The medical grapevine has been buzzing actively
|
|
- Jayson Bradford
- 5 years ago
- Views:
Transcription
1 COLLEGE OF PHYSICIANS VOL. 10 NO. 1 (FOR MEMBERS ONLY) February 2010 Message from the President Maintaining standards in housemanship training Quality in the face of quantity The medical grapevine has been buzzing actively on various issues challenging our healthcare system. One of the more persistent issues has been the failure to address the problem of persistent brain drain and the persistent disparity of healthcare standard between urban and rural areas. In some urban areas such as the Klang Valley, the doctor-patient ratio is about 1:390 which surpasses the World Health Organization s (WHO) benchmark of 1:600. On the other hand, in many rural areas, the deficit of medical manpower continues, especially in states like Sabah and Sarawak where the doctor-patient ratio could be as high as 1:4000. Since the 1980s, the key strategy has been to flood the market with increasing the production of doctors to counter the brain drain and to address the doctor-patient ratio disparity in rural areas. In addition, it was hoped that with improving service conditions in the public sector, more doctors would be encouraged to stay and serve beyond the three years of compulsory national service. Unfortunately, this strategy has had limited results. Thirty years down the road we are still faced with the same old scenario. We are producing more and more doctors each year. Doctors continue to leave for the lure of the private sector and doctors continue to want to work in urban setting where there are better facilities and opportunities for career development. More than two out of five of public medical posts are yet to be filled. In addition, this escalating production of doctors has itself resulted in an acute new problem and that is of falling standards in housemanship training. M essage cont d pg 2 Contents Message from the President 1-2 Review Article 3-4 Update Article / Short Review 5 ECG Quiz / Self Assessment 6 Answers 8 Published by :, Academy of Medicine of Malaysia
2 2 MESSAGE FEBRUARY 2010 M essage cont d from pg 1 Over the past 20 years, the mushrooming of medical schools has put a severe strain in providing sufficient and appropriate hands-on training facilities. Virtually all major public hospitals are now teaching hospitals for medical schools. The escalating commercialization of medical education has rapidly translated into more doctors produced each year in a relatively short time span. Today, we have about 22 medical schools in Malaysia that annually produce 4,000 medical graduates for a country of 27 million people. There are rumblings in the grapevine that there are plans to produce up to 5000 doctors yearly within the next five years. Superficially this appears to be a good thing except for the fact that there will now be an increasing shortage of places for comprehensive housemanship training. Comprehensive housemanship training is a fundamental process in the finishing school for a good medical training. In the early 80s, it was sheer hard work. House officers were on active call, every other night. It provided trainees with the valuable hands-on experience needed to manage patients under supervision. With the current annual production of 4,000 medical graduates, there are just not enough patients and training posts in government hospitals for all these new medical graduates. The situation will worsen further over the next five to seven years with more medical schools, both locally and overseas, churning out doctors by the thousands. The recent move by the Ministry of Health to extend the housemanship training to two years is recognition of the fact of the matter. Unfortunately, by doing so, the problem is made acutely worse because immediately, there now needs to be 8,000 (4,000 x 2) houseman posts yearly. It is now known that in some hospitals, house officers go on call once a week or once in two weeks. Some even have to share patients with their fellow housemen in the wards. At the end of the day, they will be inadequately exposed to the critical mass of patients that is essential for basic training to prepare them for their next job as medical officers where they are expected to deal with patients independently and also to supervise the next generation of house officers. On the other hand, we also hear of complaints that in some hospital units, some house officers have been so severely overworked to the extent that their quality of life and quality of care of patients may be compromised. Either way, the situation does not auger well for the system. The discordance between production of doctors and the ability to provide sufficient housemenship training will eventually affect the overall quality of healthcare delivery in the years to come. It is clear that the strategy to flood the market with doctors will do more damage than good. It is now time to critically look at how to improve the qualitative aspects and move away from the quantitative aspects of medical training. DR STEVEN KW CHOW President College of Physician, AMM
