Coronary heart disease (CHD) has. Clearfield The National Cholesterol Education Program Adult Treatment Panel III guidelines

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Coronary heart disease (CHD) has. Clearfield The National Cholesterol Education Program Adult Treatment Panel III guidelines"

Transcription

1 the osteopathic physician. The treatment approach involves therapeutic lifestyle changes with diet, exercise, and weight loss. It requires regular, careful monitoring of serum cholesterol levels. The new ATP III guidelines expand greatly the total number of patients who are eligible for treatment of hypercholesterolemia. Definite goals for LDL-C are defined for patients with coronary heart disease and patients at risk for subsequent clinical events. Many, if not most of these patients, will not be able to achieve their target LDL-C level without pharmacologic therapy. The ATP III evidence-based guidelines have defined the standard. It is our responsibility and unique opportunity to fulfill these expectations through thoughtful clinical practice. We might consider this supplement to represent a tool to help us accomplish this task. References 1. Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285: The American Heart Association 2002 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association; 2001; pp Pearson TA, Laurora I, Chu H, Kafonek S. The Lipid Treatment Assessment Project (L-TAP): A multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med. 2000;160: Stafford RS, Blumenthal D, Pasternak RC. Variations in cholesterol management practices of US physicians. J Am Coll Cardiol. 1997;29: Bramlett DA, King H, Young L, Witt JR, Stoukides CA, Kaul AF. Management of hypercholesterolemia: practice patterns for primary care providers and cardiologists. Am J Cardiol. 1997;80:39H-44H. Dr Rogers, a practicing cardiologist, is a clinical professor in the Department of Internal Medicine at the Michigan State University College of Osteopathic Medicine in East Lansing. This educational program was developed from information presented during a scientific symposium conducted on October 11, 2002, in Las Vegas, Nevada, at the 2002 Annual Convention and Scientific Seminar of the American Osteopathic Association. Coronary heart disease (CHD) remains the leading cause of death in the United States with more than 40% of all deaths each year directly attributed to the disease. Current evidence suggests that early identification and aggressive modification of risk factors offer the most promising approach to reducing the burden of CHD. Dyslipidemia has been identified as the primary risk factor leading to the development of CHD. It is estimated that nearly 65 million Americans require some form of lipid-modification therapy. The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) set of guidelines released in May 2001 provides physicians with evidence-based recommendations on the classification, diagnosis, and treatment of lipid disorders. New features of the guidelines include a scoring system for calculating CHD risk, as well as the identification of CHD risk equivalents, lower treatment target goals, and an emphasis on conditions conferring a higher risk for CHD, such as the metabolic syndrome. The ATP III emphasis on risk assessment substantially increases the number of patients considered at risk for CHD and will expand the number eligible for lifestyle and drug interventions. This article highlights the new recommendations and reviews the impact of ATP III on osteopathic physicians. (Key words: atherosclerosis, cholesterol, coronary heart disease, dyslipidemia, low-density lipoprotein cholesterol [LDL-C]) Coronary heart disease (CHD) has persisted as the single leading cause of death among Americans. According to the American Heart Association, 1 more than 1.1 million new or recurrent myocardial infarctions occurred in 2000 and more than 500,000 Americans died of CHD-related causes. Coronary heart disease also places a significant financial burden on the US economy with The National Cholesterol Education Program Adult Treatment Panel III guidelines Michael B. Clearfield, DO direct and indirect costs of the disease estimated to be nearly $330 billion in Dyslipidemia is recognized as a major modifiable risk factor for the development and progression of CHD. Numerous clinical trials have demonstrated that CHD-related morbidity and mortality is reduced after aggressive intervention that includes both lifestyle Dr Clearfield is a professor of medicine and associate dean for clinical research at the University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine. Dr Clearfield represented the American Osteopatic Association, a member organization of the National Cholesterol Education Program Coordinating Committee, which approved the Third Report of the National Cholesterol Education Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Dr Clearfield is a member of the speakers bureau of AstraZeneca, Merck & Co, Pfizer Inc, and Sankyo Pharma Inc, and he has received grant/research support from AstraZeneca and Pfizer Inc. Correspondence to Michael B. Clearfield, DO, Associate Dean for Clinical Research, Office of the Dean, Texas College of Osteopathic Medicine, University of North Texas Health Science Center at Fort Worth, 855 Montgomery St, Fort Worth, TX JAOA Supplement 1 Vol 103 No 1 January 2003 S1

