Lipoprotein(a), Cardiovascular Disease, and Contemporary Management

Slides:

Advertisements

Similar presentations

ATP III Guidelines Specific Dyslipidemias. 2 Specific Dyslipidemias: Very High LDL Cholesterol (  190 mg/dL) Causes and Diagnosis Genetic disorders –Monogenic.

Advertisements

Diagnosis and Treatment of Dyslipidemia  New guidelines are based on the “Adult Treatment Plan III (ATP III)” 2004  Focus = multiple risk factor assessment.

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories Risk Category LDL Goal (mg/dL)

{ A Novel Tool for Cardiovascular Risk Screening in the Ambulatory Setting Guideline-Based CPRS Dialog Adam Simons MD.

THE LIPID PANEL What are we missing? Robert St. Amant, MD, FAAFP Diplomate, American Board of Clinical Lipidology Baton Rouge General Medical Director,

 2010 Cengage-Wadsworth Preventing Cardiovascular Disease Chapter 11.

Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease Department of Nephrology R3. Yeehyung Kim.

The presence of cardiovascular disease is an important predictor of mortality in patients with end-stage renal disease, as it accounts for almost 50 percent.

Cardiovascular Disease

Managing Cancer Pain: Basic Principles and Invasive Treatments

Classification of total cholesterol levels

Oxford Niacin Trial.

FATS- Familial Atherosclerosis Treatment Study

A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease.

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know Siddharth Singh, MD, Kymberly D. Watt,

Charles R. Harper, MD, Terry A. Jacobson, MD Mayo Clinic Proceedings

Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention Erin D. Michos, MD, MHS, Michael J. Blaha,

Robert M. Jacobson, MD, George J. Isham, MD, MS, Lila J

Diagnostic Options for Assessment of Postmenopausal Bleeding

Efficacy of alirocumab in high cardiovascular risk populations with or without heterozygous familial hypercholesterolemia: Pooled analysis of eight ODYSSEY.

Sunjoo Boo, RN, PhD, Erika Sivarajan Froelicher, RN, PhD, FAAN

2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult Todd J.

Martin W. Schoen, MD, MPH, Joanne Salas, MPH, Jeffrey F

Charles R. Harper, MD, Terry A. Jacobson, MD Mayo Clinic Proceedings

Volume 79, Issue 9, Pages (May 2011)

Type 2 diabetes: Overlap of clinical conditions

Antilipemic Agents Lilley Pharmacology Text: Chapter 27

My Approach to the Patient With Familial Hypercholesterolemia

Omega-3 Fatty Acid Therapy: The Tide Turns for a Fish Story

Apolipoprotein E-containing high-density lipoprotein (HDL) modifies the impact of cholesterol-overloaded HDL on incident coronary heart disease risk:

Gestational Trophoblastic Disease

Cardiorespiratory Fitness: An Independent and Additive Marker of Risk Stratification and Health Outcomes Barry A. Franklin, PhD, Peter A. McCullough,

Impact of Statins on Physical Activity and Fitness: Ally or Adversary?

Jonathan C. Cohen, PhD Journal of Clinical Lipidology

Quantitating the Dose of Physical Activity in Secondary Prevention: Relation of Exercise Intensity to Survival Barry A. Franklin, PhD Mayo Clinic Proceedings

Exercise-Based Cardiac Rehabilitation and Improvements in Cardiorespiratory Fitness: Implications Regarding Patient Benefit Barry A. Franklin, PhD Mayo.

James H. O'Keefe, M.D., Carl J. Lavie, M.D., Ben D. McCallister, M.D.

Ali A. Hasnie, MD, Ashok Kumbamu, PhD, Maya S

Barriers to PCSK9 inhibitor prescriptions for patients with high cardiovascular risk: Results of a healthcare provider survey conducted by the National.

K June 03 03/06/20 1.

I. Introduction American Journal of Kidney Diseases

Assessment of statin therapy, LDL-C levels, and cardiovascular events among high-risk patients in the United States Sudhir K. Unni, PhD, MBA, Ruben G.W.

Contemporary Evidence-Based Guidelines

To B or Not to B: Is Non–High-Density Lipoprotein Cholesterol an Adequate Surrogate for Apolipoprotein B? Carl J. Lavie, MD, Richard V. Milani, MD, James.

Patient-Initiated Second Opinions: Systematic Review of Characteristics and Impact on Diagnosis, Treatment, and Satisfaction Velma L. Payne, PhD, Hardeep.