3 FEBRUARY 2010 REVIEW ARTICLE 3 ATP III At-A-Glance: Quick Desk Reference STEP 1: Determine lipoprotein levels - obtain complete lipoprotein profile after 9- to 12-hour fast. ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dl) LDL Cholesterol - Primary Target of Therapy <100 Optimal Near Optimal/Above Optimal Borderline High High 190 Very high Total Cholesterol <200 Desirable Borderline High 240 High HDL Cholesterol <40 Low 60 High STEP 2: Identify presence of clinical atherosclerotic disease that confers high risk for coronary heart disease (CHD) events (CHD risk equivalent): Clinical CHD Symptomatic carotid artery disease Peripheral arterial disease Abdominal aortic aneurysm. STEP 3: Determine presence of major risk factors (other than LDL): Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals Cigarette smoking Hypertension (BP 140/90 mmhg or on antihypertensive medication) Low HDL cholesterol (<40 mg/dl)* Family history of premature CHD (CHD in male first degree relative <55 years; CHD in female first degree relative <65 years) Age (men 45 years; women 55 years) * HDL cholesterol 60 mg/dl counts as a "negative" risk factor; its presence removes one risk factor from the total count. Note: in ATP III, diabetes is regarded as a CHD risk equivalent. STEP 4: If 2+ risk factors (other than LDL) are present without CHD or CHD risk equivalent, assess 10-year (shortterm) CHD risk (see Framingham tables). Three levels of 10-year risk: >20% -- CHD risk equivalent 10-20% <10% STEP 5: Determine risk category: Establish LDL goal of therapy Determine need for therapeutic lifestyle changes (TLC) Determine level for drug consideration LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories. Risk Category LDL LDL Level at LDL Level at Goal Whichto Initiate Which to Therapeutic Lifestyle Consider Drug Changes (TLC) Therapy CHD or CHD <100 >100 mg/dl >130 mg/d Risk Equivalents mg/dl ( (10-year risk mg/dl: drug >20%) optional)* 2+ Risk Factors <130 >130 mg/dl 10-year risk 10- (10-year risk mg/dl 20%: >130 <20%) mg/dl 10-year risk <10%: >160 mg/dl 0-1 Risk <160 >160 mg/dl >190 mg/dl Factor** mg/dl ( mg/dl: LDLlowering drug optional) * Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dl cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e.g., nicotinic acid or fibrate. Clinical judgment also may call for deferring drug therapy in this subcategory. ** Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10- year risk assessment in people with 0-1 risk factor is not necessary. STEP 6: Initiate therapeutic lifestyle changes (TLC) if LDL is above goal. TLC Features TLC Diet: Saturated fat <7% of calories, cholesterol <200 mg/day Consider increased viscous (soluble) fiber (10-25 g/day) and plant stanols/sterols (2g/day) as therapeutic options to enhance LDL lowering Weight management Increased physical activity STEP 7: Consider adding drug therapy if LDL exceeds levels shown in Step 5 table: Consider drug simultaneously with TLC for CHD and CHD equivalents Consider adding drug to TLC after 3 months for other risk categories. R eview Article cont d pg 4
4 4 REVIEW ARTICLE FEBRUARY 2010 R eview Article cont d from pg 3 Drugs Affecting Lipoprotein Metabolism Drug Class Agents and Daily Doses Lipid/Lipoprotein Effects Side Effects Contraindications HMG CoA reductase Lovastatin (20-80 mg), LDL-C i18-55% Myopathy Absolute: inhibitors (statins) Pravastatin(20-40 mg), HDL-C h5-15% Increased liver Active or chronic liver disease Simvastatin (20-80 mg), TG i7-30% enzymes Relative: Fluvastatin (20-80 mg), Concomitant use of certain Atorvastatin (10-80 mg), drugs* Cerivastatin ( mg) Bile acid Cholestyramine (4-16 g) LDL-C i15-30% Gastrointestinal Absolute: Sequestrants Colestipol (5-20 g) HDL-C h3-5% distress Constipation dysbeta-lipoproteinemia Colesevelam ( g) TG No change Decreased absorption TG >400 mg/dl or increase of other drugs Relative: TG >200 mg/dl Nicotinic acid Immediate release LDL-C i5-25% Flushing Absolute: (crystalline) nicotinic acid HDL-C h15-35% Hyperglycemia Chronic liver disease (1.5-3 gm), extended release TG i20-50% Hyperuricemia (or gout) Severe gout nicotinic acid (Niaspan ) Upper GI distress Relative: (1-2 g), sustained release Hepatotoxicity Diabetes nicotinic acid (1-2 g) Hyperuricemia Peptic ulcer disease Fibric acids Gemfibrozil (600 mg BID) LDL-C i5-20% Dyspepsia Absolute: Fenofibrate (200 mg) (may be increased in Gallstones Severe renal disease Severe Clofibrate (1000 mg BID) patients with high TG) Myopathy hepatic disease HDL-C h10-20% TG i20-50% * Cyclosporine, macrolide antibiotics, various anti-fungal agents, and cytochrome P-450 inhibitors (fibrates and niacin should be used with appropriate caution). STEP 8: Identify metabolic syndrome and treat, if present, after 3 months of TLC. Clinical Identification of the Metabolic Syndrome - Any 3 of the Following: Risk Factor Abdominal obesity* Men Women Triglycerides HDL cholesterol Men Women blood pressure Fasting glucose Defining Level Waist circumference** >102 cm (>40 in) >88 cm (>35 in) 150 mg/dl <40 mg/dl <50 mg/dl >130/85 mmhg >110 mg/dl * Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated body mass index (BMI). Therefore, the simple measure of waist circumference is recommended to identify the body weight