This document provides an update to Canadian guidelines for managing dyslipidemia based on recent clinical trial data. The primary recommendations are to aim for an LDL-C target of ≤2.0 mmol/L for high-risk patients, including most with diabetes, and a secondary target ratio of total cholesterol to HDL-C <4.0. Achieving lipid targets remains challenging, with optimal statin dosing and the addition of other agents like ezetimibe suggested when needed. Combination therapies may also be required to meet multiple targets.
Le HDL-c, où en est-on aujourd’hui ? par John Chapmanall-in-web
This document summarizes a presentation given by Dr. M. John Chapman on HDL-C (high-density lipoprotein cholesterol). It discusses the structure and composition of HDL particles, their role in reverse cholesterol transport from tissues to the liver, and functions such as promoting cholesterol efflux from cells. While HDL-C level is commonly used clinically, Dr. Chapman questions whether it accurately reflects HDL functionality in protecting against cardiovascular disease. The document presents evidence that HDL's ability to efflux cholesterol from macrophages better predicts atherosclerosis and coronary artery disease than HDL-C level alone.
The combos study an expert interview with william sJames Hilbert
The document summarizes the COMBOS study which evaluated the effects of adding prescription omega-3 ethyl esters (Lovaza) to stable statin therapy in patients with persistent hypertriglyceridemia. The study found that Lovaza plus simvastatin led to greater reductions in non-HDL cholesterol and other lipid parameters compared to simvastatin alone. Non-HDL cholesterol is a measure of total cholesterol carried by LDL, VLDL, and their remnants, and is a better predictor of cardiovascular risk than LDL alone, especially in patients with high triglycerides.
The document discusses lipid analysis and cardiovascular risk assessment. It recommends using non-fasting lipid samples for general risk screening as they seem to have similar prognostic value as fasting samples. It also recommends using non-HDL cholesterol as a primary treatment target along with LDL cholesterol, as non-HDL cholesterol does not require fasting and accounts for both LDL and triglyceride levels. The document provides guidelines on lipid analysis, risk stratification, and lipid-lowering treatment goals and strategies based on various risk factors.
The document discusses dyslipidemia prevalence and screening guidelines, summarizes studies on cholesterol-lowering drug efficacy for primary and secondary prevention, and provides treatment guidelines including lifestyle modification, medications, and combination therapy options. Prevalence of high cholesterol in Saudi Arabia is reported from various studies. Drug treatment goals and general management guidelines are outlined based on cardiovascular risk factors and disease status.
This particular presentation of mine covers salient features of recent drug developed for treatment of dyslipidaemia particularly familial hypercholesterolemia. This presentation also covers recent modifications in treatment guidelines.
Alirocumab and Cardiovascular Outcomes after Acute Coronary SyndromeShadab Ahmad
Studies have shown that mutations conveying gain or loss of function of PCSK9 result in a higher or lower level of LDL cholesterol, respectively, which in turn is associated with a corresponding higher or lower risk of incident coronary heart disease. These findings have led to the development of monoclonal antibodies to PCSK9 that produce substantial reductions in LDL cholesterol when administered alone or with a statin
Current status & recent advances in dyslipidemia managementJeffrey Pradeep Raj
The document summarizes recent advances in dyslipidemia treatment, including current and newer hypolipidemic drugs as well as clinical guidelines. It discusses statins, fibrates, bile acid sequestrants, nicotinic acid, and ezetimibe. Major clinical trials such as JUPITER and PROVE-IT established the benefits of intensive statin therapy. However, newer combination therapies with fibrates or nicotinic acid failed to show additional clinical benefits beyond statin treatment alone in trials such as ACCORD and HPS-2 THRIVE.
Le HDL-c, où en est-on aujourd’hui ? par John Chapmanall-in-web
This document summarizes a presentation given by Dr. M. John Chapman on HDL-C (high-density lipoprotein cholesterol). It discusses the structure and composition of HDL particles, their role in reverse cholesterol transport from tissues to the liver, and functions such as promoting cholesterol efflux from cells. While HDL-C level is commonly used clinically, Dr. Chapman questions whether it accurately reflects HDL functionality in protecting against cardiovascular disease. The document presents evidence that HDL's ability to efflux cholesterol from macrophages better predicts atherosclerosis and coronary artery disease than HDL-C level alone.
The combos study an expert interview with william sJames Hilbert
The document summarizes the COMBOS study which evaluated the effects of adding prescription omega-3 ethyl esters (Lovaza) to stable statin therapy in patients with persistent hypertriglyceridemia. The study found that Lovaza plus simvastatin led to greater reductions in non-HDL cholesterol and other lipid parameters compared to simvastatin alone. Non-HDL cholesterol is a measure of total cholesterol carried by LDL, VLDL, and their remnants, and is a better predictor of cardiovascular risk than LDL alone, especially in patients with high triglycerides.
The document discusses lipid analysis and cardiovascular risk assessment. It recommends using non-fasting lipid samples for general risk screening as they seem to have similar prognostic value as fasting samples. It also recommends using non-HDL cholesterol as a primary treatment target along with LDL cholesterol, as non-HDL cholesterol does not require fasting and accounts for both LDL and triglyceride levels. The document provides guidelines on lipid analysis, risk stratification, and lipid-lowering treatment goals and strategies based on various risk factors.
The document discusses dyslipidemia prevalence and screening guidelines, summarizes studies on cholesterol-lowering drug efficacy for primary and secondary prevention, and provides treatment guidelines including lifestyle modification, medications, and combination therapy options. Prevalence of high cholesterol in Saudi Arabia is reported from various studies. Drug treatment goals and general management guidelines are outlined based on cardiovascular risk factors and disease status.