2 modifications and pharmacologic therapy. 2-5 In May 2001, the Adult Treatment Panel (ATP) of the National Cholesterol Education Program (NCEP) issued its third set of guidelines (NCEP ATP III) for the identification and management of dyslipidemia. 6 Building on ATP I (1988) and ATP II (1993), ATP III pays increased attention to the identification and quantification of risk factors for CHD and therefore vastly expands the number of Americans eligible for lipid-lowering therapy. With these changes, ATP III presents a challenge to physicians and the healthcare system to identify at-risk patients, implement effective therapy, and ensure that patients meet target goals (Figure 1). Osteopathic physicians, many of whom focus on primary care with an emphasis on treating the entire patient, are in the vanguard for the reduction of CHD risk. Therefore, osteopathic physicians are uniquely positioned to have an impact on the implementation of the new guidelines. New features of the ATP III guidelines Consistent with previous editions, the new ATP guidelines provide an evidence-based approach for the detection and treatment of lipid disorders. Adult Treatment Panel III follows ATP II by continuing to focus on reduction of lowdensity lipoprotein cholesterol (LDL-C) as the primary goal of therapy and advocates that the intensity of therapy be adjusted to the degree of risk. The ATP III set of guidelines also reiterates the importance of lifestyle changes such as weight loss, dietary modifications, and increased physical activity in reducing CHD risk (Figure 1). New features of the guidelines include the use of a risk assessment tool based on data derived from the Framingham Heart Study, 7 the identification of diabetes (with or without clinically evident CHD) as a CHD risk equivalent, more aggressive lipid target levels, and the recognition that patients with the metabolic syndrome should be provided intensified lipid-modification therapy (Figure 1). Adult Treatment Panel III places patients into one of three categories of Checklist Challenges Identify patients at risk for CHD Implement effective therapy Ensure that patients meet target goals Emphasis Risk assessment Reduction of low-density lipoprotein cholesterol (LDL-C) as primary goal of therapy Adjustment of intensity of therapy to degree of risk Importance of lifestyle changes to include: weight loss dietary modifications increased physical activity New features Use of a risk assessment tool based on data derived from the Framingham Heart Study Identification of diabetes as a coronary heart disease (CHD) risk equivalent More aggressive lipid target goals Intensified lipid-modification therapy for patients with the metabolic syndrome Raising target for high-density lipoprotein cholesterol level (to 40 mg/dl) Lowering target for triglyceride concentration (to 200 mg/dl) Strategies for promoting adherence to treatment regimens Figure 1. Challenges, emphasis, and new features of the Adult Treatment Panel III guidelines. CHD risk (high, moderate, low) and identifies specific LDL-C treatment goals for each (Figure 2). The LDL-C target levels for patients with CHD and CHD risk equivalents (highest risk) are now less than 100 mg/dl. For patients with two or more risk factors (moderate risk), the target level is less than 130 mg/dl, and for patients with zero or one risk factor (low risk), the goal is less than 160 mg/dl. Adult Treatment Panel III also recognizes the role high-density lipoprotein cholesterol (HDL-C) and triglycerides play in modifying CHD risk and therefore raised the target level for HDL-C from less than 35 mg/dl to less than 40 mg/dl and lowered target goals for triglycerides to less than or equal to 200 mg/dl. Further, ATP III recognizes that the heightened emphasis on risk assessment, the inclusion of CHD risk equivalents, and the more aggressive treatment goals will significantly increase the number of patients eligible for therapy and challenge physicians and the healthcare delivery system to implement the guidelines. Therefore, ATP III also presents strategies for promoting adherence totherapeutic lifestyle changes (TLC) and drug therapy. Assessment of risk for coronary heart disease The Framingham risk scoring system incorporated into ATP III quantifies the 10-year risk for a coronary event. Point scores are calculated according to the presence of five major CHD risk factors (age and gender, total cholesterol, systolic blood pressure, HDL-C level, and smoking status), with each risk factor worth a certain number of points. When added together, the sum yields an estimate of the risk for having a coronary event in 10 years. A properly conducted assessment places patients into one of the three risk categories and forms the basis for all subsequent treatment decisions. Patients with documented CHD and CHD risk equivalents are automatically placed in the highest risk category. The CHD risk equivalents carry a risk for a major coronary event equal to that of established CHD and include diabetes, peripheral vascular disease, symptomatic carotid artery disease, and abdominal aortic aneurysm. The new set of guidelines places patients with these conditions in the same risk category as those with clinically evident CHD (eg, 20% 10-year risk of CHD). The LDL-C treatment goal for patients in this high-risk category is less than 100 mg/dl. In patients without documented CHD or CHD equivalents, assessment of CHD risk using the Framingham risk quantification system is essential to determine the most appropriate course of therapy. Patients with two or more major risk factors are considered to be at a moderately increased risk for CHD, with a 10-year risk of less than 20%. Therapy for the patients in this category should be S2 JAOA Supplement 1 Vol 103 No 1 January 2003

3 Risk stratification High risk of coronary heart disease (CHD) (documented CHD or CHD risk equivalent) Moderate (two or more risk factors) Low (zero to one risk factor) Adult Treatment Panel III sufficient to enable them to achieve an LDL-C target level of less than 130 mg/dl. Patients at the lowest risk are those with one or fewer major risk factors. In all but rare cases, these individuals have a 10-year risk of less than 10%. The target LDL-C level in this group of patients is less than 160 mg/dl. Current treatment trends With the increased emphasis on risk assessment and aggressive new treatment goals, it is estimated that the number of patients eligible for CHD risk reduction through lipid-modification therapy in the United States is currently at 65 million. The type and extent of therapy is dependent on the patient s CHD risk. Two primary modalities advocated by ATP III for lowering LDL-C, and therefore CHD risk, are ATP TLC and drug therapy. Treatment goal level (low-density lipoprotein cholesterol) 100 mg/dl 130 mg/dl 160 mg/dl Figure 2. Low-density lipoprotein cholesterol goals according to risk factor stratification. (Source: Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Full Report. Available at: nih.gov/guidelines/cholesterol/atp3_rpt.htm. Accessed December 2, 2002.) Therapeutic lifestyle changes First-line therapy for all patients is TLC and may be substantial enough in groups at lower risk to reach their LDL-C goals. Components of TLC that have demonstrated effectiveness in lowering LDL-C include eating a healthy diet, regular physical activity, smoking cessation, and weight loss. Dietary changes should include a reduction of saturated fats to less than 7% of total calories, reduction of intake of dietary cholesterol to less than 200 mg/d, addition of plant sterols and stanols at a level of 2 g/d (commercially available in special margarines), and incorporating viscous fiber into the diet at a level of 10 g/d to 25 g/d. Weight reduction can reduce LDL-C levels and ameliorate the risk factors associated with the metabolic syndrome by improving insulin sensitivity and serum glucose uptake. Physical activity raises HDL-C levels and decreases the concentration of very low-density lipoprotein cholesterol and triglycerides. Smoking cessation also results in a reduction of CHD risk. Pharmacologic therapy Although ATP III emphasizes the importance of nonpharmacologic therapy, it recognizes limitations of such therapy and encourages the addition of drug therapy if TLC fails to move a patient to goal after 3 months. High-risk patients will most likely require drug therapy along with TLC from the onset of treatment. As stated earlier, treatment goals and lipid thresholds for initiating drug therapy are based on the patient s degree of risk. For patients with the highest risk for coronary events, the LDL-C threshold for initiation of therapy is greater than or equal to 130 mg/dl (after a 3-month trial of TLC) and the goal is less than 100 mg/dl. For patients with LDL-C between 100 mg/dl and 129 mg/dl, drug therapy is optional and physicians are encouraged to use their professional clinical judgment to determine the nature of therapy required to reduce CHD risk. For patients with moderate risk without definite CHD or CHD risk equivalents but with more than two major risk factors and a 10-year risk of 10% to 20%, the threshold is greater than or equal to 130 mg/dl and the target is also less than 130 mg/dl. For patients at moderate risk but with a 10-year risk of less than 10%, the threshold for LDL-C is greater than or equal to 160 mg/dl and the target is less than 130 mg/dl. For patients without CHD and with zero to one major risk factor, drug treatment should be considered if the LDL-C cholesterol level is greater than or equal to 190 mg/dl after 3 months of TLC, with a goal of greater than or equal to 160 mg/dl. In all cases of drug therapy, TLC should continue to be maintained and reinforced. Currently available lipid-modifying drugs Four classes of lipid-modifying drugs are currently available in prescription form, including bile acid sequestrants, nicotinic acids, fibric acid derivatives, JAOA Supplement 1 Vol 103 No 1 January 2003 S3