component of the metabolic syndrome. ** Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, e.g., cm (37-39 in). Such patients may have a strong genetic contribution to insulin resistance. They should benefit from changes in life habits, similarly to men with categorical increases in waist circumference. Treatment of the metabolic syndrome Treat underlying causes (overweight/obesity and physical inactivity): Intensify weight management Increase physical activity Treat lipid and non-lipid risk factors if they persist despite these lifestyle therapies: Treat hypertension Use aspirin for CHD patients to reduce prothrombotic state Treat elevated triglycerides and/or low HDL (as shown in Step 9 below) STEP 9: Treat elevated triglycerides. ATP III Classification of Serum Triglycerides (mg/dl) < 150 Normal Borderline high High 500 Very high Treatment of elevated triglycerides (>150 mg/dl) Primary aim of therapy is to reach LDL goal. Intensify weight management. Increase physical activity. If triglycerides are >200 mg/dl after LDL goal is reached, set secondary goal for non-hdl cholesterol (total - HDL) 30 mg/dl higher than LDL goal. Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories Risk Category LDL Goal Non-HDL Goal (mg/dl) (mg/dl) CHD and CHD Risk Equivalent <100 <130 (10-year risk for CHD >20%) Multiple (2+) Risk Factors and <130 < year risk <20% 0-1 Risk Factor <160 <190 If triglycerides mg/dl after LDL goal is reached, consider adding drug if needed to reach non-hdl goal: intensify therapy with LDL-lowering drug, or add nicotinic acid or fibrate to further lower VLDL. If triglycerides >500 mg/dl, first lower triglycerides to prevent pancreatitis: very low-fat diet (15% of calories from fat) weight management and physical activity fibrate or nicotinic acid when triglycerides <500 mg/dl, turn to LDL-lowering therapy. Treatment of low HDL cholesterol (<40 mg/dl) First reach LDL goal, then: Intensify weight management and increase physical activity. If triglycerides mg/dl, achieve non-hdl goal. If triglycerides <200 mg/dl (isolated low HDL) in CHD or CHD equivalent, consider nicotinic acid or fibrate.
5 FEBRUARY 2010 UPDATE ARTICLE / SHORT REVIEW 5 The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-oddi dysfunction Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP Division of Gastroenterology, Medical College of Wisconsin, Milwaukee Forty-seven patients thought to have dysfunction of the sphincter of Oddi were randomly assigned to undergo endoscopic sphincterotomy or sham sphincterotomy in a prospective double-blind study. All the patients had pain resembling biliary pain, had previously undergone a cholecystectomy, and had clinical characteristics suggesting biliary obstruction. The patients were randomly assigned to the treatment (n = 23) or nontreatment (n = 24) group before manometric examination of the sphincter of Oddi was performed. Sphincterotomy resulted in improvement in pain scores at one-year follow-up in 10 of 11 patients with elevated sphincter pressure. In contrast, there was improvement in only 3 of 12 patients with elevated basal sphincter pressures who underwent the sham procedure. In patients with normal sphincter pressure, pain scores were similar regardless of treatment. After one year, sphincterotomy was performed in 12 symptomatic patients who had undergone the sham procedure--7 with elevated sphincter pressures and 5 with normal sphincter pressures. Forty patients were followed for four years. Of the 23 patients with increased sphincter pressure, 10 of the original 11 who underwent sphincterotomy remained virtually free of pain; 7 others who subsequently underwent sphincterotomy also benefited from it. Thus, 17 of 18 patients with sphincter-of-oddi dysfunction verified by manometry benefited from sphincterotomy. In patients with normal sphincter pressure, sphincterotomy was no more beneficial than sham therapy. Our observations suggest that endoscopic sphincterotomy offers long-term relief of pain in a group of patients with verified sphincter-of-oddi dysfunction. Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction J Toouli, I Roberts-Thomson, J Kellow, J Dowsett, G Saccone, P Evans, P Jeans, M Cox, P Anderson, C Worthley, Y Chan, N Shanks and A Craig GI Surgical Unit, Flinders Medical Centre, Adelaide, Australia. Abstract BACKGROUND Endoscopic sphincterotomy for biliary-type pain after cholecystectomy remains controversial despite evidence of efficacy in some patients with a high sphincter of Oddi (SO) basal pressure (SO stenosis). AIM To evaluate the effects of sphincterotomy in patients randomised on the basis of results from endoscopic biliary manometry. METHODS Endoscopic biliary manometry was performed in 81 patients with biliary-type pain after cholecystectomy who had a dilated bile duct on retrograde cholangiography, transient increases in liver enzymes after episodes of pain, or positive responses to challenge with morphine/neostigmine. The manometric record was categorised as SO stenosis, SO dyskinesia, or normal, after which the patient was randomised in each category to sphincterotomy or to a sham procedure in a prospective double blind study. Symptoms were