HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Paul M. Ridker, MD, MPH, FACC, FAHA, Brendan M. Everett, MD, MPH, FACC, FAHA, and Prof. Wolfgang Koenig, MD, FRCP, FESC, FACC, FAHA, prepared useful practice aids pertaining to atherosclerosis for this CME/CE activity titled "Looking Beyond Lipids: A Visual Guide to Targeting Vascular Inflammation in Atherosclerosis." For the full presentation, monograph, complete CME/CE information, and to apply for credit, please visit us at http://bit.ly/2DMRfEU. CME/CE credit will be available until December 11, 2019.
hbaic is associated with increased cardiovascular morbidity or mortality even before the diagnosis of diabetes...a patient with hba1c 0f 5.5% normal being 4.0-5.5% is prone for the acute cardiac states,the article is published in JAPI,JUN 2011...
KINDLY HAVE A LOOK FOR IT...
The learning speed of the feed forward neural
network takes a lot of time to be trained which is a major
drawback in their applications since the past decades. The
key reasons behind may be due to the slow gradient-based
learning algorithms which are extensively used to train the
neural networks or due to the parameters in the networks
which are tuned iteratively using some learning algorithms.
Thus, in order to eradicate the above pitfalls, a new learning
algorithm was proposed known as Extreme Learning Machines
(ELM). This algorithm tries to compute Hidden-layer-output
matrix that is made of randomly assigned input layer and
hidden layer weights and randomly assigned biases. Unlike the
other feedforward networks, ELM has the access of the whole
training dataset before going into the computation part. Here,
we have devised a new two-layer-feedforward network (TFFN)
for ELM in a new manner with randomly assigning the weights
and biases in both the hidden layers, which then calculates the
output-hidden layer weights using the Moore-Penrose generalized
inverse. TFFN doesn’t restricts the algorithm to fix the number
of hidden neurons that the algorithm should have. Rather it
searches the space which gives an optimized result in the neurons
combination in both the hidden layers. This algorithm provides a
good generalization capability than the parent Extreme Learning
Machines at an extremely fast learning speed. Here, we have
experimented the algorithm on various types of datasets and
various popular algorithm to find the performances and report
a comparison.
Fat, cholesterol, calcium, and other substances found in the blood can build up over time in the arteries. Over time, a sticky substance called plaque can form, hardening and narrowing these vessels, and limiting the flow of oxygen-rich blood through the body. Of all the atherosclerotic plaque constituents, cholesterol has been strongly linked to heart disease. Current expert opinion holds that people with high LDL-cholesterol levels may have atherosclerotic plaques that are more likely to burst, resulting in blood clots and downstream events such as strokes and heart disease.
This slide deck provides basic information about cholesterol and information obtained from a variety of sources.
Electrolyte abnormalities in cardiovascular emergencies are widely studied worldwide as they are mostly found to be associated with cardiovascular morbidity and mortality. The objective of this study was to compare the serum sodium. potassium,calcium and magnesium concentrations of normal healthy individuals with first time diagnosed patients of valvular heart disease and myocardial infarction as well as to evaluate the prognostic value in the severity and outcome of valvular heart disease and myocardial infarction.Following biochemical tests, the mean serum sodium concentrations in both valvular heart disease and myocardial infarction patients were signifi cantly (p ˂ 0.05) higher than normal healthy persons. The mean potassium and calcium concentrations in valvular heart disease and myocardial patients were signifi cantly (p ˂ 0.05) high and low respectively when compared with normal healthy individuals. In comparison to normal healthy persons, respective groups of valvular heart disease and myocardial infarction patients showed a non-signifi cant (p = 0.6123) and a signifi cant (p ˂ 0.05) reduction in mean serum magnesium concentrations. Moreover, comparative analysis of mean serum electrolytes among valvular heart disease and myocardial infarction patients showed a signifi cant low sodium, high potassium, calcium and magnesium concentrations in contrast to signifi cant high sodium, low potassium, calcium and magnesium concentrations respectively.
ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Di...Ancestral Health Society
Traditional cardiovascular risk factors including cholesterol may not provide the best tools for predicting individuals at risk for future cardiovascular disease and current insulin resistance. Novel and emerging evaluations of lipoproteins may provide a more accurate assessment of future cardiovascular risk. In an observational study of a small group of law enforcement officers, we studied the changes in both traditional and nontraditional risk factors when instructed in a “paleo” diet over 6 months. Overall, we found an encouraging impact on both traditional and nontraditional risk factors over the course of the study. It is proposed that a “paleo” diet supplemented with exercise has a positive effect on cardiovascular risk factors and may be a treatment recommendation for individuals at risk.
