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Treatment of Dyslipidaemias & The New Grampian Guidelines. Professor Iain Broom Director, Centre for Obesity Research and Epidemiology The Robert Gordon University Professor of Metabolic Medicine, University of Aberdeen Consultant in Clinical Biochemistry and Metabolic Medicine, NHS Grampian.

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treatment of dyslipidaemias the new grampian guidelines

Treatment of Dyslipidaemias & The New Grampian Guidelines

Professor Iain Broom

Director, Centre for Obesity Research and Epidemiology

The Robert Gordon University

Professor of Metabolic Medicine, University of Aberdeen

Consultant in Clinical Biochemistry and Metabolic Medicine, NHS Grampian

slide2
SECONDARY PREVENTION

PRIMARY PREVENTION (CV Risk Assessment)

primary prevention
PRIMARY PREVENTION
  • GLOBAL RISK SCORE (Cholesterol is only one of many Risk Factors)
  • RISK ASSESSMENT TOOL
  • > 20% RISK OF CV EVENT IN 10 YEARS (40 Years of Age)
what do we know about cv risk interheart
What do we know about CV risk? INTERHEART
  • Large, international, standardised, case-control study of acute myocardial infarction (AMI) in 52 countries
  • To determine the strength of association between various risk factors and AMI
  • 15,142 cases and 14,820 controls enrolled to the study
  • 9 risk factors were studied

Yusuf S, et al.Lancet 2004; 364: 937–952.

nine risk factors represent 90 4 of the risk of ami
Nine risk factors represent 90.4% of the risk of AMI
  • Current or former smoking
  • History of diabetes
  • History of hypertension
  • Abdominal obesity
  • Combined psychosocial stressors
  • Irregular consumption of fruits and vegetables
  • No alcohol intake
  • Avoidance of regular exercise
  • Raised plasma lipids

Yusuf S, et al.Lancet 2004; 364: 937–952.

substantial residual cv risk in statin treated patients
Substantial residual CV risk in statin-treated patients

The MRC/BHF Heart Protection Study

30

20

Patients with major

vascular events (%)

10

19.8% of statin-treatedpatients had a majorCV event by 5 years

0

0

1

2

3

4

5

6

BHF=British Heart Foundation

MRC=Medical Research Council

Year of follow-up

Risk reduction=24%

Placebo

Statin

p<0.0001

Heart Protection Study Collaborative Group. Lancet 2002; 360: 7–22.

abdominal fat distribution obesity and risk
Abdominal Fat DistributionObesity and Risk

BP 150/95

Chol 5.8

LDL 4.5

HDL 0.8

TGs 2.3

BP 120/70

Chol 4.4

LDL 2.7

HDL 1.6

TGs 1.0

effect of triacylglycerol hdl cholesterol on atherogenicity

HDL HDL 

TG  TG 

Effect of Triacylglycerol & HDL Cholesterol on Atherogenicity

apo B Lipoprotein

apo B Lipoprotein

high intensive doseage with statins
High/Intensive Doseage with Statins
  • PROVE-IT (2004)
  • Acute coronary syndromes
  • 80 mg Atorvastatin v 40 mg Pravastatin
  • 3.9% Absolute Risk Reduction
  • 16% Relative Risk Reduction
high intensive doseage with statins10
High/Intensive Doseage with Statins
  • TNT (2005)
  • Stable Coronary Disease
  • 80 mg Atorvastatin v 10 mg Atorvastatin
  • 2.2% Absolute Risk Reduction
  • 22% Relative Risk Reduction
  • 6 x  in LFT Derangement
high intensive doseage with statins11
High/Intensive Doseage with Statins
  • SPARCL (2006)
  • Post CVA or TIA, no known CHD
  • 80 mg Atorvastatin v Placebo
  • 2.2% Absolute Risk Reduction in Stroke (5 years) BUT Small Increase in Haemorrhagic Stroke
  • 3.5% Absolute Risk Reduction in CV Event (5 years)
  • No Difference in Mortality
high intensive doseage with statins12
High/Intensive Doseage with Statins
  • ASTEROID (2006) [Galaxy Studies]
  • Assessment of Coronary Atheroma Burden. 0 & 24 Months Post-Therapy
  • 40 mg Rosuvastatin
  • LDL-CHOL 53.2% Reduction

HDL OHOL 14.7% Increase

  • 6.8% Median Reduction Atheroma Volume

Other studies with high dose Rosuvastatin are underway as part of the GALAXY GROUP

conclusions
CONCLUSIONS
  • CHOLESTEROL (LDL-CHOLESTEROL) IS IMPORTANT
  • CURRENTLY POWERFUL DRUGS TO REDUCE EFFECTS
  • SHOULD BE USED IN PRIMARY & SECONDARY PREVENTION
  • SIDE-EFFECTS ARE IMPORTANT & CAN MARKEDLY EFFECT QUALITY OF LIFE
  • LIPID PROFILE IS IMPORTANT FOR CORRECT DRUG USAGE
  • DO NOT FORGET TRIACYLGLYCEROL  STATINS ARE NOT THE DRUG OF CHOICE
ad