4 and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). Statins, the most widely used lipid-modifying agent, decrease LDL-C by inhibiting cholesterol synthesis and reduce LDL-C by 25% to 50% in a dosedependent manner. The currently available statins are differentiated by the LDL-C lowering elicited at a given dose. Several large clinical outcomes trials have demonstrated that statin use reduces the incidence of CHD events, including myocardial infarction, coronary death, stroke, and total mortality. 2-5 Bile acid sequestrants are another commonly used agent. Bile acid sequestrants can be used as monotherapy when moderate reductions in LDL-C are required to achieve goal or as add-on therapy to statins, particularly in patients with severe dyslipidemia. A third class of agents is nicotinic acid, or niacin. Nicotinic acids provide a moderate LDL-C lowering action, but the primary utility of these agents is in combination with statins for patients who have elevated triglyceride concentrations or low HDL-C levels or both. Fibric acids, or fibrates, are a fourth class of lipid-modifying agents that possess minimal LDL-C reducing capacity, but these agents are useful in patients with combined forms of hyperlipidemia. Fibrates are especially effective in patients who have severe hypertriglyceridemia. Despite the efficacy of statins in modifying lipid levels and reducing coronary events, alternative agents are needed. Some patients are unable to tolerate statins, or they are not candidates for use of these agents because of either or both tolerability and safety concerns. In these cases, physicians and patients are forced to use bile acid sequestrants, niacin, fibrates, or other less common modes of therapy. These agents, however, vary in their effectiveness in reducing LDL-C levels owing to low efficacy of the agent or poor compliance due to undesired side effects. A promising new alternative mode of therapy was recently approved by the US Food and Drug Administration (FDA). Phase II data suggest that ezetimibe, the first selective inhibitor of intestinal cholesterol absorption, appears to have substantial potential for use as monotherapy in patients at low risk for CHD who require only a modest reduction in their LDL-C level or for those who do not tolerate statin therapy. 8 In addition, ezetimibe, when used in combination with a low-dose statin in patients at moderate to high risk for CHD, can elicit a reduction in LDL-C comparable to reductions seen at the highest statin doses. 9 Implementation of the ATP III guidelines The ATP III set of guidelines, with an emphasis on risk assessment and new treatment goals, presents an enormous challenge to physicians and the healthcare system in terms of implementation and patient compliance. Previous guideline adherence rates indicate that achieving the new goals will be difficult. The ATP II guidelines, although much less complex, were rarely followed in patients with CHD, let alone in patients with subclinical disease. Data from the Lipid Treatment Assessment Project (L-TAP) 10 demonstrated that only 18% of those with CHD achieved ATP II goals and that less than 40% of all patients on lipid-modification therapy receive sufficient lipid lowering to reduce CHD risk. Because overall adherence and goal achievement was low with previous guidelines, the challenges inherent in achieving ATP III goals are clear. The ATP III acknowledges that primary prevention of CHD offers the greatest opportunity for reducing the clinical and economic burden of CHD in the United States. The clinical approach to CHD prevention begins in the primary care office and requires an informed physician who does not focus solely on a specific symptom and who implements early risk screening that includes an assessment of the overall health of the patient. Because nearly 60% of all osteopathic physicians practice in primary care and account for more than 100 million primary care visits per year, they are uniquely positioned to influence the implementation of the ATP III guidelines. Thus, DOs can have a significant impact on the reduction of CHD risks in their patients. Osteopathic physicians also treat a large number of patients who have limited access to healthcare. Consequently, DOs must educate their patients about the importance of taking responsibility for their own health through the incorporation of healthy lifestyle habits. Comments The NCEP ATP III report updates the clinical guidelines for the detection and treatment of lipid disorders. Although the emphasis remains on reducing longterm CHD risk by lowering the LDL-C level, new features of the guidelines include a scoring system for calculating CHD risk as well as the identification of CHD risk equivalents. The ATP III emphasis on risk assessment will substantially increase the number of individuals considered to be at risk for CHD and will expand the number of patients who will be eligible for lifestyle and drug interventions. The new recommendations will significantly challenge physicians to screen and treat patients to more aggressive target lipid levels. Osteopathic physicians are uniquely positioned to implement the new guidelines and encourage patient compliance. References 1. American Heart Association Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association; 2001: pp 4, 11, Scandinavian Simvastatin Survival Study Group. Randomised Trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344: West of Scotland Coronary Prevention Study Group. Influence of pravastatin and plasma lipids on clinical events in the West of Scotland Coronary Prevention Study (WOSCOPS). Circulation. 1998;97: Downs JR, Clearfield M, Weis S, Whitney F, Shapiro DR, Beere PA, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA. 1998;279: Sacks FM, Moyé LA, Davis BR, Cole TG, Rouleau JL, Nash DT, et al. Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events trial. Circulation. 1998;97: Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treat- S4 JAOA Supplement 1 Vol 103 No 1 January 2003

