P H Y S I C I A N S ’ A C A D E M Y F O R C A R D I O V A S C U L A R E D U C A T I O N Insights from clinical trials: The unassailable case for LDL-c.

Slides:

Advertisements

Similar presentations

Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial Michael Miller MD,

Advertisements

Protecting the heart and the kidney: Implications from the SHARP trial Dr. Christina Reith University of Oxford United Kingdom.

P Sever (Co-chair), B Dahlöf (Co-chair), N Poulter (Secretary), H Wedel (Statistician), G Beevers, M Caulfield, R Collins, SE Kjeldsen, A Kristinsson,

Coronary heart disease (CHD) event rates in secondary prevention and acute coronary syndrome trials A. Kumar, C.P. Cannon. Arch Med Sci 2007;3:S115-S125.

Treat Everyone to an LDL-C of 70mg/dl? Daniel Edmundowicz, MS, MD, FACC Associate Professor Of Medicine Director, Preventive Cardiology UPMC Cardiovascular.

1. 2 The primary Objective of IDEAL LDL-C Simvastatin mg/d Atorvastatin 80 mg/d risk CHD In stable CHD patients IDEAL: The Incremental Decrease.

New concepts and guidelines in the management of LDL-c and CV Risk: Need for early intervention Prof. Ulf Landmesser University Hospital Zürich Switzerland.

Lipid Disorders and Management in Diabetes

Slide Source: Lipids Online Slide Library Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT): Design Cannon CP.

Evidence Based Secondary Prevention Christopher Cannon, M.D. TIMI Study Group Cardiovascular Division Brigham and Women’s Hospital Boston, MA.

Prescribing Information is available at the end of this presentation NHS Surrey Lipid Guidelines Dr Adam Jacques Ashford & St.

On-Treatment LDL and CHD Events in Statin Trials 2 Adapted from Rosenson RS. Expert Opin Emerg Drugs. 2004;9: LaRosa JC et al. N Engl J Med. 2005;352:

TNT: Study Design Treating to New Targets 2 5 years 10,001 Patients Clinically evident CHD LDL-C 130  250 mg/dL following up to 8-week washout and 8-week.

How Aggressive do we get on Lipids? Christopher Cannon, M.D. Senior Investigator, TIMI Study Group Cardiovascular Division, Brigham and Women’s Hospital,

LIPID LOWERING IN T2D (The Lower the Better?) CONS… TARGETING HARD CVD END POINTS Charles SAAB MD Consultant Endocrinologist DCRP Sacre-Coeur University.

VBWG IDEAL: The Incremental Decrease in End Points Through Aggressive Lipid Lowering Study.

Treating to New Targets Study TNT Trial Presented at The American College of Cardiology Scientific Sessions 2005 Presented by Dr. John C. LaRosa.

Welcome Ask The Experts March 24-27, 2007 New Orleans, LA.

Role of Rosuvastatin in the Treatment of Dyslipidemia

HYPERLIPIDAEMIA. 4S 4444 patients –Hx angina or MI –Cholesterol Simvastatin 20mg (10-40) vs. placebo FU 5 years  total cholesterol 25%;  LDL.

Lipid Lowering Substudy Trial of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial JAMA 2002;288: ALLHAT- LLT.

Modern Management of Cholesterol in the High-Risk Patient.

VBWG HPS. Lancet. 2003;361: Gæde P et al. N Engl J Med. 2003;348: Recent statin trials: Reduction in primary outcome in patients with diabetes.

The concept of Diabetes & CV risk: A lifetime risk challenge The Clinical Significance of LDL-Cholesterol: No Longer a Hypothesis? John J.P. Kastelein,

Cholesterol Lowering and CV Risk: Meta-analyses. On-Treatment LDL and CHD Events in Statin Trials 2 Adapted from Rosenson RS. Expert Opin Emerg Drugs.

Incremental Decrease in Clinical Endpoints Through Aggressive Lipid Lowering (IDEAL) Trial IDEAL Trial Presented at The American Heart Association Scientific.

