Accelerated atherosclerosis begins years prior to the diagnosis of diabetes
|
|
- Catherine Norah Gilbert
- 5 years ago
- Views:
Transcription
1 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Risk for atherosclerosis is 2 4 times greater in patients with diabetes CVD accounts for 65% of diabetic mortality >5% of patients with newly diagnosed type 2 diabetes already have CHD Accelerated atherosclerosis begins years prior to the diagnosis of diabetes Seven-Year Incidence of Fatal/Nonfatal MI 7-Year Incidence Rate of Myocardial Infarction No diabetes Diabetes 45% P<.1 P< % 2.2% 3.5% n=134 n=69 n=89 n=169 No DM, No MI No DM, MI DM, No MI DM, MI DM=diabetes mellitus; MI=myocardial infarction Haffner SE et al. N Engl J Med. 1998;339: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 1
2 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician 1. NIH-ONSET STUDY Proportion Alive following Acute MI No diabetes No diabetes with prior MI Diabetes Diabetes with prior MI With diabetes=1536 Without diabetes= Years Mukamal KJ et al. Diabetes Care. 21;24: Dyslipidemia Hypertension Nephropathy Obesity / sedentary lifestyle Altered coagulation, platelet function, and fibrinolysis Hyperinsulinemia / hyperproinsulinemia / insulin resistance Cigarette smoking Hyperglycemia Results from the Multiple Risk Factor Intervention Trial (MRFIT) Adjusted CV Death Rate per 1, Person-Years No diabetes Diabetes 1 2 All 3 Number of Risk Factors Stamler J et al. Diabetes Care. 1993;16: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 2
3 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Coronary Artery Disease (n=28) Position in Model First Second Third Fourth Fifth Variable Low-density lipoprotein cholesterol High-density lipoprotein cholesterol Hemoglobin A1C Systolic blood pressure Smoking P Value < *Adjusted for age and sex. Turner RC et al. BMJ. 1998;316: Serum Concentration (mg/dl) NHANES III N = 2844 Diabetes No Diabetes Total-C LDL-C HDL-C TG Recommended ADA cutpoints Resnick HE et al. Diabetes Care. 2;23: American Diabetes Association. Diabetes Care. 26;29(suppl 1):S4-S42. Fat Cells Liver FFA CE IR X Insulin VLDL-TG Apo B Apo C-III CE VLDL (CETP) LDL (CETP) TG TG HDL SD LDL Apo A-1 Kidney (lipoprotein or hepatic lipase) Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 3
4 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Media Intima Lumen LDL-C Lumen Lipid-rich core Fibrous cap Lumen Unstable Lipid-rich core Lumen Phase I: Initiation LDL-C plays a major role in initiating the development of atherosclerotic plaque Phase II: Progression Disease progression results in the remodeling of the vascular wall so that the size of the lumen does not change significantly Stable Phase III: Complication Extensive lipid accumulation and a greater inflammatory component can pose the threat of plaque rupture Libby P. In: Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, PA: WB Saunders Co; 21: Libby P. J Intern Med. 2;247: Relative Risk for Coronary Heart Disease (Log Scale) LDL-Cholesterol (mg/dl) Grundy S et al. Circulation. 24;11: RCTs 18,686 with DM 71,37 without DM No differences by presence or absence of vascular disease, other risk factors, or baseline lipid levels CTT Collaborators. Lancet. 28;371: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 4
5 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician HPS LDL-C Subgroup Analysis 175 LDL-C (mg/dl) LDL-C 35% LDL-C 37% Placebo Simvastatin LDL-C 39% LDL-C (mmol/l) 5 RR reduction (major vascular events): LDL-C <116 mg/dl LDL-C mg/dl LDL-C >135 mg/dl (<3. mmol/l) ( mmol/l) (>3.5 mmol/l) 21% 26% 19% 1.5 Modified from Heart Protection Study Collaborative Group. Lancet. 22;36:7-22 Drug Dose (mg/d) LDL-C Reduction (%) Atorvastatin 1 39 Lovastatin 4 31 Pravastatin 4 34 Simvastatin Fluvastatin Rosuvastatin For every doubling of the dose above the standard dose, an approximate 6% decrease in LDL-C level can be obtained. Grundy S et al. Circulation. 24;11: Cholesterol absorption inhibitor Ezetimibe Reduces cholesterol absorption by binding to intestinal cholesterol transporter Bile acid sequestrants (BAS) Colesevelam, cholestyramine, colestipol Bind to bile acids > increase excretion of cholesterol Increased hepatic removal of cholesterol via LDL receptor pathway Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 5