5 ment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285: Wilson PW, D Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97: Bays H, Drehobl M, Rosenblatt S, Toth P, Dujovne C, Knopp R, et al. Low density lipoprotein cholesterol reduction by SCH (ezetimibe), a novel inhibitor of cholesterol absorption, in 234 hypercholesterolemic subjects: results of a dose-response study. Atherosclerosis. 2000;151:133. Abstract. 9. Davis HR, Watkins RW, Compton DS, Cook JA, Hoos L, Pula K, et al. The cholesterol absorption inhibitor SCH and lovastatin synergistically lower plasma cholesterol and inhibit the development of atherosclerosis. J Am Coll Cardiol. 2000;35(2 suppl):252a. Abstract. 10. Pearson TA, Laurora I, Chu H, Kafonek S. The Lipid Treatment Assessment Project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieveing low-density lipoprotein cholesterol goals. Arch Intern Med. 2000;160: Underidentification and undertreatment of dyslipidemia Michael B. Clearfield, DO Despite increased attention placed on the identification and treatment of dyslipidemia, this condition remains undiagnosed and untreated in a significant number of patients. The recently released National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) set of cholesterol management guidelines increases to more than 65 million the number of Americans eligible for lipid-modifying therapy. Recent data, however, suggest that even with the availability of multiple regimens with proven efficacy, as many as 50% of all patients do not have their cholesterol assessed and less than 45% receive lipid-modifying therapy. In addition, less than 25% of patients are treated to their NCEP target low-density lipoprotein cholesterol (LDL-C) level. Persistence with therapy is another challenge, as more than 70% of patients fail to maintain their therapy beyond 12 months. If a realistic attempt is to be made to reduce the risk of coronary heart disease (CHD) among Americans, diagnosis of dyslipidemia and treatment to therapeutic targets must be improved. This article discusses the underdiagnosis and undertreatment of lipid disorders and reviews the role of osteopathic physicians in strategies achieving ATP III LDL-C goals. (Key words: Adult Treatment Panel III [ATP III], compliance, cholesterol, dyslipidemia) Large numbers of patients have undiagnosed dyslipidemia, and those who do receive a diagnosis are often given inadequate therapy. The American Heart Association 1 estimates that more than 100 million adults in the United States have total cholesterol levels greater than 200 mg/dl and at least 40% of these individuals have cholesterol levels in excess of 240 mg/dl. The true number of dyslipidemic individuals in the United States may never be known because of the enormity of effort and magnitude of cost required for screening all at-risk individuals. Because more than 12.6 million Americans have coronary heart disease (CHD) and more than 500,000 deaths are attributed to this disease each year, physicians should be strongly encouraged to heed the advice of the National Cholesterol Education Pro- Dr Clearfield is a professor of medicine and associate dean for clinical research at the University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine. Dr Clearfield represented the American Osteopatic Association, a member organization of the National Cholesterol Education Program Coordinating Committee, which approved the Third Report of the National Cholesterol Education Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Dr Clearfield is a member of the speakers bureau of AstraZeneca, Merck & Co, Pfizer Inc, and Sankyo Pharma Inc, and he has received grant/research support from AstraZeneca and Pfizer Inc. Correspondence to Michael B. Clearfield, DO, Associate Dean for Clinical Research, Office of the Dean, Texas College of Osteopathic Medicine, University of North Texas Health Science Center at Fort Worth, 855 Montgomery St, Fort Worth, TX Clearfield Underidentification and undertreatment of dyslipidemia JAOA Supplement 1 Vol 103 No 1 January 2003 S5

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour

More information

An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia

An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates

More information

Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).

Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Complete Summary GUIDELINE TITLE (1)Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment

More information

Primary Care Management of Women with Hyperlipidemia. Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing

Primary Care Management of Women with Hyperlipidemia. Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing Primary Care Management of Women with Hyperlipidemia Julie Marfell, DNP, BC, FNP, Chairperson, Department of Family Nursing Objectives: Define dyslipidemia in women Discuss the investigation process leading

More information

THE THIRD REPORT OF THE EXpert

THE THIRD REPORT OF THE EXpert SPECIAL COMMUNICATION Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults

More information

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES

MANAGEMENT OF LIPID DISORDERS: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF LIPID DISORDERS: 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 EXPLAINING

More information

Statins for Hyperlipidemia (High Cholesterol)

Statins for Hyperlipidemia (High Cholesterol) Statins for Hyperlipidemia (High Cholesterol) Examples of statin drugs Brand Name Mevacor Pravachol Zocor Lescol, Lescol XL Lipitor Crestor Chemical Name lovastatin pravastatin sodium simvastatin fluvastatin

More information

Understanding and Managing Your. Triglycerides

Understanding and Managing Your. Triglycerides Understanding and Managing Your Triglycerides What are Triglycerides? There are several types are one of several types of fat in your body, and triglycerides are the most common. Along with LDL ( bad )

More information

Managing Dyslipidemias in Patients With Chronic Kidney Disease

Managing Dyslipidemias in Patients With Chronic Kidney Disease Managing Dyslipidemias in Patients With Chronic Kidney Disease Causes of Death Among Period Prevalent Patients, 1997-1999, Treated with Hemodialysis, Peritoneal Dialysis or Kidney Transplantation Abbreviations:

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and obesity History: A 13-year-old girl is seen for a routine clinic follow-up visit. She has been previously healthy, but her growth curve shows increasing body mass index (BMI) percentiles

More information

First step: determine the goal for dyslipidemia treatment (primary prevention vs. secondary prevention)

First step: determine the goal for dyslipidemia treatment (primary prevention vs. secondary prevention) The American college of cardiology (ACC) and American Heart Association (AHA) in combination with National Heart, Lung and blood institute (NHLBI) have released 4 new guidelines. At the invitation of the

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE

ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.