assessed at intervals of three months for 24 months by an independent observer, and the effects of sphincterotomy on sphincter function were monitored by repeat manometry after three and 24 months. RESULTS In the SO stenosis group, symptoms improved in 11 of 13 patients treated by sphincterotomy and in five of 13 subjected to a sham procedure (p = 0.041). When manometric records were categorised as dyskinesia or normal, results from sphincterotomy and sham procedures did not differ. Complications were rare, but included mild pancreatitis in seven patients (14 episodes) and a collection in the right upper quadrant, presumably related to a minor perforation. At three months, the endoscopic incision was extended in 19 patients because of manometric evidence of incomplete division of the sphincter. CONCLUSION In patients with presumed SO dysfunction, endoscopic sphincterotomy is helpful in those with manometric features of SO stenosis. Keywords: sphincter of Oddi; manometry; endoscopic sphincterotomy; motility; bile duct; pancreas
6 6 ECG QUIZ / SELF ASSESSMENT FEBRUARY 2010?ECG QUIZ 1 CHARLES LESS AGE 93 MALE B. P. 150/70 DIGOXIN - NONE HISTORY: Confusion following collapse in the street. 2 JONATHAN SULLIVAN AGE 63 MALE B. P. 104/68 DIGOXIN mg. od. HISTORY: Chest pain and breathlessness. Swollen ankles. Questions 1: 1. Write a report on this ECG. 2. What is the likely significance of the T waves in this ECG? Questions 2: 1. Name five ECG diagnoses. SELF ASSESSMENT A 50 year old man presented with nausea and vomiting 1 week prior to admission. He was recently diagnosed to be hypertensive and was prescribed Moduretic by the private practitioner. He was found to be hyponatremic (sodium 110 mmol/l) and was given saline infusion. The following day, he was found to be confused. A brain MRI was performed. What complication had occurred? Answers on page 8
7
8 8 ANSWERS FEBRUARY 2010 Answers (ECG QUIZ) ECG1 1 Report: Rate Rhythm QRS Atrial 88 per minute, ventricular 25 per minute Complete heart block with variable ventricular pacemaker Duration: secs Configuration: Q in AVL, I and V4 T Giant inversion, particularly V2-4 QT 0.84 secs 2 The T waves are nearly pathognomonic of a recent syncopal attack ECG2 Report: Rate Rhythm QRC ST T 100 per minute Sinus rhythm. PR interval 0.36 secs Axis: -60 O Duration: 0.12 secs Configuration: RSR ' in AVR and V1. Slurred S in II, AVL and V6. Deep Q waves in II, III, AVF, V2 to V6 Elevation in II and III Flat in III. Each T waves is deformed by presence of a P waves Comments: The axis cannot be worked out as some of the complexes are right ventricular and some left ventricular in origin. This patient recovered spontaneously. He died a month later from bronchopneumonia. There was left ventricular hypertrophy at post-mortem and small areas of fibrosis in the left ventricle, but no area on infartion greater than 0.06 cm diameter. The brain was macroscopically normal. 1 (a) First degree heart block (b) Complete right bundle-branch block (c) Left axis deviation (d) Transmural inferior myocardial infarction (e) Transmural anterior myocardial infarction Answer (Self Assessment) A: Central pontine myelinolysis MRI T1-weighted image shows a hypointense lesion in the pontine area which appears hyperintense on T2-weighted image. Central pontine myelinolysis (CPM) is characterized primarily by the symmetric destruction of myelin sheaths in the pons. Most patients who develop pontine myelinolysis have had documented hyponatremia, and serum sodium levels were corrected rapidly to normal or supranormal levels. This condition has been associated with chronic alcoholics, undernutrition and dehydrated patients resulting from vomiting, diarrhea or diuretic therapy. The main underlying factor is related to the rapid correction of serum sodium levels. The clinical manifestations vary from asymptomatic to comatose. Neurologic signs and symptoms appear within 2 to 3 days after rapid correction of sodium levels. Findings include dysarthria, mutism, behavioral abnormalities, ophthalmoparesis, bulbar and pseudobulbar palsy, hyperreflexia, quadriplegia, seizures, and coma. Extra pontine involvement may affect the cerebellum, putamen, thalamus, corpus callosum, subcortical white matter, claustrum, caudate, hypothalamus, lateral geniculate bodies, amygdala, subthalamic nuclei or substantia nigra. Computed tomography abnormalities include symmetric areas of hypodensity in the pons or extrapontine regions without associated mass effect. Lesions appear hypointense on TIWI and hyperintense on T2WI MRI. Cerebrospinal fluid levels of protein and myelin basic protein may be elevated. In animal studies, after administration of hypertonic saline in hypotonic rats, there is opening of the blood brain barrier followed by swelling of the inner loop of the myelin sheath, oligodendrocyte degeneration and release of macrophage derived factors leading to eventual breakdown of myelin. Prevention of myelinolysis includes judicious correction of hyponatremia with saline ( not more than 12 mmol/l in 24 hours) and free water restriction, discontinuation of diuretic therapy, correction of metabolic abnormalities and medical complications.