6 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Mean Change from Untreated Baseline (%) LDL-C TG (Median) HDL-C 1% % 1% 2% 8% 2 18% Placebo ( n=431) Ezetimibe 1 mg ( n=1288) *Pooled data. P.1 vs placebo. Lipoprotein and lipid effects 1 LDL-C: 15% to 3% Triglycerides: no change or HDL-C: 3% to 5% Reduce major coronary events and CHD deaths 1,2 Improved diabetic control (colesevelam) Adverse effects: 1,2 Gastrointestinal distress (bloating and constipation) Exacerbation of hypertriglyceridemia 1. NCEP ATP III. Circulation. 22;16: Jacobson TA, et al. Am J Cardiol. 27;99(suppl 6A):47C-55C. Change from Baseline (%) LDL-C Total-C HDL-C TG LDL-C and Total-C values are expressed as mean; HDL-C and TG values are expressed as median. P<.5 vs placebo P<.5 vs atorvastatin 1 mg Placebo Atorvastatin 1 mg/d Colesevelam 3.8 g/d + Atorvastatin 1 mg/d Atorvastatin 8 mg/d Hunninghake D et al. Atherosclerosis. 21;158: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 6
7 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Therapeutic lifestyle changes (TLC) Non HDL-C HDL-C Emerging biomarkers Other lipid risk markers Nonlipid risk markers Diet Limit saturated fats (<7% total calories), cholesterol (<2 mg/day), and trans fat Therapeutic options Omega-3 fatty acids Plant stanols/sterols Increased viscous fiber Regular physical activity Weight loss Smoking cessation Expert Panel. JAMA. 21;285: In patients with TG 2 mg/dl, the cholesterol content of TG-rich, atherogenic (remnant) lipoprotein particles is increased Measurement of non HDL-C (TC minus HDL-C) takes into account cholesterol in these particles (as well as LDL-C) Predictive for CHD Can be measured under nonfasting conditions Can be used as follow-up measurement Non HDL-C goal = LDL-C goal + 3 mg/dl Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 21;285: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 7
8 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Relative CHD Risk < LDL-C (mg/dl) 2693 Men 311 Women <16 Non HDL-C (mg/dl) Liu J et al. Am J Cardiol. 26;98: Risk Category Non HDL-C Goal (mg/dl) 1 RF <19 2 RFs (CHD risk 2%) <16 CHD or CHD risk equivalent <13 (CHD risk >2%) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 21;285: Risk Reduction (%) Nonfatal MI -24% P=.1 Macrovascular CVD -11% P=.35 Coronary Revasc. -21% P=.3 Angina -18% P=.4 Amputations -38% P=.11 Microvascular Retinal Laser Therapy -3% P=.3 Albuminuria -15% P=.2 Keech A et al. Lancet. 25;366: Keech A. Atherosclerosis Supplements. 26;7:342. Abstract. Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 8
9 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician N=5518 Mean Age: 62 yr Mean f/u: 4.7 yr The ACCORD Study Group. N Engl J Med. 21;1.156/NEJMoa11282 The ACCORD Study Group. N Engl J Med. 21;1.156/NEJMoa11282 Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 9
10 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician 3. Framingham Heart Study 2.5 Relative Risk of CHD after 4 Years HDL-C, mg/dl LDL-C, mg/dl CAD=coronary artery disease. Castelli WP. Can J Cardiol. 1988;4(suppl A):5A 1A. Reverse cholesterol transport Anti-oxidant effects Anti-inflammatory effects Antithrombotic effects Anti-apoptotic effects Promotion of NO production Endothelial function-enhancing effects Movva R et al. Clin Chem. 28:54: Barter P et al. N Engl J Med. 27;357: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 1
11 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician HDL-C LDL-C Lp(a) TG -5 BL * 3* *Greater than recommended daily doses. Change from Baseline (%) Kos Pharmaceuticals, Inc., Data on file, 23. AIM-HIGH Statin + niacin vs statin Patients with CVD and metabolic syndrome (n = ~33) HPS2-THRIVE Statin + niacin/laropiprant vs statin Patients with CVD (n = ~2,) Aim HDL-C with niacin while LDL-C with statin reduces CV events better than statin alone Design 34 patients with CVD and atherogenic dyslipidemia LDL-C treated with statin to 4 8 mg/dl Randomized to niacin vs placebo Stopped early by DSMB No difference in CV events, 32 mo Increase in ischemic strokes with niacin 28 (1.6%) niacin vs 12 (.7%) placebo AIM-High Investigators. Am Heart J. 211;161: NIH News Press Release Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 11
12 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Emerging lipid markers Apo B LDL particle size LDL particle number Lp(a) Emerging markers do not supplant LDL-C, HDL-C, or TG Non HDL-C (TC minus HDL-C) Easy to calculate; no added expense Lifestyle modifications (TLC) Primary goal LDL-C < 1 mg/dl If CVD, LDL-C < 7 mg/dl with high-dose statin is an option Statin therapy added to TLC, regardless of baseline LDL-C, if Overt CVD Age > 4 yr + 1 other CVD risk factors For patients at lower risk (age < 4 yr and without CVD or MRF) Consider statin if LDL-C > 1 mg/dl after TLC Reduction in LDL-C of ~3 4% alternative therapeutic goal, if LDL-C targets not achieved with maximum tolerated statin therapy Triglycerides < 15 mg/dl, HDL-C > 4 (men) > 5 (women) mg/dl desirable, but LDL-C targeted statin therapy preferred Combination therapy to achieve lipid goals may be considered, but not evaluated by CVD outcome or safety studies Diabetes Care. 211;34(suppl 1):S11-S61. Inflammatory markers C-reactive protein (CRP) Cytokines Homocysteine Fibrinogen Metabolic syndrome Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 12