More information

Guidelines for the management of dyslipidaemia in patients with diabetes mellitus

Guidelines for the management of dyslipidaemia in patients with diabetes mellitus Guidelines for the management of dyslipidaemia in patients with diabetes mellitus Quick reference guide More than 60% of type 2 diabetic subjects in the Eastern Mediterranean Region have some degree of

More information

Lipid-lowering: Can ezetimibe help close the treatment gap?

Lipid-lowering: Can ezetimibe help close the treatment gap? REVIEW CME CREDIT RYAN C. NEAL, MD* Assistant Professor of Medicine, Baylor College of Medicine, Houston, Texas PETER H. JONES, MD Associate Professor of Medicine, Baylor College of Medicine, Houston,

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

The relationship between diabetes and vascular

The relationship between diabetes and vascular CLINICAL TRIAL OVERVIEW: ROLE OF CHOLESTEROL-REDUCING AGENTS IN PATIENTS WITH DIABETES * Lawrence A. Leiter, MD, FRCPC, FACP ABSTRACT Approximately 80% of diabetic patients will die of vascular disease,

More information

High Blood Cholesterol What you need to know

High 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 information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and type 2 diabetes mellitus History: A 17-year-old Hispanic female patient is seen for a routine clinic follow-up visit. She was diagnosed with type 2 diabetes 6 months ago. Her hemoglobin

More information

Education. Panel. Triglycerides & HDL-C

Education. Panel. Triglycerides & HDL-C Triglycerides & HDL-C Thomas Dayspring, MD, ACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph s s Hospital, Paterson, NJ Certified

More information

A CLOSER L OOK AT A JOINT PROJECT BETWEEN T HE A MERICAN H EART A SSOCIATION AND T HE N ATIONAL P HARMACEUTICAL C OUNCIL

A CLOSER L OOK AT A JOINT PROJECT BETWEEN T HE A MERICAN H EART A SSOCIATION AND T HE N ATIONAL P HARMACEUTICAL C OUNCIL A CLOSER L OOK AT Americans pay $53.4 billion each year for medical care of heart disease. An additional $47.4 billion is lost due to premature death and lower productivity. A JOINT PROJECT BETWEEN T HE

More information

Shared Decision Making

Shared Decision Making Deciding what to do about high cholesterol This short decision aid is to help you decide what to do about your high cholesterol. You can use it on your own, or with your doctor, to help you make a decision

More information

Welchol (colesevelam HCl) Receives FDA Approval to Reduce Blood Glucose in Adults with Type 2 Diabetes

Welchol (colesevelam HCl) Receives FDA Approval to Reduce Blood Glucose in Adults with Type 2 Diabetes For Immediate Release Company name: DAIICHI SANKYO COMPANY, LIMITED Representative: Takashi Shoda, President and Representative Director (Code no.: 4568, First Section, Tokyo, Osaka and Nagoya Stock Exchanges)

More information

Omega-3 Fatty Acid Products

Omega-3 Fatty Acid Products Omega-3 Fatty Acid Products Policy Number: 5.01.563 Last Review: 7/2016 Origination: 6/2014 Next Review: 7/2017 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for the

More information

Prevention of Cardiovascular Disease in Children with Diabetes

Prevention of Cardiovascular Disease in Children with Diabetes Prevention of Cardiovascular Disease in Children with Diabetes Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine The Children s Hospital Anschutz Medical Campus

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

Pediatric Metabolic Syndrome

Pediatric Metabolic Syndrome University of Michigan Hospitals and Health Centers Pediatric Metabolic Syndrome A growing epidemic Shannon Russell Dietetic Intern June 2012 Overview Causes Risk Factors Signs and Symptoms Identification/Diagnosis

More information

Anti-Atheroscrerotic Drugs

Anti-Atheroscrerotic Drugs Anti-Atheroscrerotic Drugs Masuko Ushio-Fukai, PhD, FAHA Dept. of Pharmacology University of Illinois at Chicago Anti-Atherogenic Drugs: Treatment of Hyperlipidemias Knowledge Objectives: 1) Know the mechanism

More information

Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines

Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell

More information

What You Need to Know about High Blood Cholesterol

What You Need to Know about High Blood Cholesterol What You Need to Know about High Blood Why is high cholesterol bad? is a natural substance found in our diet and made by our liver. It is important for many functions throughout our body. High blood cholesterol

More information

Role of Body Weight Reduction in Obesity-Associated Co-Morbidities

Role of Body Weight Reduction in Obesity-Associated Co-Morbidities Obesity Role of Body Weight Reduction in JMAJ 48(1): 47 1, 2 Hideaki BUJO Professor, Department of Genome Research and Clinical Application (M6) Graduate School of Medicine, Chiba University Abstract:

More information

Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines

Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines Amit Sachdeva, MD, a Christopher P. Cannon, MD, b Prakash C. Deedwania,

More information

NUTS! The Story of My Life. Prof. Joan Sabaté Department of Nutrition Loma Linda University

NUTS! The Story of My Life. Prof. Joan Sabaté Department of Nutrition Loma Linda University NUTS! The Story of My Life Prof. Joan Sabaté Department of Nutrition Loma Linda University Dr. Joan Sabate Chair, Nutrition, School of Public Health, Loma Linda University CA From Spain, Dr. Sabaté is

More information

Will The Coronary Calcium Score Affect the Decision To Treat With Statins?

Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Amresh Raina M.D. Division of Cardiology University of Pennsylvania Disclosures No financial relationships relevant to this presentation

More information

Cholesterol a biomolecule Bad cholesterol a strange tale Good cholesterol - indeed

Cholesterol a biomolecule Bad cholesterol a strange tale Good cholesterol - indeed Cholesterol a biomolecule Bad cholesterol a strange tale Good cholesterol - indeed Thomas B. Kuhn: University of Alaska, Cereon Biotechnology LLC This document is protected by copyright Dr. Thomas B. Kuhn

More information

Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment

Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment Your healthcare provider has ordered a Boston Heart Cardiac Risk Assessment What does that mean for you? Your healthcare provider has determined that you may be at risk for cardiovascular disease (CVD).

More information

Cholesterol and Triglycerides What You Should Know

Cholesterol and Triglycerides What You Should Know Cholesterol and Triglycerides What You Should Know Michael T. McDermott MD Professor of Medicine Endocrinology Practice Director Division of Endocrinology, Metabolism and Diabetes University of Colorado

More information

At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention?

At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention? European Heart Journal (2001) 22, 919 925 doi:10.1053/euhj.2000.2484, available online at http://www.idealibrary.com on At what coronary risk level is it cost-effective to initiate cholesterol lowering

More information

ROLE OF PLANT STEROLS AND STANOLS IN A CHOLESTEROL LOWERING DIET

ROLE OF PLANT STEROLS AND STANOLS IN A CHOLESTEROL LOWERING DIET ROLE OF PLANT STEROLS AND STANOLS IN A CHOLESTEROL LOWERING DIET OUTLINE What are plant sterols/stanols? Mechanism of action What is the evidence for plant sterols/stanols in cholesterol lowering? An additive

More information

OVERVIEW OF THE ADULT TREATMENT PANEL (ATP) III GUIDELINES *

OVERVIEW OF THE ADULT TREATMENT PANEL (ATP) III GUIDELINES * OVERVIEW OF THE ADULT TREATMENT PANEL (ATP) III GUIDELINES * Roger S. Blumenthal, MD INTRODUCTION Although medical evidence suggests that the mortality rates for cardiovascular disease can be significantly

More information

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process

More information

Initiation and Adjustment of Insulin Regimens

Initiation and Adjustment of Insulin Regimens Start with bedtime intermediateacting insulin or bedtime or morning long-acting insulin (can initiate with 10 units or 0.2 units per kg) Initiation and Adjustment of Insulin Regimens Insulin regimens should

More information

SEDICO Newsletter Volume 7 Omega-3 Fatty Acids & Statins

SEDICO Newsletter Volume 7 Omega-3 Fatty Acids & Statins Omega-3 fatty acids on heart function (including anti-arrhythmic effects), hemo-dynamics (cardiac mechanics) and arterial endothelial function. The link between omega-3 fatty acids and CVD risk reduction

More information

Statins: Can there be too much of a good thing?

Statins: Can there be too much of a good thing? Statins: Can there be too much of a good thing? Spoiler alert No Oh Contraire Haaaaiiiiiiile No! Frequently under prescribing statin therapy! Typical Case 68 YO Smoker ACS Multiple prior PCI s Multiple

More information

Secondary Prevention and Rehabilitation

Secondary Prevention and Rehabilitation Secondary Prevention and Rehabilitation Effectiveness of a planned strategy using cardiac rehabilitation nurses for the management of dyslipidemia in patients with coronary artery disease Manohara P. J.

More information

Expert Commentary. A response to the recent JAMA meta analysis on omega 3 supplementation and cardiovascular events

Expert Commentary. A response to the recent JAMA meta analysis on omega 3 supplementation and cardiovascular events Expert Commentary A response to the recent JAMA meta analysis on omega 3 supplementation and cardiovascular events Dr. Bruce J. Holub, Ph.D., Professor Emeritus, University of Guelph Expert Commentary:

More information

Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes

Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes Obesity Approximately 1 in 3 adults are overweight in the U.S. Arizona According to CDC, Arizona has highest reported percentage of adults who

More information

BMC Med 7/19/2007; Simvastatin linked to reduced incidence of dementia, Parkinson s disease.

BMC Med 7/19/2007; Simvastatin linked to reduced incidence of dementia, Parkinson s disease. March 3, 2012 BD Response to FDA statement regarding Statins The Food and Drug Administration announced on Tuesday (February 28, 2012) the changes to the safety information on the labels of statins regarding

More information

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2

More information

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease

ESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening

More information

The Canadian Association of Cardiac

The Canadian Association of Cardiac Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a

More information

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Genetics in Primary Care: A Faculty Development Initiative A resident asks... Why should a primary care doctor want to know about genetics and cardiovascular (CV) disease? Key Points:

More information

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications CHAPTER V DISCUSSION Background Diabetes mellitus is a chronic condition but people with diabetes can lead a normal life provided they keep their diabetes under control. Life style modifications (LSM)

More information

Cholesterol Congestion

Cholesterol Congestion Cholesterol Congestion How your blood cholesterol traffic is measured The odds of getting cardiovascular disease are very high; it is the main cause of death in the US and more than one in four Americans

More information

YOUR GUIDE TO. Managing and Understanding Your Cholesterol Levels

YOUR GUIDE TO. Managing and Understanding Your Cholesterol Levels YOUR GUIDE TO Managing and Understanding Your Cholesterol Levels Our goal at the Mercy Health Heart Institute is to help you be well. Our experienced team includes cardiologists, cardiovascular surgeons,

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

MY TYPE 2 DIABETES NUMBERS

MY TYPE 2 DIABETES NUMBERS BLOOD SUGAR MANAGEMENT GUIDE MY TYPE 2 DIABETES NUMBERS Understanding and Tracking the ABCs of Type 2 Diabetes 1 BLOOD MY TYPE SUGAR 2 DIABETES MANAGEMENT ABC NUMBERS GUIDE When you have type 2 diabetes,