MOLINA HEALTHCARE OF CALIFORNIA
MOLINA HEALTHCARE OF CALIFORNIA HIGH BLOOD CHOLESTEROL IN ADULTS GUIDELINE Molina Healthcare of California has adopted the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel
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 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 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 informationAntihyperlipidemic drugs
Antihyperlipidemic drugs The clinically important lipoproteins are LDL low density lipoprotein, VLDL very low density lipoprotein, HDL high density lipoprotein. Hyperlipidemia may caused 1. by individual
More informationAntihyperlipidemic Drugs
Antihyperlipidemic Drugs Hyperlipidemias. Hyperlipoproteinemias. Hyperlipemia. Hypercholestrolemia. Direct relationship with acute pancreatitis and atherosclerosis Structure Lipoprotein Particles Types
More informationAntihyperlipidemic Drugs
Antihyperlipidemic Drugs Lipid disorders: Disorders of lipid metabolism are manifest by elevation of the plasma concentrations of the various lipid and lipoprotein fractions (total and LDL cholesterol,
More informationANTIHYPERLIPIDEMIA. Darmawan,dr.,M.Kes,Sp.PD
ANTIHYPERLIPIDEMIA Darmawan,dr.,M.Kes,Sp.PD Plasma lipids consist mostly of lipoproteins Spherical complexes of lipids and specific proteins (apolipoproteins). The clinically important lipoproteins, listed
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 informationHyperlipidemia. Prepared by : Muhannad Mohammed Supervisor professor : Dr. Ahmed Yahya Dallalbashi
Hyperlipidemia Prepared by : Muhannad Mohammed Supervisor professor : Dr. Ahmed Yahya Dallalbashi Outline The story of lipids Definition of hyperlipidemia Classification of hyperlipidemia Causes of hyperlipidemia
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 informationCholesterol. Medicines To Help You
Medicines To Help You Cholesterol Use this guide to help you talk to your doctor, pharmacist, or nurse about your cholesterol medicines. The guide lists all of the FDA-approved products now available to
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 informationManometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction
98 GI Surgical Unit, Flinders Medical Centre, Adelaide, Australia J Toouli I C Roberts-Thomson G T P Saccone P Jeans MCox P Anderson C Worthley N Shanks A Craig Department of Gastroenterology, Royal North
More informationClinical Recommendations: Patients with Periodontitis
The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;
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 informationLipid Guidelines Who, What, and How Low. Anita Ralstin, MS, CNP Next Step Health Consultant, LLC New Mexico Heart Institute
Lipid Guidelines Who, What, and How Low Anita Ralstin, MS, CNP Next Step Health Consultant, LLC New Mexico Heart Institute Disclosures! None Objectives! List factors used in screening for dyslipidemia
More informationIn May 2001, the National Cholesterol. Effective Management of Patients With Dyslipidemia REPORT. Robert J. Lipsy, PharmD
REPORT Effective Management of Patients With Dyslipidemia Robert J. Lipsy, PharmD Abstract Coronary heart disease (CHD) is the leading cause of morbidity and mortality in the United States. A direct relationship
More informationFibrate and cardiovascular disease: Evident from meta-analysis. Thongchai Pratipanawatr
Fibrate and cardiovascular disease: Evident from meta-analysis Thongchai Pratipanawatr ??? ย คห นใหม ย คห นกลาง ย คห นเก า ?? Statin era? ย คห นใหม ย คห นกลาง ย คห นเก า CURRENT ROLE OF FIBRATE What are
More informationDiabetes Mellitus Type 2
Diabetes Mellitus Type 2 What is it? Diabetes is a common health problem in the U.S. and the world. In diabetes, the body does not use the food it digests well. It is hard for the body to use carbohydrates
More informationFinancial Disclosures
1 Lipids in Type 2 Diabetes July 20, 2013 Abhimanyu Garg, M.D. Professor of Internal Medicine Chief, Division of Nutrition and Metabolic Diseases Distinguished Chair in Human Nutrition Research UT Southwestern
More informationIntroduction Hyperlipidemia hyperlipoproteinemia Primary hyperlipidemia (Familial) Secondary hyperlipidemia (Acquired)
Introduction Hyperlipidemia, or hyperlipoproteinemia, is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. Hyperlipidemias are divided in primary and secondary
More informationDiabetic Dyslipidemia
Diabetic Dyslipidemia Dr R V S N Sarma, M.D., (Internal Medicine), M.Sc., (Canada), Consultant Physician Cardiovascular disease (CVD) is a significant cause of illness, disability, and death among individuals
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 informationSIGN 149 Risk estimation and the prevention of cardiovascular disease. Quick Reference Guide July Evidence