13 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician An acute-phase reactant in blood Increases in inflammatory states Prognostic indicator in acute MI Predicts prospective coronary risk Better than LDL-C? May be predictor of risk for new diabetes 1. C-Reactive Protein 1. LDL Cholesterol Probability of Event-Free Survival st Quintile 2nd Quintile 3rd Quintile 4 th Quintile 5 th Quintile st Quintile 2nd Quintile 3rd Quintile 4 th Quintile 5 th Quintile Years of Follow-up Years of Follow-up Ridker PM et al. N Engl J Med. 22;347: LDL (mg/dl) LDL-C decrease 5% at 12 months HDL (mg/dl) HDL-C increase 4% at 12 months hscrp (mg/l) hs-crp decrease 37% at 12 months Months Ridker PM et al. N Engl J Med. 28;359: TG (mg/dl) TG decrease 17% at 12 months Months Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 13
14 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Cumulative Incidence HR.56, 95% CI.46.69, P<.1 Number Needed to Treat (NNT ) = 25 ARR:.77 vs 1.36%/yr Placebo 251/891 Rosuvastatin 142/ Follow-up (years) Number at Risk -44% Rosuvastatin Placebo Ridker PM et al. N Engl J Med. 28;359: Patients at intermediate risk (1% 2% risk of CHD per 1 years) hs-crp may help direct further evaluation, therapy in primary prevention Patients with stable coronary disease, acute coronary syndromes hs-crp measurement may be useful as independent marker of prognosis for recurrent events Not recommended for routine screening hs-crp = high-sensitivity CRP. Pearson TA et al. Circulation. 23;17: Clustering of abdominal obesity, atherogenic dyslipidemia, hypertension, and insulin resistance Defined as any 3 of the following risk factors Waist circumference >4" (men); >35" (women) TG 15 mg/dl HDL-C <4 mg/dl (men); <5 mg/dl (women) BP 13/ 85 mm Hg FPG 1 mg/dl Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA. 21;285: Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 14
15 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician 15 Cumulative Hazard (%) 1 5 Relative Risk = 3.55 Metabolic syndrome No metabolic syndrome Follow-up (years) N=129 Lakka HM et al. JAMA. 22;288: FREE FATTY ACIDS FREE FATTY ACIDS GLUCOSE Leptin Angiotensinogen Resistin Adiponectin (ACRP-3) TNF- PAI-1 Serum amyloid-a IL-6 CRP Estrogens Cortisol RBP4 Modified from Kahn BB, Flier JS. J Clin Invest. 2;16: Lau DCW et al. Am J Physiol Heart Circ Physiol. 25;288:H Wellen. KE, Hotamisligil GS. J Clin Invest. 25;115: Produces various adipocytokines, chemokines, and prothrombotic factors Results in insulin-resistant, proinflammatory, prothrombotic state Clinical endpoints Increased diabetes Increased cardiovascular disease Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 15
16 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Identifies people at risk Allows targeting of specific risk factors May improve compliance May improve monitoring May improve therapy May be cost-effective Based on values of the following factors Age Smoking Total cholesterol HDL cholesterol Systolic blood pressure (including use of antihypertensive medication) Factors are the same for men and women but equations are different to reflect higher risk among men Integrate 1-year risk of hard CHD (MI or CHD death) Calculations can be done with online calculator available at Use computer-assisted risk assessment tools Framingham CHD Risk Calculator Reynolds Risk Score UKPDS Risk Engine for Type 2 Diabetes Tear-off sheets for self-assessment of risk scores Training office personnel in assessment tools Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 16
17 Joslin Diabetes Forum 211: Optimizing Care for the Practicing Clinician Elkeles RS et al. Eur Heart J. 28;29: LDL-C remains the primary target of lipid-altering therapies in patients with diabetes Non HDL-C is a secondary target in patients with triglycerides >2 mg/dl The benefits of treatment of low HDL-C, Apo B, LDL particle size/number or Lp(a) remain to be determined Biomarkers may help to identify patients at high cardiometabolic risk, especially in those at high risk for developing diabetes Copyright 211 by Joslin Diabetes Center, Inc. All rights reserved. These materials may be used for personal use only. Any distribution 17
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
More informationThe Metabolic Syndrome: Is It A Valid Concept? YES
The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA
More informationMOLINA 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
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 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 informationPIEDMONT 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,
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 informationDiabetes 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
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 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 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 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 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 informationLipoprotein 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
More informationDyslipedemia New Guidelines
Dyslipedemia New Guidelines New ACC/AHA Prevention Guidelines on Blood Cholesterol November 12, 2013 Mohammed M Abd El Ghany Professor of Cardiology Cairo Universlty 1 1 0 Cholesterol Management Pharmacotherapy
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 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 informationThe 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
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 informationCase Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer
Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32,
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 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 informationInflammation and and Heart Heart Disease in Women Inflammation and Heart Disease
Inflammation and Heart Disease in Women Inflammation and Heart Disease What is the link between een inflammation and atherosclerotic disease? What is the role of biomarkers in predicting cardiovascular
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
More informationDiabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology
Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the
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 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 informationPathophysiology of Lipid Disorders
Pathophysiology of Lipid Disorders Henry Ginsberg, M.D. Division of Preventive Medicine and Nutrition CHD in the United States CHD is the single largest killer of men and women 12 million have history
More informationMetabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine
Metabolic Syndrome: An overview. Kevin Niswender MD, PhD Vanderbilt University School of Medicine Setting the scene GB, 43 yo AA man followed for hypothyroidism returns on LT4 125 mcg/d and has a TSH=1.1
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 informationThe Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk
Update 2013 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine Denver Health
More informationTuesday, October 18 3:30 p.m. 5:30 p.m. Convention Center: Rooms 315 & 316
Ambulatory Care PRN Focus Session New Developments in Hypertension and Dyslipidemia Management Activity No. 0217-0000-11-101-L01-P (Application-Based Activity) Tuesday, October 18 3:30 p.m. 5:30 p.m. Convention
More informationGuidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AMERICAN COLLEGE OF ENDOCRINOLOGY Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease Writing Committee Chair: Paul S. Jellinger,
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 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 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 informationTotal 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
More informationThe inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema
The inhibition of CETP: From simply raising HDL-c to promoting cholesterol efflux and lowering of atherogenic lipoproteins Prof Dr J Wouter Jukema Dept Cardiology, Leiden University Medical Center, Leiden,
More informationPharmaceutical 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
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 informationContents. I. CV disease and insulin resistance: Challenges and opportunities. II. Insulin sensitizers: Surrogate and clinical outcomes studies
Contents I. CV disease and insulin resistance: Challenges and opportunities II. Insulin sensitizers: Surrogate and clinical outcomes studies IV. Identifying and treating patients with insulin resistance
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 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 informationQué factores de riesgo lipídicos debemos controlar? En qué medida?
Qué factores de riesgo lipídicos debemos controlar? En qué medida? Risk category High risk: CHD or CHD risk equivalents (10- year risk >20%) Moderately high risk: two or more risk factors (10-year risk
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 informationOptimizing 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
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 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 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 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 informationHow to Reduce CVD Complications in Diabetes?
