This document discusses the use of C-reactive protein (CRP) and low-density lipoprotein (LDL) cholesterol levels to predict cardiovascular risk. It summarizes a study that found CRP to be a stronger predictor of future cardiovascular events than LDL, with CRP and LDL providing complementary and non-correlated information. The document concludes that measuring both CRP and LDL provides superior risk detection compared to either marker alone, and that patients with high CRP but low LDL (<160 mg/dl) should be considered at increased risk.
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.
How to Establish an Evidence-Based Care Delivery Structure Like Allina HealthHealth Catalyst
Clinicians have to make difficult decisions on a regular basis. And when different clinicians within the same health system make markedly different decisions about medical treatment, significant waste and inconsistent outcomes arise.
What will be discussed?:
Establishing peer-reviewed and approved CPGs
Prioritizing improvements
Developing the CPG checklist
Engaging and collaborating with clinicians
Don't miss hearing firsthand how Allina established a systemwide EBDM model and realized a five percent decrease in Stage 1 lung cancer treatment variation as well as a 20 percent decrease in the number of heparin protocols.
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.
How to Establish an Evidence-Based Care Delivery Structure Like Allina HealthHealth Catalyst
Clinicians have to make difficult decisions on a regular basis. And when different clinicians within the same health system make markedly different decisions about medical treatment, significant waste and inconsistent outcomes arise.
What will be discussed?:
Establishing peer-reviewed and approved CPGs
Prioritizing improvements
Developing the CPG checklist
Engaging and collaborating with clinicians
Don't miss hearing firsthand how Allina established a systemwide EBDM model and realized a five percent decrease in Stage 1 lung cancer treatment variation as well as a 20 percent decrease in the number of heparin protocols.
Logistic Regression: Predicting The Chances Of Coronary Heart DiseaseMichael Lieberman
Logistic Regression - Predicting the Chances of Coronary Heart Disease weighs risks factors for heart disease and calculates the odds of contracting the disease within the next ten years.
This describes the techniques that are used for prediction of heart diseases using the concept of data mining.It states about IHPDS(Intelligent Heart Disease Prediction System)
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 !
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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