Rajiv Chhabra, MD, James H

Risks for Cardiovascular and Cardiac Deaths in Nonobese Patients With Diabetes and Coronary Heart Disease Tetsuro Tsujimoto, MD, PhD, Hiroshi Kajio,

Best Practices for Patients With Chronic Migraine

Familial hypercholesterolemia in a European Mediterranean population—Prevalence and clinical data from 2.5 million primary care patients Alberto Zamora,

Influence of low-glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials Allan D. Sniderman, MD, James A. Sloand,

Lecture 5b 7 Feb 2011 Atherosclerosis-Nutritional intervention-

Opening a New Lipid “Apo-thecary”: Incorporating Apolipoproteins as Potential Risk Factors and Treatment Targets to Reduce Cardiovascular Risk Terry.

Rhanderson Cardoso, MD, Roger S

Diabetes is associated with an increased risk of cardiovascular disease in patients with familial hypercholesterolemia Martine Paquette, MSc, Sophie.

Leadership Models in Health Care—A Case for Servant Leadership

Novel Risk Factors for Atherosclerosis

Medical Treatment of Overactive Bladder: In Response

Mantle Cell Involvement of the Spleen

Intensive Lowering of Low-Density Lipoprotein Cholesterol Levels for Primary Prevention of Coronary Artery Disease Dean G. Karalis, MD Mayo Clinic Proceedings

Preoperative Smoking Cessation: The Role of the Primary Care Provider

Margaret B. Nolan, MD, David O. Warner, MD Mayo Clinic Proceedings

Pediatric experience with mipomersen as adjunctive therapy for homozygous familial hypercholesterolemia Frederick J. Raal, PhD, Marjet J. Braamskamp,

PCSK9 inhibition in patients with and without prior myocardial infarction or ischemic stroke: A pooled analysis of nine randomized-controlled studies.

Managing Cancer Pain: Basic Principles and Invasive Treatments

Diagnosis and Management of Headache in Older Adults

National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 – executive summary Terry A. Jacobson, MD, Matthew.

Mayo Clinic Proceedings 2012: “A New Era in Journal Stewardship”

ATP III Guidelines Drug Therapy FUTURE RESEARCH.

Section 6: Update on lipid treatment guidelines

Specific Dyslipidemias: Very High LDL Cholesterol (>190 mg/dL)

Presentation transcript:

Lipoprotein(a), Cardiovascular Disease, and Contemporary Management Terry A. Jacobson, MD Mayo Clinic Proceedings Volume 88, Issue 11, Pages 1294-1311 (November 2013) DOI: 10.1016/j.mayocp.2013.09.003 Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 The “yin and yang” of lipoprotein(a) (Lp[a]) and low-density lipoprotein (LDL) cholesterol (LDL-C) levels. A, Although both lipoproteins contain apolipoprotein B (apo B100), their levels are influenced to differing extents by hepatic synthesis and fractional catabolic rate (FRC). B, Some patients with elevated Lp(a) can benefit from reductions in LDL-C (and vice versa). However, on the basis of extensive data relating elevated LDL-C to increased cardiovascular risk, Lp(a) should be targeted for reduction only after attaining maximal decreases in LDL-C. Approximately 45% of Lp(a) is composed of cholesterol. Hence, patients with marked Lp(a) elevations, such as those with nephrotic syndrome or those undergoing peritoneal dialysis, may be relatively resistant to LDL-C lowering by statins, which have minimal effects on Lp(a), including Lp(a)-trafficked cholesterol. FH = familial hypercholesterolemia. Mayo Clinic Proceedings 2013 88, 1294-1311DOI: (10.1016/j.mayocp.2013.09.003) Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Effects of different pharmacotherapies on lipoprotein(a) cholesterol (Lp[a]-C) and the incidence of coronary heart disease (CHD). AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health; FATS = Familial Atherosclerosis Treatment Study; HATS = HDL-Atherosclerosis Treatment Study; HERS = Heart and Estrogen/progestin Replacement Study (high-Lp[a] quartile subgroup); HRT = hormone replacement therapy. Mayo Clinic Proceedings 2013 88, 1294-1311DOI: (10.1016/j.mayocp.2013.09.003) Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Suggested clinical algorithm for assessment and treatment of elevated low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) cholesterol (Lp[a]-C) using major lipid-altering therapies to reduce cardiovascular risk. Elevated LDL-C should be the primary target of therapy. Because Lp(a) may mediate thrombogenic as well as atherogenic effects, some patients with elevated Lp(a) may be candidates for antiplatelet therapies (eg, aspirin). *The optional category includes a 10-year Framingham risk score of 5% to 19% or a CHD risk equivalent. BAR = bile acid resin (sequestrant); CAI = cholesterol absorption inhibitor; CHD = coronary heart disease; CVD = cardiovascular disease; LDL = low-density lipoprotein; NCEP = National Cholesterol Education Program. Mayo Clinic Proceedings 2013 88, 1294-1311DOI: (10.1016/j.mayocp.2013.09.003) Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions