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Postintervention Continuum of Care: Focus on Lipids

This is the first in an educational initiative on the continuum of care essential to the well-being of postintervention patients, with a special focus on the importance of aggressive lipid management. It is based on a series of meetings that brought together leading clinicians and researchers representing a variety of interests and perspectives.

The slides and their accompanying content points introduce a new paradigm of patient management that stresses the following:

  • The response of a dilated lesion has a very different time course and pathobiology than that of atherosclerotic plaque development.

  • While prevention of MI or other complications at the dilated lesion is important, the development and progression of atherosclerotic disease in the rest of the coronary tree must also be addressed.

  • In particular, LDL cholesterol (LDL-C) is a key mediator in atherosclerotic plaque development, yet many patients at risk are either not receiving lipid-lowering therapy or are not achieving their target levels.

(These slides are included in the binder when you request the update "Lipids and plaque on ultrasound: New views and new dimensions")



corerefs.pdf (0.0MB)corerefs.pdf (0.0MB)
PIS01.pdf (0.8MB)PIS01.pdf (0.8MB)

Postintervention continuum of care: Focus on lipids

Download PIS01.ppt (13 slides - 1.6MB)

Postintervention continuum of care: Focus on lipids Content outline Section 1: Achievements and challenges Percentage breakdown of deaths from cardiovascular disease Adjusted rates of in-hospital outcomes after PCI by year of procedure Prevention of stent thrombosis: Overview of key trials Coronary angioplasty vs CABG: Overall survival and survival free from Q-wave MI Coronary angioplasty vs antianginal medical therapy: Greater improvement of angina Current use of PCI Natural history of atherosclerosis and postintervention: Important differences Pathobiologic responses to intervention Postintervention: Two different pathobiologies Management of atherosclerosis and postintervention: Important differences

Section 2: Achieving lipid-lowering guidelines—Clinical status

Download PIS02.ppt (6 slides - 0.5MB)

Section 2: Achieving lipid-lowering guidelines—Clinical status L-TAP: Many high-risk adults are not reaching LDL-C goals L-TAP: Distance from LDL-C goal in patients with ≥ 2 risk factors L-TAP: Distance from LDL-C goal in patients with CHD Cardiologists and primary care physicians: Achieving NCEP goals Cholesterol management by specialty: Physician perceptions vs practice

Section 3: Role of lipids in endothelial function

Download PIS03.ppt (11 slides - 2.3MB)

Section 3: Role of lipids in endothelial functionMechanisms of oxidative stress Oxidized LDL-C disturbs the endothelium over long-term Some consequences of oxidation of LDL-C Factors in endothelial dysfunction—early stage plaque Factors in endothelial dysfunction—late stage plaque Oxidized LDL-C: A common initiating factor for cardiac events Effect of high-fat meal on endothelial activity in normocholesterolemic patients Endothelial function in patients with and without dyslipidemia Improvement within hours in endothelial function following ischemia with LDL-C apheresis Vitamins C & E attenuate reduction in endothelial function caused by high-fat meal

Section 4: Plaque dynamics and stenosis

Download PIS04.ppt (5 slides - 1.4MB)

Section 4: Plaque dynamics and stenosisSome features of vulnerable plaque Patients dying with stable versus unstable coronary syndromes: Atheromas have varying composition Role of LDL-C in plaque formation and progression Clinical viewpoints on plaques

Section 5: Intervention and drug therapy

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Section 5: Intervention and drug therapyClinical studies summary: Angiography in infarct-related artery PCI vs medical Rx for angina Complementary effect of major therapies on 3 vital Rx goals Coronary artery disease: Should plaque stabilization be a primary goal?

Section 6: Update on lipid treatment guidelines

Download PIS06.ppt (9 slides - 0.7MB)

Section 6: Update on lipid treatment guidelinesTarget LDL-C levels for initiating dietary therapy: Are they realistic? Target LDL-C levels for initiating drug therapy: Are they realistic? Treatment decisions based on LDL-C levels in adults with diabetes Risk factors for CAD: NCEP guidelines for adults Dietary therapy for patients at risk for CAD Major classes of drugs to reduce lipids Achieving NCEP goals for LDL-C Achieving NCEP goals for LDL-C

Section 7: Aggressive vs moderate approach to lipid lowering

Download PIS07.ppt (14 slides - 1.2MB)

Section 7: Aggressive vs moderate approach to lipid loweringPost-CABG: Aggressive vs moderate LDL-C reduction Post-CABG: Aggressive vs moderate LDL-C reduction Post-CABG: Aggressive vs moderate LDL-C reduction Post-CABG: Angiographic vein graft outcomes Post-CABG: Event rates by cholesterol group Post-CABG: Study summary Post-CABG: Aggressive LDL-C reduction benefits patients with other CV risk factors CURVES: Study design CURVES: Study methodology CURVES: Clinical characteristics CURVES: Comparative LDL-C reductions across dose ranges CURVES: Comparative efficacy of statins Patients reaching the NCEP-recommended LDL-C concentrations with statin treatment

Section 8: New trial update

Download PIS08.ppt (14 slides - 1.2MB)

Section 8: New trial updateAVERT: Study rationale AVERT: Major exclusion criteria AVERT: Overview of study procedures AVERT: Primary efficacy assessment AVERT: Secondary efficacy assessments AVERT: Baseline patient characteristics AVERT: Ischemic events at 18 months AVERT: Ischemic events at 18 months AVERT: Time to first ischemic event AVERT: Incidence of first ischemic event by time AVERT: Summary of lipid parameters AVERT: Safety evaluation AVERT: Summary

Section 9: Continuum of care: Summary and timeline

Download PIS09.ppt (9 slides - 0.9MB)

Section 9: Continuum of care: Summary and timelineRevascularization and plaque pathology Continuum of care ACT Clinical challenge: Aggressively   LDL-C to   CHD events Summary: Postintervention action plan Postintervention care timeline Postintervention care timeline Postintervention care timeline
Published by Medical Education Consultants, Inc. (MEDCON), on behalf of the University of Florida College of Medicine. Supported by an unrestricted educational grant from Pfizer and Parke-Davis.

Copyright © 1999.

The editorial content of this program expresses the views of the individual contributors and does not necessarily reflect the views or recommendations of the University of Florida College of Medicine, Pfizer, Parke-Davis, or the publisher. The indications and dosages of drugs discussed in this program may vary from those approved by the Food and Drug Administration (FDA). The reader is advised to consult the full prescribing information for each medication prior to use.

ContinuuminitiativeLipidLipidsPostinterventionSpecial

Related at vwbg.org

Postintervention Continuum of Care Update: Ultrasound Assessment of Plaque Dynamics

Lipids and plaque on ultrasound: New views and new dimensions

This slide lecture material is an update to the core curriculum entitled Postintervention Continuum of Care: Focus on Lipids

Vascular Biology in Clinical Practice © Vol. 3, No. 3

Lipids in the post-intervention continuum of care: New challenges and strategies in risk management

This monograph is offered as part of a series of educational programs published under the auspices of the VBWG, with continuing medical education credit provided by the University of Florida College of Medicine.
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