Cardiovascular Disease Prevention in Women: Review of the Evidence Karen E. Aspry, M.D., M.S., ABCL, FACC Assistant Professor of Medicine (Clinical) Alpert Medical School of Brown University
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 informationEnvironmental. Vascular / Tissue. Metabolics
Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood
More informationIschemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010
Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories
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 informationMarshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona,
Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Jamaica At the end of this presentation the participant
More informationWelcome! Mark May 14, Sat!
Welcome! Mark May 14, Sat! Do We Have All Answers with Statins In Treating Patients with Hyperlipidemia? Kwang Kon Koh, MD, PhD, FACC, FAHA Cardiology, Gil Heart Center, Gachon Medical School, Incheon,
More informationAndrew 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
More informationJoslin Diabetes Center Advances in Diabetes and Thyroid Disease 2013 Consensus and Controversy in Diabetic Dyslipidemia
Consensus and Controversy in Diabetes and Dyslipidemia Om P. Ganda MD Director, Lipid Clinic Joslin diabetes Center Boston, MA, USA CVD Outcomes in DM vs non- DM 102 Prospective studies; 698, 782 people,
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 informationDyslipidaemia. 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
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 informationPCSK9 Inhibitors and Modulators
PCSK9 Inhibitors and Modulators Pam R. Taub MD, FACC Director of Step Family Cardiac Rehabilitation and Wellness Center Associate Professor of Medicine UC San Diego Health System Disclosures Speaker s
More informationPlacebo-Controlled Statin Trials
PREVENTION OF CHD WITH LIPID MANAGEMENT AND ASPIRIN: MATCHING TREATMENT TO RISK Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of
More informationJAMA. 2011;305(24): Nora A. Kalagi, MSc
JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for
More informationNew ACC/AHA Guidelines on Lipids: Are PCSK9 Inhibitors Poised for a Breakthrough?
New ACC/AHA Guidelines on Lipids: Are PCSK9 Inhibitors Poised for a Breakthrough? Sidney C. Smith, Jr. MD, FACC, FAHA Professor of Medicine/Cardiology University of North Carolina at Chapel Hill Immediate
More informationTreating Lipids for Prevention of CAD in Women: Matching Therapy to Risk
TREATING LIPIDS FOR PREVENTION OF CAD IN WOMEN: MATCHING THERAPY TO RISK Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest
More information2/10/2016. Is it Time to Return to Cholesterol Goals for Optimal Patient Management? CON. Disclosures. Stipulations
Is it Time to Return to Cholesterol Goals for Optimal Patient Management? CON Donald M. Lloyd-Jones MD ScMFACC FAHA Eileen M. FoellProfessor Chair, Dept. of Preventive Medicine Senior Associate Dean Director,
More informationThe Metabolic Syndrome
The Metabolic Syndrome Advances in Internal Medicine David D. Waters, MD May 21, 27 UCSF Metabolic Syndrome: Definition abdominal obesity increased waist circumference atherogenic dyslipidemia low HDL-C,
More informationPreventing Cardiovascular Disease With Lipid Management: Matching Therapy to Risk
PREVENTING CARDIOVASCULAR DISEASE WITH LIPID MANAGEMENT : MATCHING TREATMENT TO RISK Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict
More informationKavita Sharma, MD Diplomate, American Board of Clinical Lipidology
Lipid Management Kavita Sharma, MD Diplomate, American Board of Clinical Lipidology Clinical Director, Lipid Clinics Assistant Professor Division of Cardiovascular Medicine The Ohio State University Wexner
More informationComprehensive Treatment for Dyslipidemias. Eric L. Pacini, MD Oregon Cardiology 2012 Cardiovascular Symposium
Comprehensive Treatment for Dyslipidemias Eric L. Pacini, MD Oregon Cardiology 2012 Cardiovascular Symposium Primary Prevention 41 y/o healthy male No Medications Normal BP, Glucose and BMI Social History:
More informationNovel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane
Novel HDL Targeted Therapies: The Search Continues Assoc. Prof. K.Kostner,, Univ. of Qld, Brisbane Kostner, 2007 2008 LDL Target depends on your level of Risk Acute Plaque Rupture ACS (UA/NSTEMI/STEMI)
More informationThe Cardiovascular Institute Mount Sinai School of Medicine, New York
The Cardiovascular Institute Mount Sinai School of Medicine, New York HDL YES HDL NO Juan Jose Badimon, Ph.D Professor of Medicine Director, Atherothrombosis Research Unit The Mount Sinai School of Medicine
More informationManagement of LDL as a Risk Factor. Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil
Management of LDL as a Risk Factor Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Consulting for: Merck, Astra Zeneca, ISIS- Genzyme, Novo-Nordisk, BMS, Pfizer,
More informationDyslipidemia 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
More informationFasting or non fasting?