This particular presentation of mine covers salient features of recent drug developed for treatment of dyslipidaemia particularly familial hypercholesterolemia. This presentation also covers recent modifications in treatment guidelines.
Alirocumab and Cardiovascular Outcomes after Acute Coronary SyndromeShadab Ahmad
Studies have shown that mutations conveying gain or loss of function of PCSK9 result in a higher or lower level of LDL cholesterol, respectively, which in turn is associated with a corresponding higher or lower risk of incident coronary heart disease. These findings have led to the development of monoclonal antibodies to PCSK9 that produce substantial reductions in LDL cholesterol when administered alone or with a statin
Current status & recent advances in dyslipidemia managementJeffrey Pradeep Raj
The document summarizes recent advances in dyslipidemia treatment, including current and newer hypolipidemic drugs as well as clinical guidelines. It discusses statins, fibrates, bile acid sequestrants, nicotinic acid, and ezetimibe. Major clinical trials such as JUPITER and PROVE-IT established the benefits of intensive statin therapy. However, newer combination therapies with fibrates or nicotinic acid failed to show additional clinical benefits beyond statin treatment alone in trials such as ACCORD and HPS-2 THRIVE.
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
ATP IV Guideline for Blood cholesterol levelkamalmodi481
The document summarizes new guidelines for treating blood cholesterol to reduce ASCVD risk. It classifies individuals into 4 statin benefit groups based on clinical risk factors like age and cholesterol/diabetes status. The guidelines focus on global ASCVD risk assessment for primary prevention and appropriate statin therapy intensity. Biomarkers and tests can help treatment decisions for those not in the main groups. Safety monitoring and limitations are discussed. Future updates may provide guidance for complex cases and refine risk assessment based on new data.
- The document discusses guidelines for statin use in primary prevention from the 2014 ACC/AHA, including algorithms for determining statin eligibility based on estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD).
- It notes that the guidelines lower the risk threshold for statin recommendation from greater than 7.5% 10-year ASCVD risk to greater than 5% for some patients.
- Concerns raised about the guidelines include the selection of studies included in reviews and the lack of consideration of observational data or post-hoc analyses of randomized controlled trials.
This study examined the effects of psyllium husk on HDL-cholesterol levels. Forty hyperlipidemic patients were divided into two groups - one group took 3 grams of psyllium husk daily for 3 months, while the other group took a placebo. The results showed that psyllium husk significantly increased HDL-cholesterol levels on average from 34.61 mg/dl to 36.77 mg/dl. In contrast, the placebo group showed a non-significant average increase from 35.50 mg/dl to 35.75 mg/dl. Therefore, this placebo-controlled study suggests that psyllium husk can effectively increase HDL-cholesterol levels and potentially reduce heart disease risk.
Amiloride hydrochloride 2.5mg and 25mg hydrochlorothiazide tablets smpc taj ...Taj Pharma
Amiloride hydrochloride and hydrochlorothiazide dose Taj pharmaceuticals Amiloride hydrochloride and hydrochlorothiazide interactions, Taj Pharmaceutical Amiloride hydrochloride and hydrochlorothiazide contraindications, Amiloride hydrochloride and hydrochlorothiazide price, Amiloride hydrochloride and hydrochlorothiazide Taj Pharma Amiloride hydrochloride 2.5mg and 25mg hydrochlorothiazidetablets SMPC- Taj Pharma . Stay connected to all updated on Amiloride hydrochloride and hydrochlorothiazide Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
This document discusses PCSK9 inhibitors, which are a new class of drugs for treating hyperlipidemia. It summarizes a clinical trial that evaluated the efficacy and safety of evolocumab added to statin therapy. The trial found that evolocumab significantly reduced LDL levels compared to placebo or ezetimibe when added to moderate or high-intensity statins. Evolocumab also helped over 90% of patients achieve an LDL level under 70 mg/dL. The drug was generally well-tolerated with adverse event rates similar to the comparators. However, further outcomes studies are still needed to determine if PCSK9 inhibitors can reduce cardiovascular events.
Dyslipidemia management an evidence based approachDr Vivek Baliga
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
This document reviews the relevance of triglycerides to cardiovascular disease risk. It discusses how triglycerides are associated with future risk of diabetes and cardiovascular disease. It also summarizes recent findings on using medications like fibrates, niacin, and omega-3 fatty acids to lower triglyceride levels and potentially reduce cardiovascular events beyond statin therapy alone. However, recent clinical trials adding these other drugs to statins have not conclusively shown reductions in cardiovascular outcomes. Further research is still needed regarding lipid-lowering therapies for patients whose LDL-cholesterol is controlled by statins but who still have elevated triglyceride levels.
The document discusses the importance of parental involvement in a child's education and effective parent-teacher communication. It suggests that schools should encourage parents to be involved in their child's work, provide information on classroom activities, and allow regular participation in school life. Effective parent-teacher meetings involve preparing in advance, focusing on the individual child, addressing the parent by name, sharing both positives and any concerns, and setting targets to monitor progress. The goal is to build a positive relationship and understanding between parent and teacher for the benefit of the student.
Editorial and Scientific Independence - Misreading the evidence, misleading t...John Hoey
The document discusses evidence-based medicine and summarizing key points about E. coli from a student. It raises issues about statistical significance not necessarily meaning results are true, and how flexibility in study design and financial interests can influence results. Large randomized controlled trials with simple designs, public funding, and effect sizes over 1.5 are recommended to provide more reliable evidence. Skepticism of results is encouraged.
What does the 'Public' in pubic health mean? 1 Oct08John Hoey
The document discusses the meaning of "public" in "public health" and examines determinants of health and how departments of public health address them. It defines "public" as related to populations rather than individuals and addresses both visible and implicit influences on health. It also lists factors like the economy, environment, food/housing, and social conditions as determinants of health and how different levels of government can influence public health outcomes.