How to Reduce CVD Complications in Diabetes? Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Framingham Heart Study 30-Year
More information( Diabetes mellitus, DM ) ( Hyperlipidemia ) ( Cardiovascular disease, CVD )
005 6 69-74 40 mg/dl > 50 mg/dl) (00 mg/dl < 00 mg/dl(.6 mmol/l) 30-40% < 70 mg/dl 40 mg/dl 00 9 mg/dl fibric acid derivative niacin statin fibrate statin niacin ( ) ( Diabetes mellitus,
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 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 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 informationDYSLIPIDEMIA PHARMACOLOGY. University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
DYSLIPIDEMIA PHARMACOLOGY University of Hawai i Hilo Pre- Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 LEARNING OBJECTIVES Know normal cholesterol levels Understand what the role
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 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 Disease in Diabetes
Macrovascular Disease in Diabetes William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research Conflicts CPC Clinical Research (University-based
More informationTuesday, October 18 3:30 p.m. 5:30 p.m. Convention Center: Rooms 315 & 316
Ambulatory Care PRN Focus Session New Developments in Hypertension and Dyslipidemia Management Activity No. 0217-0000-11-101-L01-P (Application-Based Activity) Tuesday, October 18 3:30 p.m. 5:30 p.m. Convention
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 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 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 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 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 informationEstablished 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
More informationDeath is inevitable but premature death is not. Sir Richard Doll
Welcome to the Diabetes Care for You webinar Please log onto the conference call so you can hear our presenter From any SCFT Cisco phone dial 800800 From a mobile phone or any other phone dial 01273 242
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 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 informationNearly 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
More information1. 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:
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 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 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 information10/1/2008. Therapy? Disclosure Statement
What s New in Lipid Therapy? Brooke Hudspeth, PharmD Diabetes Care Kroger Pharmacy Disclosure Statement In accordance with policies set forth by the Accreditation Council for Continuing Medical Education
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 informationChanging 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,
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 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 informationSTATIN UTILIZATION MANAGEMENT CRITERIA
STATIN UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: HMG Co-A Reductase Inhibitors & Combinations Agents which require prior review: Advicor (niacin extended-release/lovastatin) Crestor (rosuvastatin)(5mg,10mg,
More informationDyslipidemia Endothelial dysfunction Free radicals Immunologic
ATHEROSCLEROSIS Hossein Mehrani Professor of Clinical Biochemistry Definition Atherosclerosis: Is a chronic inflammatory process characterized by plaque formation within the vessel wall of arteries and
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 informationMacrovascular Management. What s next beyond standard treatment?
Macrovascular Management What s next beyond standard treatment? Are Lifestyle Modifications Still Relevant in Diabetic Patients? Diet Omega-6 and omega-3 fatty acids have been shown to improve CVD risk
More informationDiabetes Day for Primary Care Clinicians Advances in Diabetes Care
Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Elliot Sternthal, MD, FACP, FACE Chair New England AACE Diabetes Day Planning Committee Welcome and Introduction This presentation will:
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 informationBehind LDL: The Metabolism of ApoB, the Essential Apolipoprotein in LDL and VLDL
Behind LDL: The Metabolism of ApoB, the Essential Apolipoprotein in LDL and VLDL Sung-Joon Lee, PhD Division of Food Science Institute of Biomedical Science and Safety Korea University Composition of Lipoproteins:
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 informationMetabolic Syndrome. Bill Roberts, M.D., Ph.D. Professor of Pathology University of Utah
Metabolic Syndrome Bill Roberts, M.D., Ph.D. Professor of Pathology University of Utah Objectives Be able to outline the pathophysiology of the metabolic syndrome Be able to list diagnostic criteria for
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 informationDiabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center
Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??
More informationTailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan
Tailored Statin Treatment for Type 2 Diabetes Han, Ki Hoon Asan Medical Center University of Ulsan 1 Cardiovascular disease ; No1. death (2001) respiratory tract infection Other NCD S HIV/AIDS deaths during
More informationMetabolic 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
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 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 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 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 informationLatest Guidelines for Lipid Management
Latest Guidelines for Lipid Management Goals Recognize the differences between different guidelines Understand the effective strategies to tailor lipid lowering therapies based on evidence and guideline
More informationShould we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway
Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway The Polypill A strategy to reduce cardiovascular disease by
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 informationOn May 2001, the Third Adult
THE RISK OF DIABETES: CAN WE IMPACT CHD THROUGH THE ATP III CHOLESTEROL GUIDELINES? * Based on a presentation given by Steven M. Haffner, MD, MPH ABSTRACT Diabetes has been recognized among diabetologists
More information