?Dyslipidemia: What is your approach Khalid ALNemer MD,FRCPC,FACC,FASNC,FASCI,FSCCT Chairman of cardiac imaging working group SHA Clinical professor of cardiology ,KSU
Agenda Thanks to organizing committee for invitation No conflict of interest MCQ discussion Important concepts summary
Prevalence of dyslipidema in :saudia arabia .1 30% .2 40% .3 50% .4 60%
Rural areas saudis hyperlipdemia :compared to urban areas • A.More • B.Same • C.less
Which has worse control in our :country primary prevention.1 Secondary prevention. 2 Tertiary prevention. 3
At what age start screening for ?hyperlipdemia a.40 b.30 c.20 d.50
CV mortality lowered by statins due to .a.reduction in degree of coronary stenosis .b.plaque stabilization .c.HDL elevation d.LDL reduction
Case 1 yrs male gynecologist came to your clinic 45 ,smoker, lipid profile : TC 5.5 , HDL 1.1, LDL 3.2, TG :150, diabetic, SBP 135/85, you will advice .a.start simva 10 b.start non- pharmacological management for 3 months c.start rousevestatin 10 mg po od d. atorvestatin 80 mg po od
?Does statins causes Diabetes a.Agree b.Disagree c.Don’t know
Case 2 yrs diabetic post renal transplant on 50 simvestatin 40 mg po od , his HDL 0.2,LDL 2.1, :your next step is a.add gemfibrozil 600 mg po od .B.add niacin 1.5 gm/day c.double simva dose d.change to rousevastatin 10 mg po od .e.Continue same treatment
CASE 3 after simva 40 mg use the LDL is 4.1 in diabetic :patient, your next step a-increase to 80 mg po od b-add ezetmibe 10 mg po od c- a+b .d-switch to atorvestatin
CASE 4 LDL 16.0 post MI on diet , atorvestatin 80 mg po od ,ezetimibe 10 mg po od ,niacin 2gm od ‌ ?came for your help Nothing can be done more.1 Plasmapharesis.2 Liver tranplant.3 Bowel diversion.4
name a statin has been withdrawn from the ?market
?True or false
Omega 3 is very useful in reducing CV events in .diabetics
Impact of hypercholesterolaemia High cholesterol Atherosclerosis
Cardiovascular disease Coronary heart disease (CHD) Angina pectoris
Cerebrovascular disease Myocardial infarction
Sudden cardiac death
Peripheral vascular disease (PVD)
Transient ischaemic attack
Stroke
Intermittent claudication
Limb amputation
On-Treatment LDL-C is Closely Related to CHD Events in Statin Trials – Lower is Better 30
4S-placebo 2° prevention
Event rate (%)
25 4S-Rx
20
CHD + revasc + stroke CHD
LIPID-placebo
15
LIPID-Rx
CARE-placebo
CARE-Rx
10
HPS-placebo HPS-Rx
5
AFCAPS-Rx
80
100
WOSCOPS-placebo WOSCOPS-Rx
ASCOT-placebo
ASCOT-Rx
0
1° prevention
AFCAPS-placebo
120
140
160
180
200
Mean on-treatment LDL-C level at follow-up (mg/dL)
Ballantyne CM. Am J Cardiol 1998;82:3Q–12Q
LDL-C levels correlate with angiographic progression 0.06 PLAC-1
0.05 LCAS-1
0.04 MLD 0.03 decrease (mm/y) 0.02
CCAIT
REGRESS
PLAC-1 CCAIT MARS
0.01 0 2.1 80
MARS
MAAS
REGRESS LCAS
2.6 100
MAAS
4.1 3.1 3.6 160 120 140 LDL-C (mmol/l, mg/dl)
Ballantyne CM et al. Curr Opin Lipidol 1997; 8: 354–361
treatment placebo
4.7 180
!!Rule out secondary causes
Take home message
As a health care professional we should be at front line fighting this epidemic