Published Research, Flawed, Misleading, Nefarious - Use of Reporting Guidelin...John Hoey
Much published health sciences literature is misleading and biased
Efforts to correct this include use of reporting guidelines- criteria for doing science and reporting the results properly
Also discussion of conflicts of interest - how to report them.
The document summarizes the key messages of the 2009 Canadian Hypertension Education Program recommendations. It finds that two-thirds of people with diabetes and hypertension in Ontario have uncontrolled blood pressure. The 2009 recommendations emphasize improving blood pressure control in people with diabetes. It recommends treating people with diabetes and hypertension to a systolic blood pressure of less than 130 mm Hg and a diastolic blood pressure of less than 80 mm Hg. The recommendations also advise against combining an ACE inhibitor with an angiotensin receptor blocker (ARB) in most cases of uncomplicated hypertension based on evidence from recent clinical trials.
The document discusses the roles and responsibilities of journal editors in ensuring the integrity and quality of published research. It outlines how editors must [1] strive to meet reader and author needs while improving the journal, [2] ensure the quality of published material, and [3] preclude business interests from compromising standards. The document also provides examples of reporting biases and conflicts of interest that editors must guard against, such as selective publication of results and ghost writing. Finally, it discusses steps editors can take like using reporting guidelines and checklists to improve transparency and research quality.
Ppp kirkevækst i syd-nye toelogiske paradigmerMogensen
This document summarizes the keynote speech given by Mogens S. Mogensen at a conference for pastors in Sønderborg Provsti, Denmark on October 8, 2014. The speech discusses the demographic shift in Christianity towards the global South and the emergence of new theological paradigms as a result. It outlines the historical eras of Christianity and how the religion has adapted across cultures throughout history. It then examines current trends, including the growth of Christianity in the global South and East and the rise of new theologians and perspectives from these regions. The speech argues this demographic change will lead to new theological processes dominated by issues important to Christians in the South.
Scientific Writing And Peer Review A Guide Hoey Queens Sep08John Hoey
This document provides guidance on various aspects of scientific writing and the peer review process. It discusses picking an appropriate journal, formatting your manuscript, responding to peer reviews, and improving writing style. The key points covered are choosing a journal based on your goals and the type of article, following the target journal's format and style, addressing reviewers' comments clearly in a revised submission, and aiming for concise and accessible writing.
Editorial Integrity Conflict of Interest COPE London March 09John Hoey
This document discusses various issues related to ensuring integrity in scientific publishing, including biases, conflicts of interest, and the responsibilities of journal editors. It notes that selectively publishing positive results over negative ones, failing to publish entire studies, and other biases can mislead readers and compromise the integrity of the scientific record. Maintaining quality and preventing business interests from influencing standards is challenging for editors. Strict ethical guidelines and transparency around financial interests are important to uphold scientific integrity.
Bireyin hayat seyrindeki matematik ile olan ilişkisi 'beşeri matematik'i tanımlıyor. Beşeri matematik denkleminde her şey, bireyin fonksiyonunun yazılması ile başlıyor
This document summarizes guidelines for cholesterol treatment and clinical trials evaluating lipid targets. It discusses the ATP III guidelines, major trials after ATP III including TNT, JUPITER, ACCORD-LIPID, and AIM-HIGH. It then reviews the 2013 ACC/AHA cholesterol treatment guidelines, including the 4 groups that benefit from statins, ASCVD risk assessment, and future directions. Clinical cases are used to illustrate guideline recommendations for statin treatment based on a patient's risk factors.
ATP IV Guideline for Blood cholesterol levelkamalmodi481
The document summarizes new guidelines for treating blood cholesterol to reduce ASCVD risk. It classifies individuals into 4 statin benefit groups based on clinical risk factors like age and cholesterol/diabetes status. The guidelines focus on global ASCVD risk assessment for primary prevention and appropriate statin therapy intensity. Biomarkers and tests can help treatment decisions for those not in the main groups. Safety monitoring and limitations are discussed. Future updates may provide guidance for complex cases and refine risk assessment based on new data.
- The document discusses guidelines for statin use in primary prevention from the 2014 ACC/AHA, including algorithms for determining statin eligibility based on estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD).
- It notes that the guidelines lower the risk threshold for statin recommendation from greater than 7.5% 10-year ASCVD risk to greater than 5% for some patients.
- Concerns raised about the guidelines include the selection of studies included in reviews and the lack of consideration of observational data or post-hoc analyses of randomized controlled trials.
This study examined the effects of psyllium husk on HDL-cholesterol levels. Forty hyperlipidemic patients were divided into two groups - one group took 3 grams of psyllium husk daily for 3 months, while the other group took a placebo. The results showed that psyllium husk significantly increased HDL-cholesterol levels on average from 34.61 mg/dl to 36.77 mg/dl. In contrast, the placebo group showed a non-significant average increase from 35.50 mg/dl to 35.75 mg/dl. Therefore, this placebo-controlled study suggests that psyllium husk can effectively increase HDL-cholesterol levels and potentially reduce heart disease risk.
Amiloride hydrochloride 2.5mg and 25mg hydrochlorothiazide tablets smpc taj ...Taj Pharma
Amiloride hydrochloride and hydrochlorothiazide dose Taj pharmaceuticals Amiloride hydrochloride and hydrochlorothiazide interactions, Taj Pharmaceutical Amiloride hydrochloride and hydrochlorothiazide contraindications, Amiloride hydrochloride and hydrochlorothiazide price, Amiloride hydrochloride and hydrochlorothiazide Taj Pharma Amiloride hydrochloride 2.5mg and 25mg hydrochlorothiazidetablets SMPC- Taj Pharma . Stay connected to all updated on Amiloride hydrochloride and hydrochlorothiazide Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
This document discusses PCSK9 inhibitors, which are a new class of drugs for treating hyperlipidemia. It summarizes a clinical trial that evaluated the efficacy and safety of evolocumab added to statin therapy. The trial found that evolocumab significantly reduced LDL levels compared to placebo or ezetimibe when added to moderate or high-intensity statins. Evolocumab also helped over 90% of patients achieve an LDL level under 70 mg/dL. The drug was generally well-tolerated with adverse event rates similar to the comparators. However, further outcomes studies are still needed to determine if PCSK9 inhibitors can reduce cardiovascular events.
Dyslipidemia management an evidence based approachDr Vivek Baliga
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
This document reviews the relevance of triglycerides to cardiovascular disease risk. It discusses how triglycerides are associated with future risk of diabetes and cardiovascular disease. It also summarizes recent findings on using medications like fibrates, niacin, and omega-3 fatty acids to lower triglyceride levels and potentially reduce cardiovascular events beyond statin therapy alone. However, recent clinical trials adding these other drugs to statins have not conclusively shown reductions in cardiovascular outcomes. Further research is still needed regarding lipid-lowering therapies for patients whose LDL-cholesterol is controlled by statins but who still have elevated triglyceride levels.
The document discusses the importance of parental involvement in a child's education and effective parent-teacher communication. It suggests that schools should encourage parents to be involved in their child's work, provide information on classroom activities, and allow regular participation in school life. Effective parent-teacher meetings involve preparing in advance, focusing on the individual child, addressing the parent by name, sharing both positives and any concerns, and setting targets to monitor progress. The goal is to build a positive relationship and understanding between parent and teacher for the benefit of the student.
Editorial and Scientific Independence - Misreading the evidence, misleading t...John Hoey
The document discusses evidence-based medicine and summarizing key points about E. coli from a student. It raises issues about statistical significance not necessarily meaning results are true, and how flexibility in study design and financial interests can influence results. Large randomized controlled trials with simple designs, public funding, and effect sizes over 1.5 are recommended to provide more reliable evidence. Skepticism of results is encouraged.
What does the 'Public' in pubic health mean? 1 Oct08John Hoey
The document discusses the meaning of "public" in "public health" and examines determinants of health and how departments of public health address them. It defines "public" as related to populations rather than individuals and addresses both visible and implicit influences on health. It also lists factors like the economy, environment, food/housing, and social conditions as determinants of health and how different levels of government can influence public health outcomes.
Published Research, Flawed, Misleading, Nefarious - Use of Reporting Guidelin...John Hoey
Much published health sciences literature is misleading and biased
Efforts to correct this include use of reporting guidelines- criteria for doing science and reporting the results properly
Also discussion of conflicts of interest - how to report them.
The document summarizes the key messages of the 2009 Canadian Hypertension Education Program recommendations. It finds that two-thirds of people with diabetes and hypertension in Ontario have uncontrolled blood pressure. The 2009 recommendations emphasize improving blood pressure control in people with diabetes. It recommends treating people with diabetes and hypertension to a systolic blood pressure of less than 130 mm Hg and a diastolic blood pressure of less than 80 mm Hg. The recommendations also advise against combining an ACE inhibitor with an angiotensin receptor blocker (ARB) in most cases of uncomplicated hypertension based on evidence from recent clinical trials.
The document discusses the roles and responsibilities of journal editors in ensuring the integrity and quality of published research. It outlines how editors must [1] strive to meet reader and author needs while improving the journal, [2] ensure the quality of published material, and [3] preclude business interests from compromising standards. The document also provides examples of reporting biases and conflicts of interest that editors must guard against, such as selective publication of results and ghost writing. Finally, it discusses steps editors can take like using reporting guidelines and checklists to improve transparency and research quality.
Ppp kirkevækst i syd-nye toelogiske paradigmerMogensen
This document summarizes the keynote speech given by Mogens S. Mogensen at a conference for pastors in Sønderborg Provsti, Denmark on October 8, 2014. The speech discusses the demographic shift in Christianity towards the global South and the emergence of new theological paradigms as a result. It outlines the historical eras of Christianity and how the religion has adapted across cultures throughout history. It then examines current trends, including the growth of Christianity in the global South and East and the rise of new theologians and perspectives from these regions. The speech argues this demographic change will lead to new theological processes dominated by issues important to Christians in the South.
Scientific Writing And Peer Review A Guide Hoey Queens Sep08John Hoey
This document provides guidance on various aspects of scientific writing and the peer review process. It discusses picking an appropriate journal, formatting your manuscript, responding to peer reviews, and improving writing style. The key points covered are choosing a journal based on your goals and the type of article, following the target journal's format and style, addressing reviewers' comments clearly in a revised submission, and aiming for concise and accessible writing.
Editorial Integrity Conflict of Interest COPE London March 09John Hoey
This document discusses various issues related to ensuring integrity in scientific publishing, including biases, conflicts of interest, and the responsibilities of journal editors. It notes that selectively publishing positive results over negative ones, failing to publish entire studies, and other biases can mislead readers and compromise the integrity of the scientific record. Maintaining quality and preventing business interests from influencing standards is challenging for editors. Strict ethical guidelines and transparency around financial interests are important to uphold scientific integrity.
Bireyin hayat seyrindeki matematik ile olan ilişkisi 'beşeri matematik'i tanımlıyor. Beşeri matematik denkleminde her şey, bireyin fonksiyonunun yazılması ile başlıyor
1) LDL-C levels are a major risk factor for acute coronary syndrome (ACS) and lowering LDL-C through intensive statin therapy leads to significant reductions in recurrent events and mortality after ACS.
