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Focus: Lipids and the Endothelium

• The Endothelium: Impact on CAD treatment strategies

These slide materials represent the third in a series of slide/lecture programs that focus on what continues to be one of the most exciting new fields of emerging data: The endothelium and its role in cardiovascular health and disease.

These materials extend the knowledge presented in the two previous programs that helped define the endothelium as a mediator of cardiovascular function and structure. Endothelial function is now recognized as critically important in the pathogenesis of atherosclerosis and other cardiovascular conditions. The endothelium is also considerably influenced by cardiovascular risk factors, including hypertension, insulin resistance, and the subject of this program . . . lipids.

A new feature: Case study slides

The concluding slides cover three case histories that represent profiles of patients commonly seen in clinical practice. The purpose here is to enable speakers to translate the science of medicine into practical clinical medicine. Included are suggestions for eliciting enthusiastic discussion of management issues relating to cardiovascular risk reduction.

The outline that follows is keyed to the slides. Although this outline was conceived to help lecturers focus on lipids and the endothelium, you may find it useful to incorporate some of the earlier slide materials to establish basic concepts of endothelial function. For each slide you will find succinct content points:




Focus: Lipids and the endothelium

Download lipids0S1.ppt (11 slides - 0.5MB)

Focus: Lipids and the endothelium Content outline Endothelial health: A balancing act Oxidative stress Oxidative stress hypothesis: A common pathogenic feature of CV risk factors Effects of oxidative stress When LDL-C is oxidized... Oxidized LDL-C: A common initiating factor for cardiac events Effects of cholesterol lowering on myocardial ischemia Effects of lipid lowering on endothelial function in hypercholesterolemic patients Benefits of aggressive LDL-C lowering

Type 2 diabetes: Overlap of clinical conditions

Download lipids0S2.ppt (8 slides - 0.4MB)

Type 2 diabetes: Overlap of clinical conditions Insulin resistance syndrome Relating atherosclerosis and insulin resistance Dyslipidemia in diabetics (Framingham Heart Study) Hyperinsulinemia and CHD mortality Hypertriglyceridemia, CHD risk, and hyperinsulinemia Fasting triglyceride and risk of death from CHD (Paris Prospective Study) Relation between total cholesterol and CHD death rate in 361,662 men screened for MRFIT

LRC-CPPT and MRFIT

Download lipids0S3.ppt (14 slides - 0.6MB)

LRC-CPPT and MRFIT 4S results: Effects on lipids 4S results: Effects on study outcomes WOSCOPS results: Effects on lipids WOSCOPS results: Effects on study outcomes CARE results: Effects on lipids CARE results: Effect on study outcomes Clinical challenge in cardiovascular risk intervention management Post-CABG: Impact of aggressive vs moderate approach to lowering LDL-C Post-CABG: Impact of aggressive vs moderate approach to lowering LDL-C Post-CABG: Aggressive vs moderate LDL-C reduction Post-CABG angiographic outcomes Post-CABG: Event rates by cholesterol group Post-CABG study summary

Classification of total cholesterol levels

Download lipids0S4.ppt (6 slides - 0.3MB)

Classification of total cholesterol levels Criteria for obtaining a complete lipoprotein analysis Classification of HDL-C levels Target LDL-C levels (mg/dL) for initiating dietary therapy Target LDL-C levels for initiating drug therapy Classification of triglycerides

Major classes of drugs to reduce lipids

Download lipids0S5.ppt (13 slides - 0.7MB)

Major classes of drugs to reduce lipids Cholesterol biosynthetic pathway Atorvastatin effect on lipids in patients with hypertriglyceridemia Achieving NCEP goals for LDL-C Achieving NCEP goals for LDL-C Safety summary: HMG-CoA reductase inhibitors CURVES Trial design CURVES Trial methodology CURVES Trial results: Patient inclusion criteria and demographics Comparative LDL-C reductions across dose ranges CURVES Trial results: LDL-C reductions at usual starting doses CURVES Trial results: LDL-C reductions at usual first titrations Future clinical challenge

Case 1: A 73-year-old white female with carotid disease

Download lipids0S6.ppt (17 slides - 0.7MB)

Case 1: A 73-year-old white female with carotid disease Case 1: Discussion slide Case 1: Discussion slide Case 1: Discussion slide Case 1: Discussion slide Case 2: A 48-year-old white male with angina Case 2: Discussion slide Case 2: Discussion slide Case 2: Discussion slide Case 2: Discussion slide Case 2: Discussion slide Case 2: Discussion slide Case 3: A 38-year-old white male with a family history of coronary artery disease Case 3: Discussion slide Case 3: Discussion slide Case 3: Discussion slide Case 3: Discussion slide
This slide/lecture program has been created under the auspices of the Vascular Biology Working Group. The overall goal of this program and of those to come in the future, is to expand recognition that endothelial function is one of the keys to cardiovascular health, and to spur exploration of therapeutic interventions capable of improving endothelial function and thereby help to reduce incidence of adverse outcomes.

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Related at vwbg.org

The vascular endothelium and CAD: New target considerations in treating the cardiovascular dysmetabolic syndrome

The attached slide materials represent the seventh in a series of slide/lecture programs that focus on what continues to be one of the most exciting new fields of emerging data: The endothelium and its role in cardiovascular health and disease.

Core Curriculum

Endothelial function: Changing the pattern of treating CV disease

The attached slide materials represent the fifth in a series of slide/lecture programs that focus on what continues to be one of the most exciting new fields of emerging data: The endothelium and its role in cardiovascular health and disease.

Vascular Biology in Clinical Practice

The vascular endothelium and CAD: New target considerations in treating the cardiovascular dysmetabolic syndrome

This discourse is based on the proceedings of a national faculty meeting of the Vascular Biology Working Group held in Orlando earlier this year that explored the clustering of metabolic abnormalities associated with what previously has been recognized by many as "syndrome X.
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