SIGN 149 Risk estimation and the prevention of cardiovascular disease Quick Reference Guide July 2017 Evidence ESTIMATING CARDIOVASCULAR RISK R Individuals with the following risk factors should be considered
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 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 informationAnti Hyperlipidemic Drugs. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Anti Hyperlipidemic Drugs Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Lipoproteins Macromolecular complexes in the blood that transport lipids Apolipoproteins
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 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 informationElectrocardiography for Healthcare Professionals. Chapter 14 Basic 12-Lead ECG Interpretation
Electrocardiography for Healthcare Professionals Chapter 14 Basic 12-Lead ECG Interpretation 2012 The Companies, Inc. All rights reserved. Learning Outcomes 14.1 Discuss the anatomic views seen on a 12-lead
More informationCardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
More informationDrugs for Dyslipidemias
Drugs for Dyslipidemias HMG CoA reductase inhibitors (statins): atorvastatin, lovastatin, pravastatin, simvastatin Bile acid-binding resins: cholestyramine, colestipol, colesevelam Fibric acid derivatives
More informationThe Pharmacists Role in Lipid Management
The Pharmacists Role in Lipid Management Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant Clinical Assistant Professor, Univ. of Maryland Learning Objectives 1. ENHANCE your understanding
More informationAchieving Lipid Goals: 2008 Update. Laura Hansen, Pharm.D. Associate Professor, University of Colorado School of Pharmacy
Achieving Lipid Goals: 2008 Update Laura Hansen, Pharm.D. Associate Professor, University of Colorado School of Pharmacy Discuss relationship between lipid values and coronary events Evaluate clinical
More informationClinical Practice Guideline
Clinical Practice Guideline Secondary Prevention for Patients with Coronary and Other Vascular Disease Since the 2001 update of the American Heart Association (AHA)/American College of Cardiology (ACC)
More informationDyslipidemia. (Med-341)
Dyslipidemia (Med-341) Anwar A Jammah, MD, FRCPC, FACP, CCD, ECNU. Associate Professor of Medicine Consultant Medicine, Endocrinology, Thyroid Oncology Department of Medicine, King Saud University The
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 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 informationPATIENT INFORMATION. Medicine To Treat: C ardiac Diseases. Lipid-Lowering Medicines. Statins Fibrates Fat Binding Agents Nicotinic Acid Group
PATIENT INFORMATION Medicine To Treat: C ardiac Diseases Lipid-Lowering Medicines Statins Fibrates Fat Binding Agents Nicotinic Acid Group ABOUT YOUR MEDICINE Your doctor has just prescribed for you: Medicine
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 informationCLINICAL IMPORTANCE OF LIPOPROTEINS
25 Hyperlipidemias CLINICAL IMPORTANCE OF LIPOPROTEINS Raised levels of low-density lipoprotein (LDL) cholesterol and low levels of high density lipoprotein (HDL) cholesterol are independent risk factor
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 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 informationHigh Blood Cholesterol What you need to know
National Cholesterol Education Program High Blood Cholesterol What you need to know Why Is Cholesterol Important? Your blood cholesterol level has a lot to do with your chances of getting heart disease.
More informationCardiovascular Risk Factors: Distribution and Prevalence in a Rural Population of Bangladesh
"Insight Heart" is also available at www.squarepharma.com.bd Cardiovascular Risk Factors: Distribution and Prevalence in a Rural Population of Bangladesh Coronary heart disease has been emerging as an
More informationLipid Lowering Drugs. Dr. Alia Shatanawi
Lipid Lowering Drugs Dr. Alia Shatanawi Atherosclerosis A form of arteriosclerosis characterized by the deposition of atheromatous plaques containing cholesterol and lipids on the innermost layer of the
More informationCopy right protected Page 1
CHOLESTEROL and TGs LOWERING DRUGS Introduction: Fat (lipids) are combinations (esters) of fatty acids plus an alcohol. The two main fats in the body are triglycerides (TGs) and cholesterol Triglycerides
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 informationCoronary Artery Disease Clinical Practice Guidelines
Coronary Artery Disease Clinical Practice Guidelines Guidelines are systematically developed statements to assist patients and providers in choosing appropriate healthcare for specific clinical conditions.