Aspirin Resistance: Significance, Detection and Clinical Management of This Real Phenomenon Webcast May 10 th, 2004 Sponsored by.

The Prospective Pravastatin Pooling Project L I P I D CARECARE PPP Project Investigators Am J Cardiol 1995; 76:899–905.

Antithrombotic Trialists’ (ATT) Collaboration. Lancet 2009;373:

WOSCOPS: West Of Scotland Coronary Prevention Study Purpose To determine whether pravastatin reduces combined incidence of nonfatal MI and death due to.

The overwhelming case for LDL-C lowering

Collaborative Atorvastatin Diabetes Study CARDS Dr Sachin Kadoo.

BRIAN CLAYTON INTERNAL MEDICINE ADVISOR: ANNA MAE SMITH PRECEPTOR: DR. RAJESH PATEL Evidence Based Medicine Spring 2009.

4S: Scandinavian Simvastatin Survival Study

Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck

The IDEAL Cholesterol Christopher Cannon, M.D. TIMI Study Group Brigham and Women’s Hospital Cannon CP. JAMA 2005;294:

Number of participants with diabetes by trial Cholesterol Treatment Trialists' (CTT) Collaborators Lancet 2008;371:

Baseline characteristics and eligibility criteria of participating trials Cholesterol Treatment Trialists’ (CTT) Collaborators Lancet 2005;366:

Unnecessary Lipid Screening of Inpatient Admissions Dennis Whang 4/2/12 DSR2.

Date of download: 5/31/2016 Copyright © The American College of Cardiology. All rights reserved. From: Optimal low-density lipoprotein is 50 to 70 mg/dl:

Double-blind, randomized trial in 4,162 patients with Acute Coronary Syndrome

Date of download: 7/8/2016 Copyright © The American College of Cardiology. All rights reserved. From: The Year in Atherothrombosis J Am Coll Cardiol. 2012;60(10):

Date of download: 9/18/2016 Copyright © The American College of Cardiology. All rights reserved. From: Next Steps in Primary Prevention of Coronary Heart.

Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck.

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from participants in 26 randomised trials Lancet 2010;

NICE –CG 181 Continuum of CVD Risk and its treatment

Impact of Triglyceride Levels Beyond Low-Density Lipoprotein Cholesterol After Acute Coronary Syndrome in the PROVE IT-TIMI 22 Trial Michael Miller MD,

Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck

Predicted 5-year benefits of LDL cholesterol reductions with statin treatment at different levels of risk. (A) Major vascular events, and (B) vascular.

2013 ACC/AHA cholesterol treatment guidelines

Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck

REVEAL: Randomized placebo-controlled trial of anacetrapib in 30,449 patients with atherosclerotic vascular disease Louise Bowman on behalf of the HPS.

AIM HIGH Niacin plus Statin to prevent vascular events

HDL cholesterol and cardiovascular risk Epidemiological evidence

First time a CETP inhibitor shows reduction of serious CV events

HDL cholesterol and cardiovascular risk

AIM-HIGH Niacin Plus Statin to Prevent Vascular Events

FATS- Familial Atherosclerosis Treatment Study

Introduction to: 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults BLUF: -Shift from.

Introduction to: 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults BLUF: -Shift from.

Insights from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)

2013 ACC/AHA cholesterol treatment 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.

Potential mechanisms whereby statins may reduce the risk of stroke

Cause of death Treatment-arm events, % (n=45 054)

The Heart Rhythm Society Meeting Presented by Dr. Johan De Sutter

Strategies for Optimizing Glycemic Control and Cardiovascular Prognosis in Patients With Type 2 Diabetes Mellitus James H. O'Keefe, MD, Mohammad Abuannadi,

PROSPER: trial design

The following slides highlight a report on a presentation at the American College of Cardiology 2004, Scientific Sessions, in New Orleans, Louisiana on.

