Imaging atherosclerotic plaque inflammation in rheumatoid arthritis: methodology and initial findings in a single centre cohort study

Size: px
Start display at page:

Download "Imaging atherosclerotic plaque inflammation in rheumatoid arthritis: methodology and initial findings in a single centre cohort study"

Transcription

1 Imaging atherosclerotic plaque inflammation in rheumatoid arthritis: methodology and initial findings in a single centre cohort study Dr. Sarah Skeoch Clinical Research Fellow Centre for Musculoskeletal Research University of Manchester

2 Disclosures No conflicts of interest

3 Introduction Rheumatoid arthritis(ra) is associated with a 50% increase in cardiovascular mortality Less warning symptoms and worse outcomes Risk varies within the RA population No reliable method to identify high risk patients early in disease

4 Atherosclerosis Known to be a chronic inflammatory condition Plaque inflammation and composition are key determinants of plaque stability J Am Coll Cardiol. 2011;57(20):

5 Atherosclerosis Known to be a chronic inflammatory condition Plaque inflammation and composition are key determinants of plaque stability J Am Coll Cardiol. 2011;57(20):

6 Atherosclerosis in RA Driven by chronic inflammation Paucity of histological evidence about the type of lesions in RA There may be a more inflammatory, unstable plaque phenotype Impact of anti-inflammatory therapies is unclear Low grade inflammation may continue to drive atherosclerosis

7 Contrast enhanced carotid MRI Allows assessment of: Burden Phenotype Inflammation Validated against histology Carotid MRI and matched histology. Chu.B. Radiology 2009 Used to study predictors of cardiovascular events and effects of lipid lowering therapy on plaque

8 18F FDG-PET-CT Detects plaque inflammation Correlates with histology and clinical symptoms Sensitive to change following treatment FDG-MRI of symptomatic carotid artery plaque. Rudd. J.H Aortic PET used to detect vascular inflammation in RA

9 Hypothesis Carotid MRI and PET imaging could be employed to detect atherosclerotic plaque inflammation in patients with RA

10 Aims To test the feasibility of using carotid MRI and PET to evaluate plaque inflammation in RA patients To assess if there was an early indication that RA patients have inflamed plaque Inform a larger study to investigate plaque phenotype in RA

11 Methods

12 Study population Prospective pilot study Inclusion criteria Age years Diagnosis of RA >1 year Active joint disease (DAS-28 score> 3.2) Major exclusion criteria Statin therapy within the last 3 months Renal Impairment (egfr<60) Contra-indication to MRI

13 Study design Plaque >2mm thickness present No history of recent infection, uncontrolled diabetes or cancer

14 Results

15 Recruitment and retention 57 Patients screened 12 (21%) had plaque>2mm thickness 6 (10%) had plaque confirmed on MRI

16 Cohort characteristics Characteristics of MRI cohort Median [IQR] or frequency (total=6) Female 5 Median age (years) 57[55,59] Current smoker 3 History of CVD 1 RA disease duration (years) 9[2,20] LDL cholesterol (mmol/l) 2.82[2.13, 3.03] ESR(mm/hr) 29[17,35] Disease activity 28 score 5.15[4.69, 6.55] Degree of vessel stenosis (%) 54.5[48,59]

17 MRI showing plaque inflammation

18 MRI showing plaque inflammation Lumen Plaque

19 MRI showing plaque inflammation Lumen Plaque

20 MRI showing plaque inflammation Lumen Plaque

21 MRI showing plaque inflammation Lumen Lumen Plaque Plaque K trans Contrast enhancement was seen in all cases (median K trans =0.046[0.023, 0.105] min -1 ) All lesions were calcified and 5/6 had evidence of lipid core

22 18F FDG-PET Significant 18F FDG uptake was seen in all cases (Median SUV max =2.22[1.67, 2.95])

23 Summary Initial findings suggest plaque inflammation can be detected using both techniques Prevalence of suitable plaque was lower than estimated There is an discrepancy between ultrasound and MRI findings

24 Further work Larger prospective case control study of RA patients with longitudinal follow up Future applications: Study natural history of atherosclerosis in RA Evaluation of new and existing therapies

25 Acknowledgements Supervisors Professor Ian Bruce Professor John Waterton Professor Yvonne Alexander Funding and support * Collaborators Penny Hubbard Heather Williams Paul Hockings Jacqueline James Mary Prescott Department of Radiology, University of Washington Participating Centres in the North West NIHR Manchester Musculoskeletal Biomedical Research Unit NIHR/ Wellcome Trust Clinical Research Facility Greater Manchester Clinical Research Network *North West England Medical Research Council Fellowship Scheme in Clinical Pharmacology and Therapeutics, which is funded by the Medical Research Council (grant number G /94909), ICON, GlaxoSmithKline, AstraZeneca and the Medical Evaluation Unit.

Coronary artery calcium scoring. Con Aroney AM MD, FRACP, FCSANZ Queensland Cardiology

Coronary artery calcium scoring. Con Aroney AM MD, FRACP, FCSANZ Queensland Cardiology Coronary artery calcium scoring Con Aroney AM MD, FRACP, FCSANZ Queensland Cardiology Predicting cardiac events in asymptomatic people Risk Factors Hypertension Smoking Dyslipidemia Family History Diabetes/

More information

Exercise Stress Electrocardiography. Historical Perspective. Historical Perspective. Subject Population. Learning Objectives. ECG Exercise Testing

Exercise Stress Electrocardiography. Historical Perspective. Historical Perspective. Subject Population. Learning Objectives. ECG Exercise Testing Learning Objectives Exercise Stress Electrocardiography Gerald F. Fletcher MD Mayo Clinic Florida No Disclosures Provide an understanding of the value of the multiple ECG and Physiological measures that

More information

Quality and Outcomes Framework Programme. NICE cost impact statement

Quality and Outcomes Framework Programme. NICE cost impact statement Quality and Outcomes Framework Programme NICE cost impact statement July 2011 Indicator area: Peripheral arterial disease Indicators NM32 The practice can produce a register of people with peripheral arterial

More information

Treatment of Sexual dysfunction associated with CVD. Graham Jackson Consultant Cardiologist Guy s & St Thomas Hospital, London, UK.

Treatment of Sexual dysfunction associated with CVD. Graham Jackson Consultant Cardiologist Guy s & St Thomas Hospital, London, UK. Treatment of Sexual dysfunction associated with CVD Graham Jackson Consultant Cardiologist Guy s & St Thomas Hospital, London, UK. Recommendation 1 A significant proportion of men with erectile dysfunction

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

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

Atherosclerosis of the aorta. Artur Evangelista

Atherosclerosis of the aorta. Artur Evangelista Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis

More information

1/10/2015. Disclosures

1/10/2015. Disclosures % deaths 1//15 Disclosures Management guidelines for HIVrelated Co-morbidities Result in Increased Screening but no change in Primary Prevention Implementation Trevillyan JM, Dart A, Topliss DJ, Walker

More information

Noninvasive imaging of the vulnerable plaque in 2012

Noninvasive imaging of the vulnerable plaque in 2012 Coronary heart disease: what s new? Noninvasive imaging of the vulnerable plaque in 2012 Federico Conrotto Definition of Vulnerable Plaque The susceptibility of a plaque to rupture Circulation 1989; 79:

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

Comparison of the Progression of Coronary Atherosclerosis for Two High Efficacy Statin Regimens with Different HDL Effects: SATURN Study Results

Comparison of the Progression of Coronary Atherosclerosis for Two High Efficacy Statin Regimens with Different HDL Effects: SATURN Study Results Comparison of the Progression of Coronary Atherosclerosis for Two High Efficacy Statin Regimens with Different HDL Effects: SATURN Study Results SJ Nicholls, CM Ballantyne, PJ Barter, MJ Chapman, RM Erbel,

More information

Carotid Stenting Current Indications. 24 August 2016 Christopher Bajzer

Carotid Stenting Current Indications. 24 August 2016 Christopher Bajzer Carotid Stenting Current Indications 24 August 2016 Christopher Bajzer Conflict of Interest None Carotid Atherosclerosis Why Intervene? Annual risk of having a stroke is a function of degree of stenosis

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

Medicare Evidence Development & Coverage Advisory Committee Management of Carotid Atherosclerosis January 25, 2012

Medicare Evidence Development & Coverage Advisory Committee Management of Carotid Atherosclerosis January 25, 2012 Medicare Evidence Development & Coverage Advisory Committee Management of Carotid Atherosclerosis January 25, 2012 The American Heart Association (AHA) and the American Stroke Association (ASA), a division

More information

Chapter 22: Diagnostic Procedures for Cardiovascular Disease

Chapter 22: Diagnostic Procedures for Cardiovascular Disease Chapter 22: Diagnostic Procedures for Cardiovascular Disease American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:

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

Imaging of Atherosclerosis with PET-CT

Imaging of Atherosclerosis with PET-CT Imaging of Atherosclerosis with PET-CT Ahmed Tawakol, MD Co-Director Cardiac MR PET CT Program Mass General Hospital Assistant Professor Harvard Medical School Disclosures Research Grants: NIH, Roche/Genentech,

More information

The influence of anti-tnf therapy upon incidence of solid cancer in patients with rheumatoid arthritis. Louise Mercer