More information

To describe different types of cholesterol and their metabolism. To recognize when to treat in different age groups

To describe different types of cholesterol and their metabolism. To recognize when to treat in different age groups To describe different types of cholesterol and their metabolism To identify when to start screening To recognize when to treat in different age groups To list the treatment goals and different treatment

More information

Guidelines for the management of hypertension in patients with diabetes mellitus

Guidelines for the management of hypertension in patients with diabetes mellitus Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes

More information

HYPERCHOLESTEROLAEMIA STATIN AND BEYOND

HYPERCHOLESTEROLAEMIA STATIN AND BEYOND HYPERCHOLESTEROLAEMIA STATIN AND BEYOND Andrea Luk Division of Endocrinology Department of Medicine & Therapeutics The Chinese University of Hong Kong HA Convention 4 May 2016 Statins reduce CVD and all-cause

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

International Task Force for Prevention Of Coronary Heart Disease. Clinical management of risk factors. coronary heart disease (CHD) and stroke

International Task Force for Prevention Of Coronary Heart Disease. Clinical management of risk factors. coronary heart disease (CHD) and stroke International Task Force for Prevention Of Coronary Heart Disease Clinical management of risk factors of coronary heart disease and stroke Economic analyses of primary prevention of coronary heart disease

More information

Absolute cardiovascular disease risk management

Absolute cardiovascular disease risk management Quick reference guide for health professionals Absolute cardiovascular disease risk management This quick reference guide is for use by health professionals for primary prevention of cardiovascular disease

More information

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D.

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D. TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type

More information

Many asymptomatic individuals

Many asymptomatic individuals Facts, myths and misconceptions about LDL-C and HDL-C By Michael B. Clearfield, DO Many asymptomatic individuals will succumb to cardiovascular disease (CVD), which is the leading cause of death and loss

More information

Potential Clinical and Economic Impact of Statin Formulary Management

Potential Clinical and Economic Impact of Statin Formulary Management Potential Clinical and Economic Impact of Statin Formulary Management Karol E. Watson, MD Summary The evidence is clear that aggressive management of cardiac risk factors is beneficial and generally safe

More information

JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014

JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates. January 30, 2014 JNC-8 Blood Pressure and ACC/AHA Cholesterol Guideline Updates January 30, 2014 GOALS Review key recommendations from recently published guidelines on blood pressure and cholesterol management Discuss

More information

Pharmacy Coverage Guidelines are subject to change as new information becomes available.

Pharmacy Coverage Guidelines are subject to change as new information becomes available. capsule, VASCEPA (icosapent ethyl) oral capsule Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This

More information

Cardiovascular Effects of Drugs to Treat Diabetes

Cardiovascular Effects of Drugs to Treat Diabetes Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:

More information

Main Effect of Screening for Coronary Artery Disease Using CT

Main Effect of Screening for Coronary Artery Disease Using CT Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,

More information

HEDIS CY2012 New Measures

HEDIS CY2012 New Measures HEDIS CY2012 New Measures TECHNICAL CONSIDERATIONS FOR NEW MEASURES The NCQA Committee on Performance Measurement (CPM) approved five new measures for HEDIS 2013 (CY2012). These measures provide feasible

More information

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION

PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION Hull & East Riding Prescribing Committee PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION For guidance on Primary Prevention please see NICE guidance http://www.nice.org.uk/guidance/cg181

More information

Michel Farnier 1, Kjetil Retterstøl 2, Miroslaw Dluzniewski 3, Albert Császár 4, Armin Steinmetz 5. Dijon, France; 2 Oslo, Norway; 3 Warsaw, Poland; 4

Michel Farnier 1, Kjetil Retterstøl 2, Miroslaw Dluzniewski 3, Albert Császár 4, Armin Steinmetz 5. Dijon, France; 2 Oslo, Norway; 3 Warsaw, Poland; 4 Comparative efficacy and safety of Fenofibrate/Pravastatin/Ezetimibe therapy and Simvastatin/Ezetimibe therapy in Type 2 Diabetic patients with combined hyperlipidemia and cardiovascular disease Michel

More information

Listen to your heart: Good Cardiovascular Health for Life

Listen to your heart: Good Cardiovascular Health for Life Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular

More information

High Cholesterol (Dyslipidemia)

High Cholesterol (Dyslipidemia) High Cholesterol (Dyslipidemia) What is high cholesterol? Cholesterol is a type of fat that is found in every cell in the body. It is used to build healthy cells and some vital hormones. High levels of

More information

HEALTH CLAIMS ON PECTINS APPROVED BY EFSA

HEALTH CLAIMS ON PECTINS APPROVED BY EFSA HEALTH CLAIMS ON PECTINS APPROVED BY EFSA Scientific Opinion on the substantiation of health claims related to pectins and reduction of post-prandial glycaemic responses (ID 786) and maintenance of normal

More information

Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland

Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland Associate Professor Patrick Kay Interventional cardiologist Middlemore, Auckland and Mercy Hospitals Auckland 14:00-14:55 WS #45: New Therapies for Lipid Management 15:05-16:00 WS #57: New Therapies for

More information

Using an EMR to Improve Quality of Care in a National Network

Using an EMR to Improve Quality of Care in a National Network Using an EMR to Improve Quality of Care in a National Network James M. Gill, MD, MPH Associate Professor of Family Medicine Senior Scientist in Health Policy Jefferson Medical College, Philadelphia, PA

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

Article. Heart health and cholesterol levels of Canadians, 2007 to 2009. Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets

Article. Heart health and cholesterol levels of Canadians, 2007 to 2009. Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets Component of Statistics Canada Catalogue no. 82-625-X Health Fact Sheets Article Heart health and cholesterol levels of Canadians, 2007 to 2009 March How to obtain more information For information about

More information

Acquired Heart Disease: Prevention and Treatment

Acquired Heart Disease: Prevention and Treatment Acquired Heart Disease: Prevention and Treatment Prevention and Treatment Sharon L. Roble, MD Assistant Professor Adult Congenital Heart Program The Ohio State University/Nationwide Children s Hospital

More information

Effect of an Intervention to Increase Statin Use in Medicare Members Who Qualified for a Medication Therapy Management Program

Effect of an Intervention to Increase Statin Use in Medicare Members Who Qualified for a Medication Therapy Management Program RESEARCH Effect of an Intervention to Increase Statin Use in Medicare Members Karen M. Stockl, PharmD; Daniel Tjioe, PharmD; Sherry Gong, MS; Jenni Stroup, BA; Ann S. M. Harada, PhD, MPH; and Heidi C.