2) Guidelines recommend initiating high-dose statins early for ACS patients and achieving an LDL-C reduction of at least 50% from baseline and an LDL-C level below 55 mg/dL to reduce risk.
3) Studies show high-dose rosuvastatin preloading before percutaneous coronary intervention (PCI) significantly reduces major adverse cardiac events and peri-procedural myocardial injury compared to no preloading or lower statin doses.
Current Controversies in Dyslipidemia Management:magdy elmasry
LDL-C Goals Keep it Simple : Start the Statin or Not ?
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to
Reduce Atherosclerotic Cardiovascular Risk in Adults
The guideline
identifies high- and moderate-intensity statin therapy for use in primary and secondary prevention
Total Cardiovascular Risk Estimation
Recommendations for treatment targets for LDL-C
ESC 2016 Risk Categories & LDL Goal
2013 ACC/AHA guidelines for blood cholesterol managementPraveen Nagula
The 2013 ACC/AHA blood cholesterol treatment guidelines focus on reducing atherosclerotic cardiovascular disease (ASCVD) risk through statin therapy rather than targeting specific LDL-C levels. The guidelines are based on evidence from randomized controlled trials showing consistent ASCVD risk reduction from high- and moderate-intensity statin regimens. They recommend a patient-centered approach and starting statins based on estimated 10-year ASCVD risk rather than using non-HDL or other targets. While lifestyle changes remain important, the guidelines emphasize intensity of statin therapy over addition of nonstatin drugs or targeting specific lipid levels.
The American Heart Association and American College of Cardiology, in partnership with the National Heart, Lung and Blood Institute, have released new joint guidelines on cardiovascular disease prevention focusing on hyperlipidemia, hypertension, cardiovascular risk assessment, lifestyle interventions, and obesity. The guidelines provide recommendations on screening and treating dyslipidemia and cardiovascular risk through lifestyle modifications like diet, exercise, weight loss and smoking cessation as well as pharmacological interventions including statin therapy. The guidelines stratify treatment approaches based on levels of cardiovascular risk and recommend high or moderate intensity statins for primary and secondary prevention.
Bempedoic acid is a new non-statin therapy for lowering LDL-C. It works by inhibiting ATP-citrate lyase in the cholesterol biosynthesis pathway. Clinical trials showed bempedoic acid significantly lowered LDL-C levels when added to statin therapy or used alone in statin-intolerant patients. It provides an additional option for patients who cannot reach LDL-C goals on maximal statin therapy. The document discusses the rationale for non-statin therapies and provides recommendations from an expert group on the use of bempedoic acid in clinical practice in India.
The document provides guidelines from a committee for managing blood cholesterol to reduce atherosclerotic cardiovascular disease risk. It includes 10 key recommendations, such as emphasizing lifestyle changes for all ages, using high-intensity statin therapy for patients with clinical ASCVD, considering additional nonstatin drugs for very high risk patients, and assessing adherence to medication and lifestyle changes. The guidelines cover measuring cholesterol levels, risk assessment, and treatment approaches for different patient groups including those with diabetes or severe hypercholesterolemia.
ACTUALIZACIÓN EN LÍPIDOS Y ARTERIOSCLEROSIS 2011. LLUIS MASANA. XIV JORNADA D...La SEA
PONENCIA ACTUALIZACIÓN EN LÍPIDOS Y ARTERIOSCLEROSIS UPDATE 2011, REALIZADA POR EL DOCTOR LLUIS MASANA DURANTE LA XIV JORNADA DE LA XARXA CATALANA DE LÍPIDS i ARTERIOSCLEROSI
The document discusses lipid-lowering therapy, particularly statin use, in patients with cardiovascular risk and liver disease. While statins are effective for cardiovascular risk reduction, patients with liver disease are often excluded from clinical trials. Physicians are also hesitant to prescribe statins to such patients due to concerns about liver and muscle toxicity. The document proposes a study to assess the efficacy and safety of combining statin therapy with ursodeoxycholic acid (UDCA) in patients with hyperlipidemia, cardiovascular risk and liver disease. The study would follow 262 patients across Russia for 6 months to evaluate clinical outcomes from co-administering statins and UDCA.
1. Dyslipidemia is an important risk factor for cardiovascular disease and is defined by disorders of lipoprotein metabolism that result in high cholesterol, LDL, and triglycerides or low HDL.
2. Lifestyle changes and medications like statins are recommended to lower LDL levels and reduce cardiovascular risk, with lower LDL targets for those at highest risk.
3. Statins are the first-line treatment for lowering LDL but can cause side effects like muscle pain; newer drugs like PCSK9 inhibitors can further lower LDL in those unable to tolerate statins.
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
The document summarizes several misconceptions about new prevention guidelines for lifestyle, obesity, cholesterol, risk prediction, and hypertension. It clarifies that the lifestyle guidelines endorse Mediterranean and DASH diets but not low-fat diets; intensive behavioral therapy is recommended for more patients to help with weight loss; and the role of non-statin therapy is reduced but still exists for some high-risk patients. It also notes that the new risk calculator looks similar to prior scores but uses larger datasets and separate equations for different races.
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
The past, present and future of lipid managementGreg Searles
This document summarizes a presentation on lipid management given by Dr. Greg Searles. The presentation covered current lipid guidelines, LDL and other lipid profiles, dietary and pharmacological lipid-lowering therapies including statins, cholesterol absorption inhibitors, and PCSK9 inhibitors. It discussed landmark statin trials that demonstrated reductions in cardiovascular outcomes and the additional benefit seen when adding ezetimibe to statin therapy as shown in the IMPROVE-IT trial. The presentation aimed to provide an overview of the past, present, and future of lipid management.
The document summarizes the 2013 ACC/AHA blood cholesterol treatment guidelines. The guidelines aim to reduce atherosclerotic cardiovascular disease risk based on evidence from statin randomized controlled trials. The guidelines recommend a patient-centered approach and emphasize that high- and moderate-intensity statin therapy provides the greatest reduction in risk across all baseline LDL-C levels. Primary prevention recommendations are based on estimated 10-year cardiovascular risk. The guidelines do not recommend targeting specific LDL-C levels but rather emphasize intensity of statin therapy.
past presnt and futer of dyslidema ttt.pdfAdelSALLAM4
Dr. Greg Searles presented on the past, present, and future of lipid management. He discussed current lipid management guidelines, which recommend statin treatment and LDL-C targets based on risk level. For high-risk patients, the guidelines recommend an LDL-C target of <2.0 mmol/L or >50% reduction from baseline. Dr. Searles reviewed evidence from landmark statin trials demonstrating their efficacy in reducing cardiovascular events. He also discussed current combination therapy options for further LDL-C lowering when targets are not met with statins alone, focusing on the modest additional benefit shown for ezetimibe in the IMPROVE-IT trial.
Cardiovascular diseases are the leading cause of death globally. One major risk factor is dyslipidemia. The document discusses various clinical trials that show Rosuvastatin is more effective than other statins like Atorvastatin and Simvastatin in lowering LDL-C and raising HDL-C levels. Rosuvastatin also significantly reduces CRP and cardiovascular events. Studies demonstrated Rosuvastatin's superior efficacy over Atorvastatin in high-risk patients like those with diabetes. Rosuvastatin was also shown to be well-tolerated with fewer safety issues than other statins.
Diabetic patients are at high risk for cardiovascular disease due to dyslipidemia and should be treated aggressively to target lipid levels. Lifestyle modifications such as diet, exercise, and weight management are first-line treatment along with statin therapy. Statins should be prescribed to diabetic patients over age 40 with one or more other cardiovascular risk factors, or to those of any age with existing cardiovascular disease, to reduce LDL cholesterol. The main treatment goals are lowering LDL cholesterol to less than 100 mg/dL for patients without cardiovascular disease and less than 70 mg/dL for those with cardiovascular disease.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdf
CCanadian lipid guide
1. Expert Opinions is published by E.O.C.I. Pharmacomm Ltd.
faculty
J. Robin Conway, MD, PhD
Canadian Centre for Research
on Diabetes
Smiths Falls, ON
Jacques Genest, MD
McGill University
Montréal, QC
Rafik Habib, MD
Centre cardiovasculaire de Laval
Laval, QC
Lawrence Leiter, MD
St. Michael’s Hospital
University of Toronto
Toronto, ON
Canadian Lipid
Guidelines Update
Volume 1, number 10
For more information please contact PTM Health, 20 Torbay Road, Markham, ON L3R 1G6
info@eocipharma.com Publications Mail Agreement Number 40816046 Canada Post: Please return undeliverable mail blocks to:
2. Update on lipid management in Canada primary goal in the management of dyslipidemia. First-line treatment
Since the last publication of recommendations for the management and should consist of optimally dosed statin therapy. This means giving an
treatment of dyslipidemia,1,2 important new clinical data has emerged to appropriate statin at an appropriate dose. If this does not lower LDL to
support more intensive lipid lowering in certain patient groups. Recent ≤2 mmol/L, then the addition of a cholesterol absorption inhibitor such
studies in subjects with both stable coronary artery disease (CAD) as well as ezetimibe should be associated with a further 20% LDL-C lowering.
as in those with an acute coronary syndrome (ACS), such as the Once the LDL-C target has been achieved, physicians can consider addi-
Treatment to New Targets (TNT),3 Incremental Decrease in Endpoints tional therapies to achieve the secondary target of a TC/HDL-C ratio of
through Aggressive Lipid Lowering (IDEAL)4 and PRavastatin Or <4.0.
atorVastatin Evaluation and Infection Therapy (PROVE-IT)5 studies have
shown that lowering LDL-cholesterol more intensively, to a value of at least Challenges to Achieving Lower LDL-C Targets
<2.0 mmol/L is associated with additional cardiovascular risk reduction in There is a major challenge in lipid management today in achieving the
these high-risk individuals. This has been further supported by two surro- recommended LDL-C treatment goal. An analysis from 8182 patients in
gate endpoint studies, REVERSal of Atherosclerosis with Lipitor (REVER- two prospective Canadian registries (Vascular Protection [VP] and the
SAL)6 and A Study To Evaluate the effect of Rosuvastatin On Intravascular Guideline Orientated Approach to Lipid Lowering [GOALL])14 showed that
ultrasound-Derived coronary atheroma burden (ASTEROID),7 which both 78% of high-risk patients (with either established cardiovascular disease
demonstrated slowing or regression of atherosclerosis using intravascular or diabetes) were receiving a lipid-lowering agent. However, only 51.2% of
ultrasound (IVUS). Treatment benefit in intermediate- and high-risk these patients had achieved the then recommended LDL-cholesterol target
(5-10% of the study population) groups was also shown in the Anglo- of <2.5 mmol/L. For patients with diabetes without cardiovascular disease,
Scandinavian Cardiac Outcome Trial (ASCOT),8 even in those patients the target was achieved in only 44.7% of patients. Persons with both vas-
without overt dyslipidemia. As a result of some of this data, the National cular disease and diabetes are at the highest CV risk, yet only 59% of
Cholesterol Education Program Adult Treatment Panel III updated their these individuals had an LDL-C ≤2.5 mmol/L. Similarly, the Canadian Lipid
treatment recommendations in 2004 to reflect an optional lower LDL-C Study-Observational (CALIPSO)15 studied 3721 patients on statin therapy,
target in “very high risk” patients.9 and showed that 68% of these subjects were at high risk for coronary
artery disease. Of these high-risk patients, 36% had not achieved the then
Updates to Canadian Recommendations for Lipid Management target LDL-C of <2.5 mmol/L. When the new target of <2.0 mmol/L was
In light of these recent data, Canadian guidelines for the management of applied, 70% of these high-risk patients were not at goal.