Vascular harmony Robert Chilton Professor of Medicine University of Texas Health Science Center Director of Cardiac Catheterization labs Director of clinical proteomics Which is best to measure Lower continues
More informationControversies in Preventative Cardiology
Controversies in Preventative Cardiology Francisco Lopez-Jimenez, M.D., M.Sc, FACC, FAHA Professor of Medicine, Mayo Medical School Chair, Division of Preventive Cardiology Co-Director, Artificial Intelligence
More informationShould we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice
Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice Pathogenesis of atherosclerosis A decades-long disease course Inflammation Selectins ICAM IL M-CSF CRP
More informationProspective Natural-History Study of Coronary Atherosclerosis
Introduction Review of literature from April 2010 to present Concentrated on clinical studies Categories: Atherosclerosis, Lipids, Diabetes and CVD Risk Medical Therapy Statins really could there be anything
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 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 informationLipid Therapy: Statins and Beyond. Ivan Anderson, MD RIHVH Cardiology
Lipid Therapy: Statins and Beyond Ivan Anderson, MD RIHVH Cardiology Outline The cholesterol hypothesis and lipid metabolism The Guidelines 4 Groups that Benefit from Lipid therapy Initiation and monitoring
More informationESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future
ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future Rory Collins BHF Professor of Medicine & Epidemiology Clinical Trial Service Unit & Epidemiological Studies
More informationLipid Management: Beyond LDL
Lipid Management: Beyond LDL Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine University of Kentucky Overview Discuss the concept of residual risk Review current evidence-based medicine
More informationNovel PCSK9 Outcomes. in Perspective: Lessons from FOURIER & ODYSSEY LDL-C. ASCVD Risk. Suboptimal Statin Therapy
LDL-C Novel PCSK9 Outcomes Suboptimal Statin Therapy ASCVD Risk in Perspective: Lessons from FOURIER & ODYSSEY Jennifer G. Robinson, MD, MPH Professor, Departments of Epidemiology & Medicine Director,
More informationDyslipidemia and the Use of Statins. Troy L Randle, DO, FACC, FACOI
Dyslipidemia and the Use of Statins Troy L Randle, DO, FACC, FACOI Objective: Identify CV risk. Determine what dyslipidemia (dyslipoproteinemia) is Decrease CV risk and optimize lipid levels for your
More informationLow-density lipoprotein as the key factor in atherogenesis too high, too long, or both
Low-density lipoprotein as the key factor in atherogenesis too high, too long, or both Lluís Masana Vascular Medicine and Metabolism Unit. Sant Joan University Hospital. IISPV. CIBERDEM Rovira i Virgili
More informationData 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
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 informationLAMIS (Livalo in AMI Study)
JCR 2018. 12. 8 LAMIS (Livalo in AMI Study) Young Joon Hong Division of Cardiology, Chonnam National University Hospital Gwangju, Korea Trend of hypercholesterolemia in Korea < Prevalence of hypercholesterolemia
More informationDiabetes Mellitus: Implications of New Clinical Trials and New Medications
Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October
More informationBeyond Framingham: Risk Assessment & Treatment for Primary Prevention
Beyond Framingham: Risk Assessment & Treatment for Primary Prevention Ronald M. Goldenberg, MD, FRCPC, FACE Consultant Endocrinologist, North York General Hospital Medical Co-Director, LMC Endocrinology
More informationEugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG
Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System
More information9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t?
Primary Prevention of Heart Disease: What works? What doesn t? Samia Mora, MD, MHS Associate Professor, Harvard Medical School Associate Physician, Brigham and Women s Hospital October 2, 2015 Financial
More informationBest Lipid Treatments
Best Lipid Treatments Pam R. Taub MD, FACC Director of Step Family Cardiac Rehabilitation and Wellness Center Associate Professor of Medicine UC San Diego Health System Overview of Talk Review of pathogenesis
More informationThe TNT Trial Is It Time to Shift Our Goals in Clinical
The TNT Trial Is It Time to Shift Our Goals in Clinical Angioplasty Summit Luncheon Symposium Korea Assoc Prof David Colquhoun 29 April 2005 University of Queensland, Wesley Hospital, Brisbane, Australia
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 informationSupplementary Online Content
Supplementary Online Content Navarese EP, Robinson JG, Kowalewski M, et al. Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering: a systematic review and
More informationEffective Treatment Options With Add-on or Combination Therapy. Christie Ballantyne (USA)
Effective Treatment Options With Add-on or Combination Therapy Christie Ballantyne (USA) Effective treatment options with add-on or combination therapy Christie M. Ballantyne, MD Center for Cardiovascular
More informationIl rischio residuo nella persona con diabete: come individuarlo e come trattarlo?
Il rischio residuo nella persona con diabete: come individuarlo e come trattarlo? Alberto Zambon University of Padova - Italy DISCLOSURE - CONFLICT OF INTEREST Prof. A. Zambon reports having received grants,
More informationAdvanced Treatment of LDL: How Low Should You Go?
Advanced Treatment of LDL: How Low Should You Go? C. Michael White, Pharm.D., FCP, FCCP Professor and Head, Pharmacy Practice, UCONN Co-Director, HOPE Collaborative Group, UCONN/Hartford Hospital Potential
More informationAdvanced Treatment of LDL: How Low Should You Go?
Advanced Treatment of LDL: How Low Should You Go? C. Michael White, Pharm.D., FCP, FCCP Professor and Head, Pharmacy Practice, UCONN Co-Director, HOPE Collaborative Group, UCONN/Hartford Hospital Potential
More informationCOURAGE to Leave Diseased Arteries Alone
COURAGE to Leave Diseased Arteries Alone Spencer King MD MACC, FSCAI St. Joseph s s Heart and Vascular Institute Professor of Medicine Emeritus Emory Univ. Atlanta, USA Conflict: I am an Interventionalist
More information