More information

Management of Lipids in 2015: Just Give them a Statin?

Management of Lipids in 2015: Just Give them a Statin? Management of Lipids in 2015: Just Give them a Statin? James H. Stein, M.D. Division of Cardiovascular Medicine University of Wisconsin School of Medicine and Public Health Stone NJ, et al. Circulation

More information

Cholesterol for Your Health. Things that you will learn from reading through this packet include:

Cholesterol for Your Health. Things that you will learn from reading through this packet include: Page 1 of 6 PHA-GEN-003-2004 Cholesterol for Your Health Things that you will learn from reading through this packet include: What the fuss about cholesterol and other lipids is all about What the risk

More information

Prescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003 2012

Prescription Cholesterol-lowering Medication Use in Adults Aged 40 and Over: United States, 2003 2012 NCHS Data Brief No. 77 December 4 Prescription Cholesterol-lowering Medication Use in Adults Aged 4 and Over: United States, 3 2 Qiuping Gu, M.D., Ph.D.; Ryne Paulose-Ram, Ph.D., M.A.; Vicki L. Burt, Sc.M.,

More information

Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075

Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075 Title: Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075 Investigator: Institution: Gail Gates, PhD, RD/LD Oklahoma State University Date

More information

Triglycerides are an important measure of heart health. Here's why triglycerides matter and what to do if your triglycerides are too high.

Triglycerides are an important measure of heart health. Here's why triglycerides matter and what to do if your triglycerides are too high. Diseases and Conditions High cholesterol Triglycerides are an important measure of heart health. Here's why triglycerides matter and what to do if your triglycerides are too high. By Mayo Clinic Staff

More information

Obesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000

Obesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 P F I Z E R F A C T S Obesity in the United States Workforce Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 p p Obesity in The United States Workforce One

More information

GUIDELINES FOR DIET CONTROL IN DIABETES MELLITUS Importance of Food Exchange Lists and Perspectives for the Future *

GUIDELINES FOR DIET CONTROL IN DIABETES MELLITUS Importance of Food Exchange Lists and Perspectives for the Future * 57 GUIDELINES FOR DIET CONTROL IN DIABETES MELLITUS Importance of Food Exchange Lists and Perspectives for the Future * Hiroshi KAJINUMA** Asian Med. J. 44(2): 57 63, 2001 Abstract: Food Exchange List

More information

Rx Updates New Guidelines, New Medications What You Need to Know

Rx Updates New Guidelines, New Medications What You Need to Know Rx Updates New Guidelines, New Medications What You Need to Know Maria Pruchnicki, PharmD, BCPS, BCACP, CLS Associate Professor of Clinical Pharmacy OSU College of Pharmacy Background scope and impact

More information

Clinical Practice Guidelines for Diabetes Management

Clinical Practice Guidelines for Diabetes Management Clinical Practice Guidelines for Diabetes Management Diabetes is a disease in which blood glucose levels are above normal. Over the years, high blood glucose damages nerves and blood vessels, which can

More information

Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007

Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007 Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007 The cardiometabolic risk syndrome is increasingly recognized

More information

HANDBOOKS for HEALTH MANAGING CHOLESTEROL

HANDBOOKS for HEALTH MANAGING CHOLESTEROL HANDBOOKS for HEALTH MANAGING CHOLESTEROL WELCOA s Handbooks for Health target health problems that need the most attention. EDUCATE YOUR EMPLOYEES WELCOA s Handbooks for Health target health problems

More information

Coronary Heart Disease (CHD) Brief

Coronary Heart Disease (CHD) Brief Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs

More information

An important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and

An important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and An important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and CoaguChek systems Cardiovascular disease: the #1 killer in

More information

LDL-CHOLESTEROL REDUCTION AND CHD-COST SAVINGS THROUGH PHYTOSTEROL AND PSYLLIUM DIETARY FIBER USAGE

LDL-CHOLESTEROL REDUCTION AND CHD-COST SAVINGS THROUGH PHYTOSTEROL AND PSYLLIUM DIETARY FIBER USAGE LDL-CHOLESTEROL REDUCTION AND CHD-COST SAVINGS THROUGH PHYTOSTEROL AND PSYLLIUM DIETARY FIBER USAGE Reducing an individual s LDL cholesterol level will help to reduce his or her odds of experiencing a

More information

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program High Blood Cholesterol Detection Evaluation Treatment Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and

More information

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?

More information

Cardiovascular Disease Risk Factors

Cardiovascular Disease Risk Factors Cardiovascular Disease Risk Factors Risk factors are traits and life-style habits that increase a person's chances of having coronary artery and vascular disease. Some risk factors cannot be changed or

More information

National Lipid Association 2014 Scientific Sessions, Orlando, FL

National Lipid Association 2014 Scientific Sessions, Orlando, FL National Lipid Association 2014 Scientific Sessions, Orlando, FL Lori Alexander, MSHS, RD, CCRC, CLS, FNLA Site Director St Johns Center for Clinical Research Ponte Vedra, FL Financial Disclosures None

More information