James H O'Keefe, Jr et al. JACC 2004;43:

Presentation transcript:

P H Y S I C I A N S ’ A C A D E M Y F O R C A R D I O V A S C U L A R E D U C A T I O N Insights from clinical trials: The unassailable case for LDL-c lowering Kausik Ray, MD St Georges University London, United Kingdom Master class: Exploring the clinical innovations in lipid management? June 4-5, 2010, Barcelona

P H Y S I C I A N S ’ A C A D E M Y F O R C A R D I O V A S C U L A R E D U C A T I O N Prof. Kausik Ray: Biography Dr Ray is per June 2010 Professor of Cardiovascular Disease Prevention at St George’s University of London on the Monday. Dr. Kausik Ray received his BSc (Hons) in Pharmacology and MBChB from Birmingham Medical School, and subsequently completed his post graduate training in the West Midlands obtaining his MRCP (UK). He undertook higher specialist training in Cardiology in the West Midlands and Sheffield. He received his MD from the University of Sheffield, studying the role of the IL-1 locus in coronary disease and endothelial function, as a British Heart Foundation Junior Research Fellow, under Professor David Crossman. After completing his clinical training at Sheffield, he was a British Heart Foundation International Fellow at Harvard Medical School/Brigham and Women’s Hospital, working in the TIMI study group under Dr Eugene Braunwald and Dr Christopher Cannon. Whilst in US he undertook many of the key analyses of high dose statin therapy for the management of acute coronary syndromes (ACS) and studies of novel biomarkers in patients with ACS. His clinical interests are in preventative cardiology and the pathogenesis and management of acute coronary syndromes. His present research in Cambridge (funded by the British Heart Foundation) focuses on large scale studies of cardiometabolic risk factors, and in particular adipokines and HDL in prospective studies. He is also assessing the practical utility of novel biomarkers in the management of patients with coronary artery disease.

Clinical Events Correlate Directly With On-Treatment LDL-Cholesterol Levels P = placebo; S = statin. Reproduced from O'Keefe et al. J Am Coll Cardiol. 2004;43:2142, with permission. CHD Events (%) LDL Cholesterol (mg/dL) y = x R 2 = P=.0019 AFCAPS-S WOSCOPS-S ASCOT-S ASCOT-P AFCAPS-P WOSCOPS-P

Cholesterol Trialist Collaboration Meta-Analysis of Dyslipidemia Trials 50% 40% 30% 20% 10% 0% -10% Reduction in LDL Cholesterol (mmol/L) Major Vascular Events Proportional Reduction in Event Rate (SE) Adapted from CTT Collaborators. Lancet. 2005; 366:

High-dose statin betterHigh-dose statin worse Odds Reduction Event Rates No./Total (%) High DoseStd Dose -16% 3972/13798 (28.8) 4445/13750 (32.3) -16% 1097/13798 (8.0) 1288/13750 (9.4) -12% 462/13798 (3.3) 520/13750 (3.8) +3% 340/13798 (2.5) 331/13750 (2.4) -6% 808/13798 (5.9) 857/13750 (6.2) -18% 316/13798 (2.3) 381/13750 (2.8) Coronary Death or Any Cardiovascular Event Coronary Death or MI Cardiovascular Death Non-Cardiovascular Death Total Mortality Stroke OR % CI, p=0.012 Odds Ratio (95% CI) Meta-Analysis of Intensive Statin Therapy All Endpoints OR, % CI, P=0.20 OR, % CI, p=0.73 OR, % CI, p=.054 OR, % CI, p= OR, % CI, P= Cannon CP, et al. JACC 2006; 48:

Coronary Heart Disease (CHD) Event Rates in Secondary Prevention Trials R² = p < LDL Cholesterol (mg/dl) CHD Events (%) PROVE-IT-PR PROVE-IT-AT CARE-S LIPID-S HPS-S 4S-S HPS-P CARE-P LIPID-P 4S-P O’Keefe, J. et al., J Am Coll Cardiol 2004;43: