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Core Curriculum

• Impact of vascular biology in treatment of cardiovascular disease Section II: Lipid management

The VBWG Core Curriculum 2002 slide lecture program, Impact of vascular biology in treatment of cardiovascular disease, covers basic science and clinical advances in vascular biology in a spectrum of disorders. The material is presented in four sections:

The information in this section of the slide lecture program discusses basic and clinical advances in lipid management with a focus on the following areas:

  • Atherosclerosis as an evolving process and new insights in lipid mechanisms of vascular pathobiology
  • Recent clinical trials that are accelerating the mandate for aggressive lipid managment
  • Importance of early and aggressive lipid management in patients with acute coronary syndromes



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Section II: Lipid management

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Section II: Lipid management Long-term risk of CHD death in young men according to baseline Impact of weight on 10-year risk of developing heart disease

B. Mechanisms of disease

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B. Mechanisms of disease Key pleiotropic effects of statins Potential markers of vascular inflammation and their sources Statins blunt markers of coagulation, systemic inflammation, and soluble vascular cell adhesion Cholesterol ↓ rapidly improves vascular function post ACS Beneficial effects of statins on endothelial function and BP Statins downregulate AT1 receptors and reduce ROS production Statins upregulate ecNOS expression and increase ecNOS activity in normocholesterolemic SHR Statins decrease LOX-1 expression Oxidized LDL levels are positively related to severity of acute coronary syndromes Potential interaction of LOX-1 and Ang II in endothelial cells Hypertension and hypercholesterolemia: Interactions and potential mechanisms

Section II: Lipid management

Download S003.ppt (24 slides - 4.1MB)

Section II: Lipid management Statins reduce CV risk in women Statins: Adverse events since US launch to 12/2000 Heart Protection Study (HPS): Design HPS: Primary outcome HPS: Reduction in major vascular events with statin therapy HPS: Vascular events according to prior disease HPS: Vascular events according to age and sex HPS: Reduction in vascular events regardless of baseline lipid levels HPS: Main conclusions HDL-Atherosclerosis Treatment Study (HATS): Design HATS: Changes in lipid levels with treatment HATS: Rate of clinical events according to treatment HATS: Statin-niacin combination lowers the risk of coronary events HATS: Simvastatin-niacin combination causes angiographic regression of coronary lesions HATS: Adverse effects and study limitations VA-HIT: Secondary prevention of CHD in men with low HDL-C and normal LDL-C Post-CABG: Long-term follow-up demonstrates clinical benefit of aggressive lipid lowering Post-CABG long-term follow-up: Reduction in mortality with low-dose warfarin Aggressive lipid-lowering (LDL-C <100 mg/dL) slows plaque growth and improves plaque stability Prolonged intensive lipid-lowering therapy (10 years) reduces lipid content of carotid plaques 10-Year risk of CHD by LDL-C quintile Changes in LDL-C levels with five statins at weeks 6 and 54 of treatment Patients at NCEP target for LDL-C with five statins

Hyperlipidemia: A well-documented modifiable risk factor for stroke

Download S004.ppt (8 slides - 1.4MB)

Hyperlipidemia: A well-documented modifiable risk factor for stroke Elevated C-reactive protein concentrations predict risk of first ischemic stroke and TIA Neuroprotective actions of statins in stroke and cerebral ischemia Reduction in stroke risk with statin therapy MIRACL: Reduction in fatal and nonfatal stroke with atorvastatin in patients with ACS Heart Protection Study: Effect of simvastatin on stroke by etiology Ongoing statin trials for primary and secondary stroke prevention AHA recommendations: Managing hyperlipidemia for primary prevention of ischemic stroke

Many post-MI patients are not receiving optimal therapy

Download S005.ppt (6 slides - 1.0MB)

Many post-MI patients are not receiving optimal therapy CHAMP: Hospital-initiated program for post-AMI management CHAMP: Medication utilization rates at discharge in post-AMI patients CHAMP: Reduction in clinical events at 1 year CHAMP: LDL-C levels during follow-up     

Published by Medical Education Consultants, Inc. (MEDCON), on behalf of the University of Florida College of Medicine.

The editorial content of this program does not necessarily reflect the views or recommendations of the University of Florida College of Medicine or AstraZeneca, Aventis Pharmaceuticals, Monarch Pharmaceuticals, Pfizer Inc, Wyeth Pharmaceuticals, or the publisher. The reader is advised to consult the full prescribing information of each product prior to use.

This program was prepared and produced by Medical Education Consultants, Inc., Westport, Connecticut, on behalf of the University of Florida College of Medicine through an unrestricted educational grant provided by AstraZeneca, Aventis Pharmaceuticals, Monarch Pharmaceuticals, Pfizer Inc, and Wyeth Pharmaceuticals.

©2002 Medical Education Consultants, Inc. (MEDCON). All rights reserved.

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