Paul M. Ridker, MD, MPH, FACC, FAHA, Brendan M. Everett, MD, MPH, FACC, FAHA, and Prof. Wolfgang Koenig, MD, FRCP, FESC, FACC, FAHA, prepared useful practice aids pertaining to atherosclerosis for this CME/CE activity titled "Looking Beyond Lipids: A Visual Guide to Targeting Vascular Inflammation in Atherosclerosis." For the full presentation, monograph, complete CME/CE information, and to apply for credit, please visit us at http://bit.ly/2DMRfEU. CME/CE credit will be available until December 11, 2019.
hbaic is associated with increased cardiovascular morbidity or mortality even before the diagnosis of diabetes...a patient with hba1c 0f 5.5% normal being 4.0-5.5% is prone for the acute cardiac states,the article is published in JAPI,JUN 2011...
KINDLY HAVE A LOOK FOR IT...
The learning speed of the feed forward neural
network takes a lot of time to be trained which is a major
drawback in their applications since the past decades. The
key reasons behind may be due to the slow gradient-based
learning algorithms which are extensively used to train the
neural networks or due to the parameters in the networks
which are tuned iteratively using some learning algorithms.
Thus, in order to eradicate the above pitfalls, a new learning
algorithm was proposed known as Extreme Learning Machines
(ELM). This algorithm tries to compute Hidden-layer-output
matrix that is made of randomly assigned input layer and
hidden layer weights and randomly assigned biases. Unlike the
other feedforward networks, ELM has the access of the whole
training dataset before going into the computation part. Here,
we have devised a new two-layer-feedforward network (TFFN)
for ELM in a new manner with randomly assigning the weights
and biases in both the hidden layers, which then calculates the
output-hidden layer weights using the Moore-Penrose generalized
inverse. TFFN doesn’t restricts the algorithm to fix the number
of hidden neurons that the algorithm should have. Rather it
searches the space which gives an optimized result in the neurons
combination in both the hidden layers. This algorithm provides a
good generalization capability than the parent Extreme Learning
Machines at an extremely fast learning speed. Here, we have
experimented the algorithm on various types of datasets and
various popular algorithm to find the performances and report
a comparison.
Fat, cholesterol, calcium, and other substances found in the blood can build up over time in the arteries. Over time, a sticky substance called plaque can form, hardening and narrowing these vessels, and limiting the flow of oxygen-rich blood through the body. Of all the atherosclerotic plaque constituents, cholesterol has been strongly linked to heart disease. Current expert opinion holds that people with high LDL-cholesterol levels may have atherosclerotic plaques that are more likely to burst, resulting in blood clots and downstream events such as strokes and heart disease.
This slide deck provides basic information about cholesterol and information obtained from a variety of sources.
Electrolyte abnormalities in cardiovascular emergencies are widely studied worldwide as they are mostly found to be associated with cardiovascular morbidity and mortality. The objective of this study was to compare the serum sodium. potassium,calcium and magnesium concentrations of normal healthy individuals with first time diagnosed patients of valvular heart disease and myocardial infarction as well as to evaluate the prognostic value in the severity and outcome of valvular heart disease and myocardial infarction.Following biochemical tests, the mean serum sodium concentrations in both valvular heart disease and myocardial infarction patients were signifi cantly (p ˂ 0.05) higher than normal healthy persons. The mean potassium and calcium concentrations in valvular heart disease and myocardial patients were signifi cantly (p ˂ 0.05) high and low respectively when compared with normal healthy individuals. In comparison to normal healthy persons, respective groups of valvular heart disease and myocardial infarction patients showed a non-signifi cant (p = 0.6123) and a signifi cant (p ˂ 0.05) reduction in mean serum magnesium concentrations. Moreover, comparative analysis of mean serum electrolytes among valvular heart disease and myocardial infarction patients showed a signifi cant low sodium, high potassium, calcium and magnesium concentrations in contrast to signifi cant high sodium, low potassium, calcium and magnesium concentrations respectively.
ASH13 Scott Hall and Robb Wolf — Evaluation of the Impact of a Paleolithic Di...Ancestral Health Society
Traditional cardiovascular risk factors including cholesterol may not provide the best tools for predicting individuals at risk for future cardiovascular disease and current insulin resistance. Novel and emerging evaluations of lipoproteins may provide a more accurate assessment of future cardiovascular risk. In an observational study of a small group of law enforcement officers, we studied the changes in both traditional and nontraditional risk factors when instructed in a “paleo” diet over 6 months. Overall, we found an encouraging impact on both traditional and nontraditional risk factors over the course of the study. It is proposed that a “paleo” diet supplemented with exercise has a positive effect on cardiovascular risk factors and may be a treatment recommendation for individuals at risk.
Poster shared with audience at AHS 2016 Denver, Colorado. By Dr. Jeff Gerber, Dr. Amy H. Savagian and Ivor Cummins BE(Chem) CEng MIEI - forget 'cholesterol' - it's Insulin that pertains to heart disease risk !
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Hot Selling Organic intermediates
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. What Do You Do With A Patient
Who Has High CRP and Low LDL?
Editorial Slides
VP Watch – November 27, 2002 - Volume 2, Issue 47
2. More than 200 risk factors have been
suggested for atherosclerotic
cardiovascular disease.
However, only hypercholesterolemia,
hypertension, diabetes, and smoking,
are traditionally considered as modifiable
major risk factors for CAD.
