Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.
From Evidence to Practice: Optimizing Lipid-Lowering Therapy
To provide physician assistants with information on the prevention of coronary heart disease (CHD), focusing on achieving target cholesterol levels in at-risk patients.
This activity is designed for physician assistants. No prerequisites required.
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:
- Recognize and assess patients who are at risk for CHD using the National Cholesterol Education Program's Third Adult Treatment Panel guidelines.
- Describe the 2 components of CHD and understand the role of each in the development of the disease.
- Implement lifestyle and pharmacologic therapies in patients who are at risk for CHD.
- Apply aggressive management strategies in patients who are at risk for CHD.
This program has been reviewed and is approved for a maximum of 2 hours of clinical Category 1 (Preapproved) CME credit by the Physician Assistant Review Panel. Approval is valid for 1 year from the issue date of October 1, 2003. Participants may submit self-assessments at any time during that period.
This program was planned in accordance with the AAPA's CME standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
This program is supported by an unrestricted educational grant from AstraZeneca LP.
Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.
Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:
Gary Gerstenblith, MD
Professor of Medicine
Director of Clinical Trials
Division of Cardiology
Department of Medicine
Johns Hopkins University School of Medicine
• Dr Gerstenblith reports serving on the speakers bureau for Pfizer, Inc.
Benjamin J. Ansell, MD, FACP
Assistant Clinical Professor
Division of General Internal Medicine and Health Services Research
UCLA Center for Primary Care-Based Cardiovascular Disease Prevention
University of California at Los Angeles School of Medicine
Los Angeles, California
• Dr Ansell reports receiving honoraria and travel expenses from AstraZeneca LP and Pfizer, Inc; receiving grant and or/research support from Merck & Co, Inc, and Pfizer, Inc; serving on the speakers bureau for Kos Pharmaceuticals and Pfizer, Inc; and holding stock in Pfizer, Inc.
Keith C. Ferdinand, MD, FACC
Clinical Cardiologist and Medical Director
Heartbeats Life Center
Professor, Clinical Pharmacology
Xavier University College of Pharmacy
New Orleans, Louisiana
• Dr Ferdinand reports receiving grant and/or research support from AstraZeneca LP, Merck & Co, Inc, and Pfizer, Inc.
Sandra L. Mackey, MPAS, PA-C
Director of Staff Wellness
Texas Scottish Rite Hospital for Children
• Ms Mackey reports having no financial or advisory relationships with corporate organizations related to this activity.
John R. White, Jr, PharmD, PA-C
Primary Care Provider
Indian Health Service Clinic
Department of Pharmacotherapy
Washington State University College of Pharmacy
• Dr White reports receiving honoraria from and serving on the speakers bureau for Aventis, Omron Corporation, Pfizer, Inc, and TheraSense; and receiving grant and/or research support from Aventis and TheraSense.
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices.
Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or products.
Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.
The concept that high cholesterol is an important health risk is widely accepted. Many people understand that there are "good" and "bad" cholesterol components and the importance of each in reducing the risk of a myocardial infarction (MI), or heart attack. While these serve well in an educational marketing campaign for the general public, medical researchers, are discovering the complex processes involved in the development of an atherosclerotic plaque and the progression from an arterial fatty streak to MI.
Our understanding of coronary heart disease (CHD) is expanding along two frontiers: a better understanding of the pathophysiology of the complex atheroma and, as a result, increased awareness of newly identified measures of risk.
This issue of Advanced Studies in Medicine provides a summary of the presentations from a symposium preceding the American Academy of Physician Assistants 31st Annual Physician Assistant Conference (May 22-27, 2003, New Orleans, Louisiana).
Dr Keith C. Ferdinand, Director of the Heartbeats Life Center in New Orleans, provides a useful overview of our current understanding of the pathophysiology of the complex atheroma. It is important for healthcare practitioners to understand this process because it provides one rationale for the identification of heart disease risk factors and the treatments recom-mended by leading authorities. As Dr Ferdinand notes, although recommended therapies and their targets are not yet changed, testing for emerging cardiovascular disease risk factors can help to identify at-risk individuals who may otherwise be overlooked by population-based guidelines. We are also beginning to understand the importance of inflammatory processes in the development and progression of atherosclerotic disease and its clinical manifestations. The importance of thrombus formation and propagation is also recognized.
Cardiovascular disease is the leading cause of death in the Western world and in the United States. Lifestyle changes may significantly reduce the incidence of cardiovascular disease, yet Americans remain unable to make the necessary changes. Dr John R. White, Jr, provides a comparison of the guidelines from the National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP III) from the previous version (ATP II) and summarizes the treatment targets based on CHD risk factors. The NCEP ATP III guidelines are an important tool primary care providers can use to reduce heart disease. As Dr White remarks, physician assistants (PAs) are in the front line of managing disease and encounter many patients with hyperlipidemia. Using the NCEP ATP III guidelines as a basis, PAs also encounter many previously unidentified patients who are at increased risk for CHD and are therefore not receiving the benefit of cholesterol-lowering therapies.
Dr Benjamin J. Ansell takes the NCEP ATP III guidelines one step further, by discussing the most recent clinical studies of lipid-lowering drugs (statins, fibrates, and niacin) and what the results indicate regarding optimal cholesterol levels. It is now becoming clear that certain subsets of patients with normal cholesterol levels may still benefit from statin therapy. Dr Ansell also reviews some of the newer agents under investigation (pitavastatin and rosuvastatin [recently approved by the US Food and Drug Administration]) as well as ezetimibe (a cholesterol-absorption blocker).
Finally, this issue also contains coverage of a seminar by a PA with many years' experience in preventive medicine. Sandra L. Mackey discusses her experience with "prescribing" therapeutic lifestyle changes, as recommended by the NCEP ATP III guidelines, and offers some practical approaches for PAs, given their time constraints, the difficulty in learning motivational skills, and the unique obstacles faced by each patient.
PAs, as the frequent first encounter with the patient in primary care, are indeed in a unique position to identify and treat dyslipidemia in a clinically meaningful and cost-effective way. Heart disease, as one of the primary causes of death in America, is a public health problem of enormous proportions. PAs have the opportunity to make a substantial impact on the public health of American adults.
*Professor of Medicine, Director of Clinical Trials, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.