The influence of anti-tnf therapy upon incidence of solid cancer in patients with rheumatoid arthritis. Louise Mercer The influence of anti-tnf therapy upon incidence of solid cancer in patients with rheumatoid arthritis Louise Mercer Disclosure Presenter BSR receives restricted income financial support from Abbott Laboratories,

More information

CCS Dyslipidemia Guidelines Update: Emerging Evidence and 2015 Draft Recommendations Discussion

CCS Dyslipidemia Guidelines Update: Emerging Evidence and 2015 Draft Recommendations Discussion CCS Update: Emerging Evidence and 2015 Draft Recommendations Discussion March 2016 Todd Anderson Libin Cardiovascular Institute Todd Anderson Disclosures Advisory board: Merck Clinical Trials: AMGEN, Merck,

More information

Jenny Humphreys Arthritis Research UK Clinical Research Fellow University of Manchester

Jenny Humphreys Arthritis Research UK Clinical Research Fellow University of Manchester Incidence of rheumatoid arthritis in the UK using the 2010 ACR/EULAR classification criteria; and comparison with estimates using the 1987 ACR criteria Jenny Humphreys Arthritis Research UK Clinical Research

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

Official reprint from UpToDate UpToDate

Official reprint from UpToDate UpToDate Official reprint from UpToDate www.uptodate.com 2013 UpToDate The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek

More information

Always Start with PECO

Always Start with PECO Goals of This Course Be able to understand a study design (very basic concept) Be able to understand statistical concepts in a medical paper Be able to perform a data analysis Understanding: PECO study

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

Disclosures. Can We Optimize Individual Care Without Knowledge of Particle Number?

Disclosures. Can We Optimize Individual Care Without Knowledge of Particle Number? Can We Optimize Individual Care Without Knowledge of Particle Number? William Cromwell, MD, FAHA, FNLA Diplomate, American Board of Clinical Lipidology Chief Lipoprotein and Metabolic Disorders Institute

More information

Status of Coronary Calcium Scoring in the Lung Screening Setting

Status of Coronary Calcium Scoring in the Lung Screening Setting Status of Coronary Calcium Scoring in the Lung Screening Setting Matthew Cham, M.D. Associate Professor of Radiology and Medicine The Icahn School of Medicine at Mount Sinai Lung Cancer Workshop X Prevent

More information

Ischemic vs. Embolic Stroke

Ischemic vs. Embolic Stroke Ischemic vs. Embolic Stroke Paul M. Katz, M.D. Director, Temple Stroke Program Professor Department of Neurology Temple University School of Medicine Stroke: Incidence and Cost in the United States 795,000

More information

CLEAN. What Do Your Arteries Look Like - Clean or Clogged? Thick or Thin? What Do Your Arteries Look Like - Clean or Clogged? Thick or Thin?

CLEAN. What Do Your Arteries Look Like - Clean or Clogged? Thick or Thin? What Do Your Arteries Look Like - Clean or Clogged? Thick or Thin? ASK YOUR DOCTOR ABOUT What Do Your Arteries Look Like - Clean or Clogged? Thick or Thin? CLEAN Visit www.cardiohealthtest.com an affiliated company of Panasonic Healthcare Co., Ltd. CardioHealth is a registered

More information

LLL Session - Nutritional support in respiratory diseases

LLL Session - Nutritional support in respiratory diseases ESPEN Congress Leipzig 2013 LLL Session - Nutritional support in respiratory diseases Issues related to obesity in COPD F. Franssen (NL) Issues related to obesity in COPD Frits M.E. Franssen, MD, PhD CIRO+,

More information

Objectives. Who faces a higher mortality from cardiovascular related illness? Epidemiology of CVD. Cardiovascular Disease Management in Women

Objectives. Who faces a higher mortality from cardiovascular related illness? Epidemiology of CVD. Cardiovascular Disease Management in Women Cardiovascular Disease Management in Objectives. Epidemiology 2. Risk Stratification 3. Depression Screening in 4. Aspirin Use in 5. Summary Lisa Ward, MD, MSPH, MS Associate Clinical Professor Santa Rosa

More information

Disclosures. Objective. Educational Need/Practice Gap. Lecture Content. CVD is an Inflammatory Disorder

Disclosures. Objective. Educational Need/Practice Gap. Lecture Content. CVD is an Inflammatory Disorder Findings from large clinical trials of anti-inflammatory drugs and vitamins to prevent heart attack and stroke Robert C. Block, MD, MPH, FACP, FNLA Associate Professor Dept of Public Health Sciences; Cardiology

More information

The worldwide burden of peripheral artery disease

The worldwide burden of peripheral artery disease www.tasc-2-pad.org The worldwide burden of peripheral artery disease The role of the physician Based on the Inter-Society Consensus Edited by Dr Kenneth Harris The University of Western Ontario, London,

More information

Cardiovascular Disease Prevention. Dr Nicole KARAM, MD, MPH Interventional Cardiology European Hospital Georges Pompidou

Cardiovascular Disease Prevention. Dr Nicole KARAM, MD, MPH Interventional Cardiology European Hospital Georges Pompidou Cardiovascular Disease Prevention Dr Nicole KARAM, MD, MPH Interventional Cardiology European Hospital Georges Pompidou Atherosclerotic CVD, especially CHD, remains the leading cause of premature death

More information

Is Lithoplasty followed by DCB the answer in case of calcified vessels?

Is Lithoplasty followed by DCB the answer in case of calcified vessels? Is Lithoplasty followed by DCB the answer in case of calcified vessels? William A. Gray MD DISRUPT PAD III Principal Investigator System Chief Division of Cardiovascular Disease Main Line Health Lankenau

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

PRALUENT (alirocumab) ICD-10 Pocket Guide

PRALUENT (alirocumab) ICD-10 Pocket Guide PRALUENT (alirocumab) ICD-10 Pocket Guide Your guide to ICD-10 coding for clinical atherosclerotic cardiovascular disease (ASCVD) INDICATION AND USAGE PRALUENT (alirocumab) is a PCSK9 (Proprotein Convertase

More information

New Imaging Management Solution Frequently Asked Questions

New Imaging Management Solution Frequently Asked Questions New Imaging Management Solution Frequently Asked Questions Beginning July 1, 2014, HealthKeepers, Inc. will require prospective clinical case review (prior authorization) for outpatient, nonemergent imaging

More information

Cholesterol Treatment Trialists (CTT) Collaboration. Slide deck

Cholesterol Treatment Trialists (CTT) Collaboration. Slide deck Cholesterol Treatment Trialists (CTT) Collaboration Slide deck CTT Collaboration: Background* History: Founded in 1993 (prior to publication of 4S trial in 1994) Original protocol published in 1995 Trial

More information

Diagnostic algorithms for CAD assessment Chronic stable angina- When is calcium score and CTA first choice? Prof.Dr. Stephen Schröder, FESC

Diagnostic algorithms for CAD assessment Chronic stable angina- When is calcium score and CTA first choice? Prof.Dr. Stephen Schröder, FESC Diagnostic algorithms for CAD assessment Chronic stable angina- When is calcium score and CTA first choice? Prof.Dr. Stephen Schröder, FESC Klinik für Kardiologie, Pneumologie und Angiologie mit Lokaler

More information

and successfully conclude the act of sexual intercourse to the satisfaction of themale-

and successfully conclude the act of sexual intercourse to the satisfaction of themale- Is Erectile Dysfunction the New Penile Angina? Nick Gerning General Cardiologist Interventional Cardiologist the ability to initiate, sustain and successfully conclude the act of sexual intercourse to

More information

South African Cholesterol Guidelines Compared

South African Cholesterol Guidelines Compared South African Cholesterol Guidelines Compared Jacqueline van Schoor, Amayeza Info Centre While infectious diseases are currently the leading cause of death in South Africa, cardiovascular disease (CVD)

More information

Definition and Evaluation of

Definition and Evaluation of The American Academy of Neurology (AAN) affirms the value of this paper as an educational tool for neurologists. Definition and Evaluation of Transient Ischemic Attack A Scientific Statement for Health

More information

Diabetes and Hyperlipidemia

Diabetes and Hyperlipidemia Diabetes and Hyperlipidemia State of the art 2010 Lars Rydén Karolinska Institutet Stockholm, Sweden Diabetes and hyperlipidemia Diabetes and hyperlipidemia Treatment targets Treatment targets Lipid category

More information

Plaque Inflammation Imaging in Severe Carotid Stenosis and Recurrent Cerebral Ischemia. Vijay K Sharma, MD 1,2. Prakash R Paliwal, MRCP 1

Plaque Inflammation Imaging in Severe Carotid Stenosis and Recurrent Cerebral Ischemia. Vijay K Sharma, MD 1,2. Prakash R Paliwal, MRCP 1 J of Nuclear Medicine Technology, first published online April 9, 2015 as doi:10.2967/jnmt.114.153627 Plaque Inflammation Imaging in Severe Carotid Stenosis and Recurrent Cerebral Ischemia Vijay K Sharma,

More information

OHTAC Recommendation

OHTAC Recommendation OHTAC Recommendation Multiple Sclerosis and Chronic Cerebrospinal Venous Insufficiency Presented to the Ontario Health Technology Advisory Committee in May 2010 May 2010 Issue Background A review on the

More information

Type 2 diabetes is a cardiovascular equivalent and should be treated aggressively!

Type 2 diabetes is a cardiovascular equivalent and should be treated aggressively! Type 2 diabetes is a cardiovascular equivalent and should be treated aggressively! Schramm TK et al, 2008 Circulation 117:1945, 2008 Steno-2: Major papers Lancet 1999; 353: 617-22 New Engl J Med 2003;

More information

How to find the Angina Template. AAA Home. EMR Tutorial Angina

How to find the Angina Template. AAA Home. EMR Tutorial Angina How to find the Angina Template AAA Home EMR Tutorial Angina 1 Master Tool Bar Icon When the Template button is clicked you will be presented with the preference list. If the Angina Template is listed

More information

Introduction 10/27/10 ROLE OF NOVEL BIOMARKERS IN DISEASE PREVENTION: CRP, CT CALCIUM, AND CYSTATIN C

Introduction 10/27/10 ROLE OF NOVEL BIOMARKERS IN DISEASE PREVENTION: CRP, CT CALCIUM, AND CYSTATIN C ROLE OF NOVEL BIOMARKERS IN DISEASE PREVENTION: CRP, CT CALCIUM, AND CYSTATIN C Michael G. Shlipak, MD, MPH Professor of Medicine, University of California, San Francisco Chief, Division of General Internal

More information

Drug Delivery and Drug Coated Balloons

Drug Delivery and Drug Coated Balloons Drug Delivery and Drug Coated Balloons Patrick B. Alexander, MD, FACC, FSCAI Interventional Cardiologist Medical Director Critical Limb Clinic Providence Heart Institute Southfield, MI 48075 Disclosure

More information

Dyslipidemia Mahmoud Hassanein, MD Plasma Lipoproteins Relation of lipoproteins to atherosclerosis: Measurement of plasma lipids

Dyslipidemia Mahmoud Hassanein, MD Plasma Lipoproteins Relation of lipoproteins to atherosclerosis: Measurement of plasma lipids Dyslipidemia 1. Mahmoud Hassanein, MD Professor of Cardiology - Alexandria University Plasma Lipoproteins * Lipoproteins are large macromolecular complexes that transport cholesterol and triglycerides

More information

SYSTEMIC LUPUS ERYTHEMATOSUS: PATHOGENESIS, CLINICAL MANIFESTATIONS AND DIAGNOSIS

SYSTEMIC LUPUS ERYTHEMATOSUS: PATHOGENESIS, CLINICAL MANIFESTATIONS AND DIAGNOSIS SYSTEMIC LUPUS ERYTHEMATOSUS: PATHOGENESIS, CLINICAL MANIFESTATIONS AND DIAGNOSIS IN-DEPTH DISCUSSION II Atherosclerosis in systemic lupus erythematosus In 1974, Urowitz et al. [1] described the bimodal

More information

American Association of Clinical Chemistry. Contois JH, et al. Clinical Chemistry 2009; 55:

American Association of Clinical Chemistry. Contois JH, et al. Clinical Chemistry 2009; 55: American Association of Clinical Chemistry Recommendations from AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices LDL particles, not simply LDL-C, play a central role in

More information

Spirometry, COPD and lung cancer

Spirometry, COPD and lung cancer Spirometry, COPD and lung cancer Associate Professor Robert Young BMedSc, MBChB, DPhil (Oxon), FRACP, FRCP University of Auckland, New Zealand Spirometry for those with smoking and dust exposures Risk

More information

Chronic kidney disease and cerebral small vessel disease

Chronic kidney disease and cerebral small vessel disease Chronic kidney disease and cerebral small vessel disease M. Arfan Ikram, MD PhD Department of Epidemiology, Radiology, Neurology Erasmus MC Rotterdam, The Netherlands No disclosures Kidney-brain: Two pulsating

More information

Diagnosis Code Crosswalk : ICD 9 CM to ICD 10 CM Coronary and Peripheral Vascular

Diagnosis Code Crosswalk : ICD 9 CM to ICD 10 CM Coronary and Peripheral Vascular Diagnosis Code Crosswalk : to Coronary and Peripheral Vascular 411.1 Intermediate coronary syndrome (unstable angina) I20.0 Unstable angina 412 Old myocardial infarction I25.2 Old myocardial infarction

More information

Challenges for up scaling treatment?

Challenges for up scaling treatment? Co-morbidities and co-medications of patients with chronic hepatitis C under specialist care in the UK Challenges for up scaling treatment? Dr Ben Hudson Dr Alex Walker Professor William Irving Disclosures

More information

Menopause- An Update Management Consensus & Controversies. Michel Abou Abdallah, MD. Reproductive Endocrinology

Menopause- An Update Management Consensus & Controversies. Michel Abou Abdallah, MD. Reproductive Endocrinology Menopause- An Update Management Consensus & Controversies Michel Abou Abdallah, MD. Reproductive Endocrinology Learning Objectives At the conclusion of this presentation, participants should be able to:

More information

Cardiovascular Combination Pharmacotherapy Global Summit, 2014 from concept to reality

Cardiovascular Combination Pharmacotherapy Global Summit, 2014 from concept to reality Cardiovascular Combination Pharmacotherapy Global Summit, 2014 from concept to reality Major Trials in Progress HOPE 3, HOPE 4, TIPS 3 Koon K. Teo, MB, PhD, McMaster University Melbourne May 8 th, 2014

More information

Lipid Management in CKD: Insights from the SHARP Trial

Lipid Management in CKD: Insights from the SHARP Trial 1 Lipid Management in CKD: Insights from the SHARP Trial George Bakris, MD, FAHA, FASN Professor of Medicine Director, Hypertensive Diseases Center The University of Chicago-Pritzker School of Medicine

More information

Disclosures (with apologies to the Wizard of Oz) A Brain; Heart; and COURAGE

Disclosures (with apologies to the Wizard of Oz) A Brain; Heart; and COURAGE 2008 Update: Tools for the Management of Stable Angina Disclosures (with apologies to the Wizard of Oz) A Brain; Heart; and COURAGE Daniel Edmundowicz, MS, MD, FACC Associate Professor Of Medicine Director,

More information

Transition of the High Tech Radiology Imaging Services Program Frequently Asked Questions

Transition of the High Tech Radiology Imaging Services Program Frequently Asked Questions Transition of the High Tech Radiology Imaging Services Program Frequently Asked Questions Effective January 1, 2011, Empire BlueCross BlueShield (Empire) will transition the administration of its diagnostic

More information

How the Data Will Influence Treatment of Carotid Disease The Symptomatic vs. the Asymptomatic Patient Challenges

How the Data Will Influence Treatment of Carotid Disease The Symptomatic vs. the Asymptomatic Patient Challenges How the 2013-2014 Data Will Influence Treatment of Carotid Disease The Symptomatic vs. the Asymptomatic Patient Challenges Ralph L. Sacco, MS MD FAHA FAAN FANA Olemberg Professor and Chair of Neurology

More information

Statin Therapy An Update on Adverse Effects. Aaron Weisbord, MD, FACC South County Cardiology Division

Statin Therapy An Update on Adverse Effects. Aaron Weisbord, MD, FACC South County Cardiology Division Statin Therapy An Update on Adverse Effects Aaron Weisbord, MD, FACC South County Cardiology Division Introduction Statin use has been associated with many potential side effects. Statin intolerance rates

More information

Diabetes and Chronic Kidney Disease. The CKD Symposium November 30, 2013 Melanie Brown, MD, FRCPC

Diabetes and Chronic Kidney Disease. The CKD Symposium November 30, 2013 Melanie Brown, MD, FRCPC Diabetes and Chronic Kidney Disease The CKD Symposium November 30, 2013 Melanie Brown, MD, FRCPC Outline Understand the link between diabetes and kidney disease Management of diabetic kidney disease Primarily

More information

Improving HDL Cholesterol: How, Why and NOW! Len Kravitz, Ph.D.

Improving HDL Cholesterol: How, Why and NOW! Len Kravitz, Ph.D. Improving HDL Cholesterol: How, Why and NOW! Len Kravitz, Ph.D. Cardiovascular disease, the number one cause of mortality with men and women in the U.S., is a cluster of problems of the heart and blood

More information

Montreal HIV and Aging cohort. Rau PR (1), Durand M (2, 6), Tremblay C (3, 6), Mansour S (4, 6), Bernard S (5, 6), Chartrand-Lefebvre C (1, 6)

Montreal HIV and Aging cohort. Rau PR (1), Durand M (2, 6), Tremblay C (3, 6), Mansour S (4, 6), Bernard S (5, 6), Chartrand-Lefebvre C (1, 6) Assessment of cardiovascular risk in middle to older-age HIV-infected patients with coronary artery calcium CT scoring: preliminary results of a crosssectional pilot study from the Montreal HIV and Aging

More information

SAMPLE Self Assessment Program Questions and Educational Critiques

SAMPLE Self Assessment Program Questions and Educational Critiques SAMPLESelfAssessmentProgramQuestionsandEducationalCritiques TheAmericanSocietyforPreventativeCardiologySelfAssessmentProgram(SAP)Seriesconsistsofa QuestionBookwithMultipleChoiceand/orMultipleTrue/FalseQuestionsandacorresponding

More information

Electronic Long-term Conditions Integrated Review Template (GM-ELIRT)

Electronic Long-term Conditions Integrated Review Template (GM-ELIRT) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester Electronic Long-term Conditions Integrated Review Template (GM-ELIRT) Trish Gray Research Fellow, NIHR GM CLAHRC

More information

Traumatic Carotid and Vertebral Artery Injuries. William W. Scott, MD Assistant Professor, Department of Neurosurgery University of South Alabama

Traumatic Carotid and Vertebral Artery Injuries. William W. Scott, MD Assistant Professor, Department of Neurosurgery University of South Alabama Traumatic Carotid and Vertebral Artery Injuries William W. Scott, MD Assistant Professor, Department of Neurosurgery University of South Alabama 10 Year Retrospective Analysis of Clinical and Radiographic

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

Geriatric Grand Rounds

Geriatric Grand Rounds Geriatric Grand Rounds TIA; underrecognized, undertreated Tuesday, March 25, 2008 12:00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital Visit the following web sites: For handouts, poster,

More information

CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Agenda Item 9.3 Report of: Paper prepared by: Robert Pearson Medical Director, CMFT Lisa Miles Senior Project Manager, Research & Innovation

More information

Didactic Session 1-Summary Daniel L. Menkes, M.D. University of Connecticut Health Center

Didactic Session 1-Summary Daniel L. Menkes, M.D. University of Connecticut Health Center Didactic Session 1-Summary Daniel L. Menkes, M.D. University of Connecticut Health Center Concept: Stroke = dead brain All living tissue requires blood and oxygen Decreased oxygen supply = hypoxia Decreased

More information

Learning Objectives Patient Care: Prevention/General Cardiology

Learning Objectives Patient Care: Prevention/General Cardiology Rotation: Director: Faculty: Preventive /General Cardiology Emily G. Kurtz, M.D./Waleed Irani, M.D. Prevention: Jeff Boord, M.D., Sergio Fazio, M.D., Emily G. Kurtz, M.D., MacRae Linton, M.D., David Maron,

More information

CT Coronary Angiography

CT Coronary Angiography CT Coronary Angiography Dr Smruti Mulani Coronary CT Angiography (CTA) is the only noninvasive technique available for imaging the coronary arteries. However, visualization of the small, tortuous, and

More information

The Clinical Utility of Coronary Computed Tomography

The Clinical Utility of Coronary Computed Tomography March 2004 To Scan or Not to Scan: The Clinical Utility of Coronary Computed Tomography Alanna Morris, HMS Year III Patient KS CC: 52 yo female former smoker with hypercholesterolemia presents with chest

More information

Hypoglycemia as a risk factor for cardiovascular disease and mortality

Hypoglycemia as a risk factor for cardiovascular disease and mortality Hypoglycemia as a risk factor for cardiovascular disease and mortality Dong-Jun Kim, M.D.,PhD. Department of Internal Medicine, Inje University College of Medicine Hypoglycemia: the most important complication

More information

Intracranial Stenting and Angioplasty

Intracranial Stenting and Angioplasty Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Can Statins Prevent the First Stroke? Abdullah Nassief, M.D. Assistant Professor of Neurology Washington University School

More information

2 Reasons for developing guidance on SeQuent Please

2 Reasons for developing guidance on SeQuent Please NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE CENTRE FOR HEALTH TECHNOLOGY EVALUATION EVALUATION PATHWAY PROGRAMME FOR MEDICAL TECHNOLOGIES 1 Technology Medical technologies guidance SCOPE SeQuent

More information

Specific Basic Standards for Osteopathic Fellowship Training in Cardiology

Specific Basic Standards for Osteopathic Fellowship Training in Cardiology Specific Basic Standards for Osteopathic Fellowship Training in Cardiology American Osteopathic Association and American College of Osteopathic Internists BOT 07/2006 Rev. BOT 03/2009 Rev. BOT 07/2011

More information

Hypertension Guidelines

Hypertension Guidelines Overview Hypertension Guidelines Aim to reduce Blood Pressure to 140/90 or less (140/80 for diabetics), adding drugs as needed until further treatment is inappropriate or declined. N.B. patients do not

More information

The New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk

The New Gold Standard for Lipoprotein Analysis. Advanced Testing for Cardiovascular Risk The New Gold Standard for Lipoprotein Analysis Advanced Testing for Cardiovascular Risk Cardiovascular Disease Mortality Trends for Males and Females United States: 1979-2002 Deaths in Thousands 520 500

More information

What s Inside. Your. Heart? A Guide To EBT Cardiac Screening HEART HEALTH CENTER OF BELLEVUE

What s Inside. Your. Heart? A Guide To EBT Cardiac Screening HEART HEALTH CENTER OF BELLEVUE What s Inside Your Heart? A Guide To EBT Cardiac Screening HEART HEALTH CENTER OF BELLEVUE Finally, There s A Way To Accurately Detect Heart Disease At Its Earliest Stages Leading Causes of Death for All

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

26/09/2015. Agenda. Background. Overprescribing of statin for primary prevention especially for women? Statins for primary prevention, evidence based?

26/09/2015. Agenda. Background. Overprescribing of statin for primary prevention especially for women? Statins for primary prevention, evidence based? 26/9/215 Faculty c u l ty of o f Helth Heal th and a nd Medical M e al Sciences S c ce s Agenda Initiation of statin therapy for primary prevention: Overprescribing in postmenopausal women with hypercholesterolemia?

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

STROKE: SECONDARY PREVENTION

STROKE: SECONDARY PREVENTION STROKE: SECONDARY PREVENTION OBJECTIVE: To provide an evidence based approach to the secondary prevention of ischemic stroke or transient ischemic attack (TIA). BACKGROUND: Secondary prevention refers

More information

Developing a National Audit for Rheumatoid and Early Inflammatory Arthritis Ian Rowe

Developing a National Audit for Rheumatoid and Early Inflammatory Arthritis Ian Rowe Developing a National Audit for Rheumatoid and Early Inflammatory Arthritis Ian Rowe Chair Clinical Affairs Committee, BSR Outline The British Society for Rheumatology Challenges in improving patient outcomes

More information

Background. Stages. we detect these easily? New technology: The CT scanner, 1971. Example: calcium in peripheral vascular disease.

Background. Stages. we detect these easily? New technology: The CT scanner, 1971. Example: calcium in peripheral vascular disease. Coronary Calcium Background Ahtherosclerosis: Maturation of a plaque into symptomatic disease Coronary Artery disease Fatty Streak: Autopsy, seen in autopsy Occurs very early, 0s, late teens Seen almost

More information

Vascular Disease in Women. Aimee Swartz, MD RPVI Vascular and Endovascular Associates of WNY

Vascular Disease in Women. Aimee Swartz, MD RPVI Vascular and Endovascular Associates of WNY Vascular Disease in Women Aimee Swartz, MD RPVI Vascular and Endovascular Associates of WNY Vascular Disease Atherosclerosis Hardening of the arteries Restriction of blood flow Arteries beyond the heart

More information

Ischemic coronary disease without significant coronary lesions. What are the options?

Ischemic coronary disease without significant coronary lesions. What are the options? CARDIOLOGY HIGHLIGHTS 2013 Ischemic coronary disease without significant coronary lesions. What are the options? Maja Strozzi Department of Cardiovascular Diseases Zagreb University Hospital Center Croatia

More information

Detection & Management of Retinal Emboli in a County Diabetes Retinal Screening Programme an audit

Detection & Management of Retinal Emboli in a County Diabetes Retinal Screening Programme an audit Detection & Management of Retinal Emboli in a County Diabetes Retinal Screening Programme an audit Prashant K Singh Specialist Registrar in Endocrinology, Diabetes & Internal Medicine The Royal Shrewsbury

More information

Big Data for Population Health

Big Data for Population Health Big Data for Population Health Prof Martin Landray Nuffield Department of Population Health Deputy Director, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery University of Oxford

More information

Taking Good Care of Your Heart

Taking Good Care of Your Heart Taking Good Care of Your Heart Preventive Cardiology PREVENTIVE CARDIOLOGY CARE Great strides have been made in heart care. In the case of heart disease and stroke, medical breakthroughs mean that patients

More information

Cholesterol Treatment Coverage Criteria

Cholesterol Treatment Coverage Criteria Coverage for these four medications is described below: Evolocumab (Repatha) Alirocumab (Praluent) Lomitapide (Juxtapid) Mipomersen (Kynamro) Evolocumab (Repatha) is reserved for requests meeting all three

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

THE ASSESSMENT AND MANAGEMENT OF CARDIOVASCULAR RISK

THE ASSESSMENT AND MANAGEMENT OF CARDIOVASCULAR RISK BEST PRACTICE EV I DENCE-BASED GUIDE LINE THE ASSESSMENT AND MANMENT OF CARDIOVASCULAR RISK KEY MESSS Assessment of absolute is the starting point for all discussions with people who have factors measured.

More information

Yes, it does, but should it?

Yes, it does, but should it? Does Gender Make a Difference When Managing CVD in General Practice? Does Gender Make a difference in the Treatment of CHD? Dr Jennifer Johns MBBS, FRACP, FCSANZ Cardiologist Austin Health Cardiologist

More information

SPRINT: A RANDOMIZED TRIAL OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL

SPRINT: A RANDOMIZED TRIAL OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL 1 SPRINT: A RANDOMIZED TRIAL OF INTENSIVE VERSUS STANDARD BLOOD-PRESSURE CONTROL Presenter: Mackenzie Clark, PharmD, BCPS University of California, San Francisco Medical Center 2 Disclosures I have no

More information