This document summarizes a presentation on diabetes, atherosclerosis, and cholesterol. It discusses how diabetes increases the risk of cardiovascular disease and mortality. It notes that achieving lipid targets substantially reduces cardiovascular risk, but that target achievement is still uncommon. New therapies that inhibit microsomal triglyceride transfer protein, apolipoprotein C3, proprotein convertase subtilisin/kexin type 9, and other targets may help lower lipids and reduce risk, but require further study of long-term safety and efficacy. The need to more intensively reduce risk factors to further lower cardiovascular event rates is emphasized.
this was the first lecture which i delivered as a doctor. it was about dyslipidemia. i hope you will find information valuable to you here. please read. let me know about your ideas. comment.
Personalized medicine in Familial HypercholesterolaemiaDr. Julius Kwedhi
Familial hypercholesterolemia (FH) is an autosomal-dominant genetic disease present in all racial and ethnic groups and has long been recognized as a cause of premature atherosclerotic coronary heart disease.1–3 Heterozygous FH has the highest prevalence of genetic defects that cause significant premature mortality (≈1:200 to 1:500 or higher in founder populations).
The genetic basis of the disorder, impaired functioning of the low-density lipoprotein (LDL) receptor, was first recognized by Goldstein and Brown4 in their Nobel Prize–winning work.
Studies of LDL receptor function have identified additional mechanisms for the pathogenesis of FH (defects in apolipoprotein [apo] B impairing binding with the LDL receptor and gain-of-function mutations in proprotein convertase subtulisin/kexin type 9 [PCSK9] that enhance LDL receptor degradation).
FH leads to elevated LDL concentrations, with levels in heterozygous FH generally in untreated adults >190 mg/dL LDL cholesterol (LDL-C) and in untreated children or adolescents >160 mg/dL LDL-C. Long-term exposure to elevated plasma concentrations of LDL-C begins in utero, leading in heterozygotes to premature ischemic heart disease in mid adulthood and in homozygotes to ischemic heart disease in childhood or early adulthood.
this was the first lecture which i delivered as a doctor. it was about dyslipidemia. i hope you will find information valuable to you here. please read. let me know about your ideas. comment.
Personalized medicine in Familial HypercholesterolaemiaDr. Julius Kwedhi
Familial hypercholesterolemia (FH) is an autosomal-dominant genetic disease present in all racial and ethnic groups and has long been recognized as a cause of premature atherosclerotic coronary heart disease.1–3 Heterozygous FH has the highest prevalence of genetic defects that cause significant premature mortality (≈1:200 to 1:500 or higher in founder populations).
The genetic basis of the disorder, impaired functioning of the low-density lipoprotein (LDL) receptor, was first recognized by Goldstein and Brown4 in their Nobel Prize–winning work.
Studies of LDL receptor function have identified additional mechanisms for the pathogenesis of FH (defects in apolipoprotein [apo] B impairing binding with the LDL receptor and gain-of-function mutations in proprotein convertase subtulisin/kexin type 9 [PCSK9] that enhance LDL receptor degradation).
FH leads to elevated LDL concentrations, with levels in heterozygous FH generally in untreated adults >190 mg/dL LDL cholesterol (LDL-C) and in untreated children or adolescents >160 mg/dL LDL-C. Long-term exposure to elevated plasma concentrations of LDL-C begins in utero, leading in heterozygotes to premature ischemic heart disease in mid adulthood and in homozygotes to ischemic heart disease in childhood or early adulthood.
"48 SLIDES???!!", my friends shouted.
A boring "48 slides" is depend on how you arrange it. And this is not the one for sure.
I always love to prepare a short and sweet presentation. Or maybe long but sweet presentation? Oh yeah! Enjoy!
#SLIDESKILLSvsSLIDEKILLS
Anemia, Classification, Clinical Manifestations (General vs Specific Sign & Symptoms), Lab Investigations (Normal vs Abnormal Lab values) and Treatment
"48 SLIDES???!!", my friends shouted.
A boring "48 slides" is depend on how you arrange it. And this is not the one for sure.
I always love to prepare a short and sweet presentation. Or maybe long but sweet presentation? Oh yeah! Enjoy!
#SLIDESKILLSvsSLIDEKILLS
Anemia, Classification, Clinical Manifestations (General vs Specific Sign & Symptoms), Lab Investigations (Normal vs Abnormal Lab values) and Treatment
eHealth Summit: "Case Study: How Finland became a leader in eHealth adoption"...3GDR
Slides from National eHealth Summit, 30 Sept 2015 at Carton House, Kildare: Maritta Korhonen, head of development, Ministry of Social Affairs and Health, Finland.
#eHealthSummit15
http://www.ehealthsummit.ie
http://mhealthinsight.com/2015/09/25/mhealth-insights-from-the-ehealth-summit/
Diabetic Dyslipidemia
By Dr. Usama Ragab Youssif
ISMA CME Activity 2021
In Tolip EL Galala Hotel
-----------
Introduction
Physiology of lipid metabolism
Pathophysiology of diabetic dyslipidemia
Statin therapy (+/- ezetimibe) evidence and translation of evidence
Residual CV risk: excess TG
EPA therapy evidence and translation of evidence
Ponencia realizada por el Prof. Alberto Zambon en la segunda sesión de CardioVascular Virtual Topic 2022, titulada Residual cardiovascular risk. What is the role of icosapent ethyl?
Atherotech’s VAP+ is a simple non-fasting blood test that directly measures your cardiovascular risk and disease progression that breaks down lipid abnormalities into three categories: triglycerides, cholesterol and hereditary components. The basic lipid does NOT fully assess cardiovascular risk/disease. Often, misclassifying the high risk patients approximately 60% of the time; and inaccurately reports a falsely low LDL, the main target of therapy. Why would anyone with family history of cardiovascular disease NOT want this complete assessment at NO additional cost????
Call 202-527-1953 to find out where to get your VAP+ test done, today!
*Additional markers included in the VAP+ report are LDL-P, Lp(a), remnants (IDL, VLDL3), ApoB and Apo A1.
Statins are highly effective LDL-c lowering agents that actually reduce clinical cardiovascular events. The 2013 ACC/AHA guidelines on the management of blood cholesterol recommend high-intensity statin therapy in individuals with high cardiovascular risk as assessed by the 10-year atherosclerotic cardiovascular disease risk calculator. However, a significant number of individuals do not tolerate or respond adequately to statins, and continue to have residual risk in spite of high intensity statin therapy.
There are some exciting developments in the field of lipidology. This decade has been labeled “The PCSK9 decade”. A new class of monoclonal antibodies directed against the PCSK9 glycoproteins appears very promising in further lowering LDL cholesterol and thereby cardiovascular risk. Evolocumab and alirucomab are novel PCSK9 inhibitors that can be given subcutaneously once or twice in a month, and have the potential to reduce LDL-cholesterol to very low levels without any major adverse effects.
Other classes of drugs like Apo-B antisense oligonucleotides (mipomersen), CETP inhibitors (especially anacetrapib), microsomal transfer protein inhibitors (lomitapide) also hold some promise. The future of lipid lowering therapy looks reassuring with these new developments.
Shashikiran Umakanth presented this at the Egyptian Association of Endocrinology, Diabetes & Atherosclerosis (EAEDA) 2014 conference at Alexandria, Egypt. This conference was help in association with Endocrine Society, USA and the European Association for the Study of Diabetes (EASD).
iPCSK9 Una nueva era en riesgo cardiovascular
17 de Mayo de 2014, 17:00h
http://iPCSK9.secardiologia.es
iPCSK9 Nuevo paradigma. Dislipemia en Cardiología: ¿Cuál es el futuro?
Dr. José Luis López-Sendón Hentschel
Jefe de Servicio de Cardiología. Hospital Universitario La Paz (Madrid)
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
2. Disclosures
• Very small grants from Lilly, Novo Nordisk, Bayer,
AstraZeneca, Johnson and Johnson, Merck
• Small stock holdings in Sanofi Aventis, GlaxoSmithKline,
Ionis, Malin Corp, Allergan
5. Haffner SM, et al. N Engl J Med 1998;339;229–234.
Probability of death from CHD in 1059
NIDDM and 1378 non-diabetic subjects
6. ESC/EASD guidelines
• Very high-risk DM + at least one other risk factor
– LDL cholesterol <1.8
• High-risk DM alone
– LDL cholesterol <2.5
Ryden L, et al. Eur Heart J 2013;34:3035-3087
7. Cannon CP, et al. J Am Coll Cardiol. 2006;48:438–445.
Meta-analysis of cardiovascular outcomes trials
comparing intensive versus moderate statin therapy
• 27,548 patients enrolled in four large trials
• 16% odds reduction of coronary death
or any cardiovascular event (p<0.00001)
8. The effect of cholesterol-lowering
therapy on major vascular events
Alas! Even with treatment, 20%
developed major vascular events
Heart Protection Study Collaborative Group. Lancet 2003;361;2005–
Log rank p<0.0001
Placebo-allocated
Simvastatin-allocated
Benefit (SE) per 1000
allocated simvastatin
–1 (6) 13 (8) 34 (9) 47 (10) 58 (48)
Years of follow-up
Majorvascularevents(%)
51 (15)
9. Risk of CHD by dyslipidaemia status in women
and men with DM and LDL-C <2.58mmol/l
Rana JS, et al. Am J Cardiol. 2015;116:1700–1704.
HDL-C normal
TG normal
N=7278
HDL-C normal
TG high
N=4484
HDL-C low
TG normal
N=4048
HDL-C low
TG high
N=12,508
Women
Men
Hazardratio
10. • NCEP ATP III guidelines
– Only 66% of patients with very high cardiovascular
risk achieve their lipid targets
• ESC/EAS guidelines
– Only 25% of patients with very high cardiovascular
risk achieve their lipid targets
Lipid target achievement among patients with
very high cardiovascular risk in a lipid clinic
Barkas F, et al. Angiology. 2015;66(4):346–353.
11. Cardiovascular Risk Factor Targets and Cardiovascular
Disease Event Risk in Diabetes: A Pooling Project of the
Atherosclerosis Risk in Communities Study, Multi-Ethnic
Study of Atherosclerosis, and Jackson Heart Study
.
Wong et al diabetes care 2016,
Targets reached
Blood pressure 42%
LDL 33%
HbA1C 42%
1 target 41%
2 targets 26.5%
3 targets 7%
12. Risk Reduction
• 1 Target 36%
• 2 Targets 52%
• 3 targets 62%
Conclusion
1.achievement of targets uncommon!
2.Achieving targets substantially reduces risk
Wong et al diabetes care 2016,
18. Fig. 1. Intestinal MTP mRNA levels in type 2 diabetic (black) and non-diabetic (white) subjects on statin therapy and not treated with
statins. Data is expressed as amol/μg total RNA (mean ± S.D.). *p < 0.05 compared to non-diabetic subjects .
Catherine Phillips, Karen Mullan, Daphne Owens, Gerald H. Tomkin Atherosclerosis, Volume 187, Issue 1, 2006, 57–64
MTP expression in diabetic and control subjects
19. Effect of MTP inhibitor – Lomitapide - on
plasma lipids and lipoproteins
Cuchel M, et al. Lancet. 2013;381(9860):40–46.
Study week
Changefrombaseline(%)
20. Cuchel M, et al. Lancet. 2013;381(9860):40–46.
Effect of MTP inhibitor lomitapibe on ALT
AST and liver fat
21. Apo C111 defender of delipidation
Apo B100
LPL
O2
apo C
111
LDL particle
22. LDL containing apoC3 and risk of CHD
Mendivil CO, et al. Circulation. 2011;124:2065–2072.
23. Gaudet D et al. N Engl J Med. 2015;373:438–447.
Antisense inhibition with Volanesorsen of apoC3 in patients with hypertriglyceridaemia
26. Long-term efficacy and safety of apo B inhibition with Mipomersen in patients
with familial hypercholesterolaemia: 2-year interim results of an open-label
extension
Santos RD, et al. Eur Heart J. 2015;36(9):566–575.
N=141 130 111 66 53
LDL-C Apo B Lp(a)
Baseline Week 26 Week 52 Week 76 Week 104
-40
-35
-30
-25
-20
-15
-10
-5
0
%Changefrombaseline
Timepoint
30. LAPLACE-TIMI 57 trial: PCSK9 inhibitor + statin
Desai NR, et al. J Am Coll Cardiol. 2014;63(5):430–433.
31. Lipinski MJ, et al. Eur Heart J 2016;37:536–545.
Incidence of all-cause mortality (A), CV death (B)
and CV events (C) with PCSK9 inhibitors or ezetimibe
32. Event
101 mg/dl
HeFH
127 mg/dl
Intolerant 123 mg/dl
Last LDL-C >70 mg/dl
Whole cohort n = 734 (100%)
HeFH n = 734 100%
CVD event n = 180 (25%)
Statin intolerance n = 179 (24%)
Irrespective of statin intolerance
HeFH alone 23%
CVD event alone 20%
HeFH and/or CVD event 48%
LDL-C <100 n = 134
LDL-C >100 n = 220
PCSK9 treatment eligible 30%
Glueck CJ, et al. Lipids Health Dis. 2016;15(1):55.
Heterozygous familial
hypercholesterolaemia (HeFH)
34. We need to work harder to reduce
risk factors more intensively
Conclusion
Thank you for listening and as Maureen Potter used
to say “If you enjoyed the talk, tell your friends and if
not save your breath to cool your porridge”
Editor's Notes
Disclosures
Disclosures
Forrest plots comparing the incidence of all-cause mortality (A), cardiovascular death (B), and cardiovascular events (C) for patients randomized to proprotein convertase subtilisin-kexin type 9 serine protease inhibitors or ezetimibe. Data are presented with odds ratios and 95% confidence intervals.