3. During the last decade, atherosclerosis has
found a new face as an inflammatory disease,
with a its metabolic aspect (e.g.
hypercholesterolemia) as a background
component.
A composite marker that reflects the combined
metabolic and inflammatory aspects of
atherosclerosis, and their interactions, is now
wanted more than ever.
4. Cholesterol screening was the first
screening tests used for CAD risk
assessment and still is the major routine
clinical test.
LDL cholesterol is the focus of current
national guidelines for the determination of
the risk of atherosclerotic cardiovascular
disease. 11
5. Results of Framingham study showed
that more than 35% of CAD events occur
in people with total cholesterol of less
than 200 mg/dl. 10
Based on this result, most of the cases
of acute MI occur in people with less
than average cholesterol levels which is
around 200-240mg/dl in the USA.
6. Ridker et al showed that CRP
predicts adverse cardiovascular
events in asymptomatic healthy
populations. 4,5,14,15
They also showed that CRP can
predict future incidence of diabetes
in apparently healthy people. 4,5,14,15
7. As reported in VP Watch of this week, Ridker
and his colleagues showed that CRP is a stronger
predictor of future cardiovascular events than LDL
cholesterol. 12
They measured CRP and LDL at base line in
(all of) 27,939 apparently healthy American
women, who were then followed for a mean of
eight years for the occurrence of myocardial
infarction, ischemic stroke, coronary
revascularization, or death from cardiovascular
causes. 12
8. Seventy seven percent of all events (MI,
ischemic stroke, coronary revascularization, or
death from cardiovascular causes) occurred
among women with (normal) LDL below 160
mg/dl, and 46% occurred among those with
LDL levels below (current treatment target)
130 mg/dl. 12
CRP and LDL levels were minimally
correlated, which shows that each biologic
marker was detecting a different group of
people at risk. 12
Results
9. 0
0.5
1
1.5
2
2.5
3
3.5
4
1 2 3 4 5
LDL
CRP
Quintile
RelativeRisk
All Cardiovascular Events
Age-Adjusted Relative Risk of Future Cardiovascular Events, According to Base-
Line CRP and LDL Cholesterol Levels.
Adopted from: Ridker et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the
prediction of first cardiovascular events. N Engl J Med. 2002 Nov 14;347(20):1557-65.
10. Increasing levels of CRP were
associated with increased risk of
cardiovascular events at all levels of
estimated 10-year risk based on the
Framingham risk score. 12
Increasing CRP were associated with
increased risk of cardiovascular events
at LDL cholesterol levels below 130,
130-160, and above 160 mg/dl. 12
Results
11. Advantages of measuring CRP: 13
stable over long periods
has no diurnal variation
can be measured inexpensively with available high-sensitivity
assays
Not directly related to lipid metabolism
More importantly, CRP predicts incidence
of diabetics and insulin resistance
syndrome as it does cardiovascular events,
which means it can be considered as a
cumulative risk marker of metabolic as well
as inflammatory aspects of atherosclerosis.
12. Conclusion:
CRP is a stronger predictor of future
cardiovascular events than LDL.
CRP and LDL are minimally correlated.
The combined evaluation of both CRP
and LDL is superior as a method of risk
detection to measurement of either
biologic marker alone.
13. CRP now has the final verdict
to be considered as a major
risk factor/marker for
prediction of adverse
cardiovascular events.
Conclusion:
14. Questions:
What do you do with a patient who
has high CRP and low LDL
(<160mg/dl)?
• What are the other useful
combinations of risk markers
(factors), like CRP and LDL in this
study, for risk assessment?
15. Questions:
Do you agree that CRP, LDL, and
Coronary Calcium Score jointly can
provide a more powerful predictive
value for risk assessment?
16. Questions:
What is the difference in value of CRP
in primary versus secondary
prevention?
And which one of the following should
be used for patient follow up and
monitoring their response to treatment?
CRP, LDL, Calcium Score, or all?
17. 1) Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340:115-126
2) Libby P. Molecular bases of the acute coronary syndromes. Circulation 1995;91:2844-2850.
3) MB Pepys, GM Hirschfield:C-reactive protein and atherothrombosis. Ital Heart J 2001, 2: 196-199
4) Wilson PWF, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97: 1837–1847.
5) Pekkanen J, Linn S, Heiss G, Suchindran CM, Leon A, Rifkind BM, Tyroler HA; Ten-year mortality from cardiovascular disease in relation to
cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med. 1990 Jun 14;322(24):1700-7.
6) Speidl et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J.
2002 Sep;144(3):449-55.
7) Anderson JL, Carlquist JF, Muhlestein JB, Horne BD, Elmer SP; Evaluation of C-reactive protein, an inflammatory marker, and infectious serology
as risk factors for coronary artery disease and myocardial infarction.J Am Coll Cardiol. 1998 Jul;32(1):35-41.
8) Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first
myocardial infarction. Circulation. 1998; 97: 2007–2011.
9) Koenig W, Sund M, Frohlich M, et al. C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially
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