dyslipidemia have been updated and recently published, by both the
Canadian Cardiovascular Society (CCS)10 and the Canadian Diabetes The ACTFAST study16 was a 12-week, open-label trial that examined 2113
Association (CDA).11 The CCS position statement was developed based high-risk patients requiring treatment with a statin, who had their statin
on reviews of meta-analyses of studies of the efficacy and safety of lipid- dose selected based on a predefined algorithm in an attempt to achieve
lowering therapies, and of the predictive value of established and emerg- LDL-C targets quickly. The majority (81%) of the statin-naïve patients
ing risk factors. Emerging risk factors may play a role in moving patients achieved LDL-C targets using a flexible starting dose of atorvastatin, plus
at intermediate risk to a higher or lower risk category. These risk factors one titration if necessary, but only 61% of previously statin-treated patients
include: laboratory measurements such as apo B, hsCRP, Lp(a), and achieved their LDL-C goals. Patients not achieving LDL-C goals appeared
HbA1C (in patients with elevated plasma glucose); assessment of exer- to be more refractory to atorvastatin monotherapy, or experienced side
cise capacity by graded exercise stress testing; non-invasive assessment effects, thus limiting the up-titration of the dose.
of atherosclerosis, such as determination of ankle-brachial index (ABI)
and carotid imaging. In high-risk patients, pharmacological treatment is One reason for LDL-C targets not being achieved in all patients is a result
recommended immediately with diet and exercise. The primary treat- of a lack of dose titration. The hesitancy to titrate stain doses up may stem
ment goal for most high-risk patients is to achieve an LDL-C of <2.0 from fears of increased side effects on both the patient’s and physician’s
mmol/L. Once the LDL-C target has been achieved, attempts should be part, despite the fact that there have been careful evaluations of statin
made to achieve a TC/HDL-C ratio of <4.0 by further lifestyle modifica- safety, both in randomized clinical trials and meta-analyses, all of which
tion, or through the addition of further lipid-modifying therapy. Weight have reaffirmed the extremely safe side effect profiles of the currently
loss (if required) and increased physical activity can increase HDL-C available statins. Another factor that may be contributing to the lack of
levels by approximately 7-10%. If HDL-C is not sufficiently increased LDL-C control among patients is the choice of statin. The “right” statin
using these lifestyle modifications, niacin can increase HDL-C levels by must be capable of achieving the required LDL-C lowering in a given
15-20%, or fibrates can induce an increase of 6-10%. It is noted that patient, and must be prescribed at the appropriate dose. Clinical studies
people considered to be at low or moderate risk may actually have high have shown that atorvastatin, rosuvastatin, simvastatin, or lovastatin are
lifetime risk because of other comorbidities such as obesity. It is known the most effective choices (see Table 1).
that the reduction in CAD and stroke events and overall cost-effectiveness
of therapy is proportional to the decrease in LDL-C.12 It is therefore Table 1. Efficacy of selected statins in lowering LDL-C
recommended that one consider pharmacologic therapy for an LDL-C
>3.5 mmol/L in patients at moderate risk, and >5.0 mmol/L for those at Statin Appropriate dose % reduction in
low risk, and aiming for an LDL-C reduction of at least 40% is con- LDL-C achieved
sidered to be generally appropriate. A 40% LDL reduction can generally Atorvastatin17 10, 20, 40, 80 mg 37-51%
be achieved with atorvastatin 20 mg, rosuvastatin 10 mg, simvastatin
40 mg, or lovastatin 80 mg. Lovastatin 18
20, 40, 80 mg 29-54%
Rosuvastatin 17
10, 20, 40 mg 46-55%
A recently published national chart audit study of 2473 Canadian
patients with type 2 diabetes revealed that 55% of patients with a diag- Simvastatin 17
10, 20, 40, 80 mg 28-46%
nosis of diabetes of 2 years had dyslipidemia. This proportion rose to
66% in those who had had diabetes for ≥15 years.13 Despite this, less
than 50% of diabetic patients in Canada are treated with any lipid-lower- The Benefits of Dual Inhibition
ing agent. This high burden of dyslipidemia in patients with diabetes, as The majority of patients, including those with metabolic syndrome, diabetes
well as the increasing compelling trial evidence on the benefits of inten- mellitus and combined dyslipidemia, are able to achieve target levels of LDL-C
sive management of dyslipidemia in diabetes, led to a review of the lipid with statin monotherapy. When titrating statins, in general, an additional 6%
recommendations published in the Canadian Diabetes Association 2003 lowering in LDL-C can be expected for each doubling of the statin dose.
Clinical Practice Guidelines for the Prevention and Management of However, not all patients are able to tolerate higher doses of statins, as the
Diabetes in Canada. The 2006 Lipid Expert Committee used the same risk of side effects (particularly myositis), although low, tends to increase
evidence-based methodological principles of the 2003 guidelines to with higher doses. Such patients may be candidates for combination therapy
develop revised recommendations for adults with diabetes. Once again, with an agent that inhibits cholesterol absorption (ezetimibe) or bile acid
it is recommended that the vast majority of people with established dia- reabsorption (cholestyramine or colestipol). The addition of cholestyramine
betes be considered at high risk of a vascular event, and should be can lower LDL-C levels by an additional 20-25% at maximal doses, but
treated accordingly. The targets for people with diabetes previously con- these are typically not well tolerated. Therefore, when further LDL-C lowering
sidered at “moderate risk” of a vascular event have been eliminated in is required, the combination of ezetimibe with statins is useful, as this com-
these new recommendations. Instead, the LDL-C target has been low- bination has been shown to provide, on average, an additional 20% reduc-
ered from <2.5 mmol/L to ≤2.0 mmol/L and is now recommended as the tion in LDL-C.
EXPERT OPINIONS: CLINICAL IMPACT — M E E T I N G R E P O R T
3. Combination therapy may also be required in many patients to achieve the lowering therapy, despite the fact that trials such as CARDS have shown
TC/HDL-C ratio of <4.0. In patients with dyslipidemia and low HDL-C levels, that statin treatment is associated with a 37% reduction in major cardio-
the combination of a statin with niacin is very effective, and has been vascular events. It is therefore important to establish a simple, effective
reported in small studies to significantly reduce CAD events. For patients pharmacological protocol for the treatment of our dyslipidemic patients,
who do not tolerate, or who are not candidates for niacin and exhibit signifi- such as:
cant hypertriglyceridemia despite statin monotherapy, a combination of a
statin with a fibrate may also be used. Recommended fibrates for combina- • Start with an effective statin dose that is calculated to achieve the tar-
tion therapy include fenofibrate and bezafibrate. Gemfibrozil should not be get LDL-C based on the starting and target LDL-C levels (e.g., atorvas-
used in combination with statins, due to the increased risk of myopathy and tatin 10 mg, lovastatin 80 mg, rosuvastatin 10 mg, or simvastatin
rhabdomyolysis. Fibrates are also recommended as first-line therapy for dia- 40 mg)
betic patients with fasting TG levels >10 mmol/L who do not respond to • If the patient does not achieve target, increase the statin to its maxi-
other measures, such as tight glycemic control, weight loss and restriction of mum therapeutic or tolerated dose
refined carbohydrates and alcohol. • If LDL-C is still not at target, add a cholesterol absorption inhibitor
(e.g., ezetimibe 10 mg)
Conclusion
The introduction of the new LDL-C and TC/HDL-C ratio targets will By following these simple steps in order to achieve lipid targets, we
increase the number of Canadians not achieving their lipid targets. should be well on our way to closing the “care gap” that currently exists
Currently, about 50% of patients with diabetes are not receiving lipid- with our dyslipidemic patients in Canada.
Canadian Diabetes Association 2006 Recommendations for the Management of Dyslipidemia
Lipid targets for adults with diabetes at high risk for CVD
* Clinical judgment should be used to decide whether additional
Index Target value
LDL-C lowering is required for patients with an on-treatment LDL-C
of 2.0 to 2.5 mmol/L.
Primary target HDL-C = high-density lipoprotein cholesterol
LDL-C = low-density lipoprotein cholesterol
LDL-C ≤2.0 mmol/L* TC = total cholesterol
Secondary target
TC/HDL-C ratio <4.0
2006 Recommendations for the Management of Dyslipidemia ◆ If the TC/HDL-C ratio is ≥4.0, consider strategies to achieve a
Note: Readers are referred to the original guidelines document for TC/HDL-C ratio <4.0, such as improved glycemic control, intensi-
supporting references and evidence grading. fication of lifestyle (weight loss, physical activity, smoking cessa-
tion) and, if necessary, pharmacologic interventions.
◆ = New Recommendation
Plasma apo B can be measured, at the physician's discretion, in addi-
Prevention tion to LDL-C and TC/HDL-C, to monitor adequacy of lipid-lowering
People with type 1 or type 2 diabetes should be encouraged to therapy in the high-risk patient. Target apo B should be <0.9 g/L.
adopt a healthy lifestyle to lower their risk of CVD. This entails adop-
ting healthy eating habits, achieving and maintaining a healthy Treatment
weight, engaging in regular physical activity, and smoking cessation. ◆ Patients at high risk of a vascular event should be treated with a
statin to achieve an LDL-C ≤2.0 mmol/L. Clinical judgment should
Risk Assessment be used as to whether additional LDL-C lowering is required for
◆ Most people with type 1 or type 2 diabetes should be considered patients with an on-treatment LDL-C of 2.0 to 2.5 mmol/L.
at high risk for vascular disease. The exceptions are younger peo- ◆ In patients with serum TG >10.0 mmol/L, despite best efforts at
ple with type 1 or type 2 diabetes with shorter duration of disease optimal glycemic control and other lifestyle interventions, a fibrate
and without complications of diabetes (including established should be prescribed to reduce the risk of pancreatitis. For those
CVD) and without other CVD risk factors. A computerized risk with moderate hyper-TG (4.5-10.0 mmol/L), either a statin or a
engine (e.g. UKPDS risk engine, Cardiovascular Life Expectancy fibrate can be attempted as first-line therapy, with the addition of
Model) can be used to estimate vascular risk. a second lipid-lowering agent of a different class if target lipid
levels are not achieved after 4 to 6 months on monotherapy.
Screening
Fasting lipid levels (TC, HDL-C,TG and calculated LDL-C) should be For patients not at target(s), despite optimally dosed first-line therapy
measured at the time of diagnosis of diabetes and then every 1 to 3 as described above, combination therapy can be considered.
years as clinically indicated. More frequent testing should be per- Although there are as yet no completed trials demonstrating clinical
formed if treatment for dyslipidemia is initiated. outcomes in patients receiving combination therapy, pharmacologic
treatment options include (listed in alphabetical order):
Targets • Statin plus ezetimibe
◆ The primary target of therapy is the LDL-C; the secondary target is • Statin plus fibrate
the TC/HDL-C ratio. • Statin plus niacin
- Adapted from Canadian Diabetes Association Clinical Practice Guidelines
Expert Committee11 and Conway et al19
Canadian Lipid Guidelines Update 3