2/8/2016. Speaker Disclosures. What we know. Sandra Revill Tremulis, MBA Founder and President

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1 Revealing a hidden risk for premature cardiovascular disease Sandra Revill Tremulis, MBA Founder and President Speaker Disclosures I have no relevant commercial relationships to disclose. What we know CVD is the leading cause of death in the United States and the world. Doing nothing about CVD will cost the world $47 trillion in the next 25 years, president of the World Heart Federation, Dr. Sidney Smith. 1

2 FOUNDER S STORY My father died at 50 of a heart attack Founder s Story My Framingham Risk Score Informationabout your risk score: Age: 39 Gender: Total Cholesterol: HDL Cholesterol: Smoker: Systolic Blood Pressure: On medication for HBP: 1% risk female 136 mg/dl 30 mg/dl No 117 mm/hg Risk Score* Less than 1% No Means less than 1 of 100 people with this level of risk will have a heart attack in the next 10 years. * Your risk score was calculated using an equation. Other NCEP products, such as printed ATP III materials, use a point system to determine a risk score that is close to the equation score. 2

3 My Reynolds Risk Score Informationabout your risk score: Age: 39 Gender: Total Cholesterol: HDL Cholesterol: Smoker: Systolic Blood Pressure: High Sensitivity C-ReativeProtein (hscrp) Didyour Mother or Father have a heart attack before age 60? *Note the value you enteredfor age is outside of the lower Range. The result below is based on age 45. 1% risk female 136 mg/dl 30 mg/dl No 117 mm/hg.16 mg/l Yes. As shown in the graph below, age 45, your chance of having a heart attack,stroke, or other heart disease event at some point in the next 10 years is 1% Founder s Story 95% occluded proximal LAD Only risk marker high Lp(a) Stented widow-maker Faces of High Lipoprotein(a) 3

4 What we know - The Problem Lp(a) test not included in regular lipid panel 50% of hospital admissions for coronary artery disease have a normal LDL-C < 100 mg/dl 2 ~ 63M people in U.S. unaware of risk, 1 in 5 Americans 1 Lp(a) currently the strongest single genetic risk factor for coronary heart disease and aortic stenosis 3 Increasing evidence reveals that high Lp(a) is a genetic, independent and causal risk factor for coronary heart disease, atherosclerosis, thrombosis, stroke and aortic stenosis 1 1. Nordestgaard, B, Chapman J, et al. Lipoprotein(a) as a cardiovascular risk factor current status. European Heart J 2010; 31, SachdevaA, Cannon CP, DeedwaniaPC, et al. Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations I n Get With the Guidelines. Am Heart J 2009;157:111-7.e2. 3. KronnenbergF., UtermanG. Lipoprotein(a): resurrected by genetics. Internal Medicine J, 2013, 273; 6-30 What we know Clinical Evidence Clinical Evidence that Lp(a) is a Causal Risk Factor for Cardiovascular Disease and Calcific Aortic Stenosis Epidemiological Studies/Meta-Analyses 1 Mendelian Randomized Studies 2 Genetic Association Studies 3 RCT have not been performed to date in patients with high Lp(a) levels that were randomized to a therapy, primarily due to lack of specific agents to lower Lp(a). 1. Erqouet al JAMA 2009:302: Kamstrup et al JAMA 2009:301: Clarke et al NEJM 2009:361: Vision To live in a world where high Lipoprotein(a) is routinely diagnosed, treated and family screened. 4

5 Mission To reveal this inherited lipid risk for premature cardiovascular disease; educate and empower patients and save lives. Our goal is to save lives by increasing awareness, advocating for routine testing, and a specific treatment for high Lipoprotein(a). Objectives 1. Advocacy Research/registry and clinical trials targeting Lp(a) Lp(a) as a risk target in guidelines Standardized assay and testing included in lipid panel Early detection, accurate diagnosis and proper treatment Reimbursable, ICD-10 code equal access to treatment and care 2. Community Education Need to know your risks in order to have a pre-emptive strike before your first symptom, which maybe death 3. Patient Support Empower patients and their families to partner with healthcare providers to take control of their inherited cardiovascular future What you should do Join The Lipoprotein(a) Foundation Lipoproteinafoundation.org Support our objectives Learn the latest information about Lipoprotein(a) Tell your Lp(a) patients about us 5

6 Conclusion Key Takeaways: Lp(a) currently the strongest single genetic risk factor for coronary heart disease and aortic stenosis 2 ~ 20% of people in U.S. unaware of risk, 1 in 5 Americans 1 Patients need an accurate prediction of risk for premature CVD to prevent the first symptom from being death. Valentin Fuster, JACC editor in chief states: "let's begin to pay attention to Lp(a), it may explain CAD events in patients who otherwise do not have a significant risk-factor profile 3 1. Nordestgaard, B, Chapman J, et al. Lipoprotein(a) as a cardiovascular risk factor current status. European Heart J 2010; 31, KronnenbergF., UtermanG. Lipoprotein(a): resurrected by genetics. Internal Medicine J, 2013, 273; Mortensen MN, Afzal S, NordestgaardBG, Falk E. Primary Prevention With Statins: ACC/AHA Risk-Based Approach Versus Trial-Based Approaches to Guide Statin Therapy J AM CollCardiol.2015 Dec 22;66(24): Acknowledgements Thank you to: Dr. Tom Hinohara and Kathy Berra NP My husband, daughter, family and friends The Board of the Foundation The Foundation SAB Board Lipoprotein (a) Foundation 6