More informationImbalances in lipid components
Drugs for Dyslipidemia Vivien Gam, Pharm.D. 1 Dyslipidemia Imbalances in lipid components High total cholesterol High LDL cholesterol Low HDL cholesterol High triglycerides Significant risk factor for
More informationHigh ( 50%) Restrictions mg 20-40mg PA; TS ⱡ 15 ⱡ
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Cholesterol P&T DATE: 5/9/2017 THERAPEUTIC CLASS: Cardiovascular REVIEW HISTORY: 5/16, 5/15, 2/14, 5/12, LOB AFFECTED: Medi-Cal
More informationNCEP Report. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines
NCEP Report Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer,
More informationNew Features of the National Cholesterol Education Program Adult Treatment Panel III Lipid-Lowering Guidelines
Clin. Cardiol. Vol. 26 (Suppl. III), III-19 III-24 (2003) New Features of the National Cholesterol Education Program Adult Treatment Panel III Lipid-Lowering Guidelines H. BRYAN BREWER, JR, M.D. Molecular
More informationCase Discussions: Treatment Strategies for High Risk Populations. Most Common Reasons for Referral to the Baylor Lipid Clinic
Case Discussions: Treatment Strategies for High Risk Populations Peter H. Jones MD, FNLA Associate Professor Methodist DeBakey Heart and Vascular Center Baylor College of Medicine Most Common Reasons for
More informationThe American Diabetes Association estimates
DYSLIPIDEMIA, PREDIABETES, AND TYPE 2 DIABETES: CLINICAL IMPLICATIONS OF THE VA-HIT SUBANALYSIS Frank M. Sacks, MD* ABSTRACT The most serious and common complication in adults with diabetes is cardiovascular
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 information2013 Hypertension Measure Group Patient Visit Form
Please complete the form below for 20 or more unique patients meeting patient sample criteria for the measure group for the current reporting year. A majority (11 or more) patients must be Medicare Part
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationGuidelines to assist General Practitioners in the Management of Type 2 Diabetes. April 2010
Guidelines to assist General Practitioners in the Management of Type 2 Diabetes April 2010 Foreword The guidelines were devised by the Diabetes Day Centre in Beaumont Hospital in consultation with a number
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 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 informationAccelerated atherosclerosis begins years prior to the diagnosis of diabetes
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
More informationRoyal Wolverhampton Hospital Adult Lipid Lowering Therapy Guidelines Lipid Lowering Therapy for the Prevention of Cardiovascular Disease
Royal Wolverhampton Hospital Adult Lipid Lowering Therapy Guidelines 1 This guideline is intended to assist rational and cost-effective prescribing of lipid regulating medications across both primary and
More information2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension.
2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on Management of Hypertension Writing Group: Background Hypertension worldwide causes 7.1 million premature
More informationIn the Know: Canadian Guidelines for Dyslipidemia, 2003
In the Know: Canadian Guidelines for Dyslipidemia, 2003 In his reviews of Canadian dyslipidemia guidelines, Dr. Curnew explores the impact of major trials, the assessment and categories of risk, and both
More informationMY CHOLESTEROL GUIDE. Take Action. Live Healthy! heart.org/cholesterol
MY CHOLESTEROL GUIDE Take Action. Live Healthy! heart.org/cholesterol UNDERSTANDING AND MANAGING CHOLESTEROL CONTENTS Understanding Risk...3 Why Am I at Risk?...3 How Will My Risk Factors Be Treated?...4
More informationDyslipidemia. Team Members: Laila Mathkour, Khalid Aleedan, Bayan Al-Mugheerha, Fatima AlTassan
Dyslipidemia Objectives: Not given. Team Members: Laila Mathkour, Khalid Aleedan, Bayan Al-Mugheerha, Fatima AlTassan Team Leader: Amal Alshaibi Revised By: Yara Aldigi and Basel almeflh Resources: 435
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 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 information> 130 > 130 (10-20% risk) <130 >160 (<10% risk) 0-1 Risk Factors <160 >160 >190
Pharmacotherapy of Dyslipidemia Disease State Definition Epidemiology Pathophysiology Clinical Presentation Polygenic LDL above 160 or TG HDL below 40-65 million quality for lifestyle changes - 36 million
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 informationCHOLESTAGEL 625 mg Genzyme
CHOLESTAGEL 625 mg Genzyme 1. NAME OF THE MEDICINAL PRODUCT Cholestagel 625 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains 625 mg colesevelam hydrochloride (hereafter
More informationStatistical Fact Sheet Populations
Statistical Fact Sheet Populations At-a-Glance Summary Tables Men and Cardiovascular Diseases Mexican- American Males Diseases and Risk Factors Total Population Total Males White Males Black Males Total
More informationThe new guidelines issued in PRESENTATIONS... Future Outlook: Changing Perspectives on Best Practice
... PRESENTATIONS... Future Outlook: Changing Perspectives on Best Practice Based on a presentation by Daniel J. Rader, MD Presentation Summary The guidelines recently released by the National Cholesterol
More informationMetabolic Syndrome and Chronic Kidney Disease
Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference
More information... CPE/CNE QUIZ... CPE/CNE QUESTIONS
CPE/CNE QUESTIONS Continuing Pharmacy Education Accreditation The Virginia Council on Pharmaceutical Education is approved by the American Council on Pharmaceutical Education as a provider of continuing
More informationCE Prn. Pharmacy Continuing Education from WF Professional Associates ABOUT WFPA LESSONS TOPICS ORDER CONTACT MCA EXAM REVIEWS
CE Prn Pharmacy Continuing Education from WF Professional Associates ABOUT WFPA LESSONS TOPICS ORDER CONTACT MCA EXAM REVIEWS Hyperlipidemia---Update & Review The objectives of this lesson are such that
More informationEvidence-Based Medicine
Assessing Risks for Cardiovascular Disease in a Pharmacy Setting Jeff Rochon, Pharm.D. Director of Pharmacy Care Services Washington State Pharmacy Association Evidence-Based Medicine Use established guidelines
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 informationChronic Benefit Application Form Cardiovascular Disease and Diabetes
Chronic Benefit Application Form Cardiovascular Disease and Diabetes 19 West Street, Houghton, South Africa, 2198 Postnet Suite 411, Private Bag X1, Melrose Arch, 2076 Tel: +27 (11) 715 3000 Fax: +27 (11)
More informationCardiovascular Disease Risk Factors:
Cardiovascular Disease Risk Factors: Risk factors are traits or habits that increase a person's chances of having cardiovascular disease. Some risk factors can be changed. These risk factors are high blood
More informationCHOLESTEROL REDUCING MEDICATIONS. Five Main Categories. 1. Statins 2. Fibrates 3. Resins 4. Niacin 5. Cholesterol absorption inhibitor
Page 1 of 5 PHA-GEN-002-2004 CHOLESTEROL REDUCING MEDICATIONS Five Main Categories 1. Statins 2. Fibrates 3. Resins 4. Niacin 5. Cholesterol absorption inhibitor Statins Also called HMG-CoA reductase inhibitors
More informationnicotinic acid 375mg, 500mg, 750mg, 1000mg modified release tablet (Niaspan ) No. (93/04) Merck
Scottish Medicines Consortium Resubmission nicotinic acid 375mg, 500mg, 750mg, 1000mg modified release tablet (Niaspan ) No. (93/04) Merck New formulation 6 January 2006 The Scottish Medicines Consortium
More informationFigure S1. Comparison of fasting plasma lipoprotein levels between males (n=108) and females (n=130). Box plots represent the quartiles distribution
Figure S1. Comparison of fasting plasma lipoprotein levels between males (n=108) and females (n=130). Box plots represent the quartiles distribution of A: total cholesterol (TC); B: low-density lipoprotein
More informationElectrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD
Electrocardiography Abnormalities (Arrhythmias) 7 Faisal I. Mohammed, MD, PhD 1 Causes of Cardiac Arrythmias Abnormal rhythmicity of the pacemaker Shift of pacemaker from sinus node Blocks at different
More informationChapter 08. Health Screening and Risk Classification
Chapter 08 Health Screening and Risk Classification Preliminary Health Screening and Risk Classification Protocol: 1) Conduct a Preliminary Health Evaluation 2) Determine Health /Disease Risks 3) Determine
More informationStroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital
Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke
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 informationSupplement Table 2. Categorization of Statin Intensity Based on Potential Low-Density Lipoprotein Cholesterol Reduction
Supplement: Tables Supplement Table 1. Study Eligibility Criteria Supplement Table 2. Categorization of Statin Intensity Based on Potential Low-Density Lipoprotein Cholesterol Reduction Supplement Table
More informationMyocardial Infarction. Reading Assignment (p66-78 in Outline )
Myocardial Infarction Reading Assignment (p66-78 in Outline ) Objectives 1. Why do ST segments go up or down in ischemia? 2. STEMI locations and culprit vessels 3. Why 15-lead ECGs? 4. What s up with avr?
More informationECG Workshop. Nezar Amir
ECG Workshop Nezar Amir Myocardial Ischemia ECG Infarct ECG in STEMI is dynamic & evolving Common causes of ST shift Infarct Localisation Left main artery occlusion: o diffuse ST-depression with ST elevation
More informationFull prescribing information is available to doctors and pharmacists on request.
INFORMATION FOR THE CONSUMER Full prescribing information is available to doctors and pharmacists on request. Sandoz Fenofibrate E reduces levels of low density cholesterol (LDL-C or bad cholesterol),
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 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 informationANTI-HYPERLIPIDEMIC AGENTS AND NSAIDS LECTURE 6
ANTI-HYPERLIPIDEMIC AGENTS AND NSAIDS LECTURE 6 HYPERLIPIDEMIA Cholesterol Total cholesterol LDL cholesterol HDL cholesterol men women Triglycerides
More informationNICE QIPP about Lipitor. Robert Trotter. Clinical Effectiveness Consultant
NICE QIPP about Lipitor Robert Trotter Clinical Effectiveness Consultant LIP2894c Date of preparation: April 2009 Prescribing information for atorvastatin is available on the last slide Roadmap Background
More informationCARDIOVASCULAR DISEASE WHAT IS IT? WHAT IS THE ROLE OF CHOLESTEROL? HOW CAN WE REDUCE RISK?
1 CARDIOVASCULAR DISEASE WHAT IS IT? WHAT IS THE ROLE OF CHOLESTEROL? HOW CAN WE REDUCE RISK? Perry J Weinstock, MD, F.A.C.C. Head, Division of Cardiovascular Disease Director of Clinical Cardiology Cooper
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 information