Syndrome X 6.4.07 For Selam Part D

Metformin Statin Aspirin BP  Weight  RIMONABANT (Canab) HDL  TORCETRAPIB (CETP  ) A B C D AMLO α – Bloc BPH

Rimonabant ( Canabis ) ( Wt  )

Table5: Categories of dyslipidaemia and treatment options

Elevated LDL(Type2-a)

Statins

Bile acid sequestrant

Low HDL

Hypoalphalipoproteinemia

Fibrates

Nicotinic acid

Estrogen

Anticonvulsants(phenytoin)

Elevated TG(Type4 )

Fibrates,Nicotinic acid,fish oil(statins)

Mixed dyslipidemia(Type2-b)

Statin+nicotinic acid *

Statin+fibrate#

Statin+bile acid sequestrant

Nicotinic acid+bile acid sequestrant

* increased risk for myopathy or live dysfunction # increased risk of myopathy CETP  Torcetrapib – HDL 

Doses to get to the level of 100mg/dl The starting dose should be the one necessary to achieve the goal and not the lowest one *Approval for use of this dose level applied for to the FDA LE >3*ULN=liver enzyme incr >3 times upper limit of normal 42% 55% 2% 160 80 37% 48% 2% 80 40 32% 41% 7% 1% 80 40 20 27% 34% 0.50% 80 40 40 20 10 22% 27% 0.25% 40 20 20 10 5 Cholesterol LE >3*ULN Total LDL HDL Fluvastatin Pravastatin Lovastatin Simvastatin Atorvastatin

Inspite of proven data on effective BP control, There is a GAP between awareness, treatment and actual control… Life Style ( Smoking ) BP Diabetic Lipids Waist Line > 95 Pre Hyper 135/85 Pre Dia FBS 115 HDL < 35 TGL > 195 CRP IHD – Sudden Death Vulnerable Plaque Vulnerable Person Polypill

Diabetic risk score Age >65 = 20 Waistline>90 = 5 Family History =5 If > 25 Hypertension risk score Age >40 =10 Family History=5 Cold &Exercise BP=5 If > 15 Cardioc risk CRP MICROALB TMT CAROTIDDOP CT CALCIUM SC

1.00 1.82 2.78 8.68 0 1 2 4 6 8 Normal thickening plaque stenosis Relative hazard of acute MI in men with different manifestation of common carotid atherosclerosis P=0.22 0.01mm/yr 0.06mm/yr Relative hazard of acute MI