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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Evaluating Treatment Strategies in the Management of Dyslipidemias


GOAL
The goal of this issue is to provide physicians with the most current information available for the treatment and management of hypercholesterolemia.

TARGET AUDIENCE
This activity is designed for cardiologists, internists, and primary care physicians. No prerequisites required.

LEARNING OBJECTIVES
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:

  • Identify the unmet needs for patients striving to obtain low-density lipoprotein cholesterol goals as set forth by the third National Cholesterol Education Program Adult Treatment Panel guidelines.
  • Evaluate new approaches to treating diabetic patients at risk for coronary heart disease.
  • Describe the benefits of combination therapy and the opportunity it offers to explore new and emerging treatments in the reduction of coronary risk, including inflammation.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hour.

Release date: April 15, 2003. Expiration date: April 15, 2005.

DISCLAIMER STATEMENT
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 Merck/Schering-Plough Pharmaceuticals.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. 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. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

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:

PROGRAM DIRECTORS

    Roger S. Blumenthal, MD
    Associate Professor of Medicine
    Johns Hopkins University School of Medicine
    Director of Preventive Cardiology
    The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
    Baltimore, Maryland
    • Dr Blumenthal reports receiving grants and/or research support and honoraria from Kos, Merck & Co. Inc, Novartis Corporation, and Pfizer Inc.

    Peter O. Kwiterovich, Jr, MD
    Professor of Medicine and Pediatrics
    Johns Hopkins University School of Medicine
    Director, Johns Hopkins University Lipid Clinic
    Chief, Lipid Research
    Johns Hopkins University Hospital
    Baltimore, Maryland
    • Dr Kwiterovich reports receiving grant/research from AstraZeneca Pharmaceuticals LP and Merck/Schering-Plough Pharmaceuticals; serving as a consultant to Atherotech, Merck/Schering-Plough Pharmaceuticals, and Sankyo Pharma; and receiving honoraria from AstraZeneca Pharmaceuticals LP, Kos Pharmaceuticals, Merck/Schering-Plough Pharmaceuticals, Pfizer Inc, and Sankyo Pharma.

PARTICIPATING FACULTY

    Christie M. Ballantyne, MD
    Professor of Medicine
    Clinical Director, Section of Atherosclerosis and Lipoprotein Research
    Baylor College of Medicine
    Houston, Texas
    • Dr Ballantyne reports receiving grant/research support from AstraZeneca Pharmaceuticals LP, diaDexus, GlaxoSmithKline, Merck & Co. Inc, Novartis Corporation, Pfizer Inc, Reliant Pharmaceuticals, and Schering-Plough; serving as a consultant to AstraZeneca Pharmaceuticals LP, Merck & Co. Inc, Novartis Corporation, Pfizer Inc, Reliant Pharmaceuticals, and Schering-Plough; receiving honoraria from AstraZeneca Pharmaceuticals LP, Bristol-Myers Squibb, Kos, Merck & Co. Inc, Novartis Corporation, Pfizer Inc, Reliant Pharmaceuticals; and Schering-Plough.

    H. Bryan Brewer, Jr, MD
    Chief, Molecular Disease Branch
    National Heart, Lung, and Blood Institute
    National Institutes of Health
    Bethesda, Maryland
    • Dr Brewer reports having no financial or advisory relationships with corporate organizations listed in this activity.

    John M. Dietschy, MD
    Professor of Internal Medicine
    The University of Texas Southwestern Medical Center at Dallas
    Dallas, Texas
    • Dr Dietschy reports serving as a consultant to Merck/Schering-Plough Pharmaceuticals.

    Peter Libby, MD
    Chief, Cardiovascular Medicine
    Brigham and Women’s Hospital
    Harvard Medical School
    Boston, Massachusetts
    • Dr Libby reports receiving honoraria from and owning stock shares in Merck/Schering-Plough Pharmaceuticals.

    Evan A. Stein, MD, PhD
    Director of Research
    Cholesterol Research Center
    Metabolism and Atherosclerosis Research Center
    Cincinnati, Ohio
    • Dr Stein reports receiving grant/research support from and serving as a consultant to AstraZeneca Pharmaceuticals LP, GlaxoSmithKline, Merck/Schering-Plough Pharmaceuticals, Novartis Corporation, and Pfizer Inc; and receiving honoraria from and/or serving on the speakers’ bureau for AstraZeneca Pharmaceuticals LP, Merck/Schering-Plough Pharmaceuticals, and Novartis Corporation.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity contains reference(s) to unlabeled or unapproved uses of drugs or devices.

Faculty members have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

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.

Elevated serum low-density lipoprotein (LDL) cholesterol plays a major role in the development and progression of coronary heart disease. The updated National Cholesterol Education Program (NCEP) treatment guidelines define LDL target values according to the presence and number of coronary risk factors. The guidelines focus on the treatment of elevated LDL levels to modify dyslipidemia, which increases coronary risk. In addition, the guidelines identify diabetes as a coronary disease risk equivalent, meaning that diabetic patients without coronary disease and nondiabetic individuals with established coronary disease have the same coronary risk. Moreover, the metabolic syndrome is recognized as a high-risk condition that warrants careful evaluation and aggressive management of associated risk factors, which typically occur in clusters in affected patients.

Multiple large clinical trials over the past 2 decades have clearly established that lipid-lowering therapy reduces coronary risk. In particular, statin therapy has been found to be the most potent single therapy for reducing LDL cholesterol. Despite the availability of statins and other lipid-lowering therapies, a majority of patients with dyslipidemia still fail to achieve target lipid values. Furthermore, even though statins have reduced the rate of cardiovascular events by as much as 40% in some clinical trials, the majority of expected events are not prevented.

Clearly, new approaches are needed to reduce the morbidity and mortality from coronary heart disease. Recent advances in our understanding of cholesterol metabolism have led to new pharmacologic strategies to reduce the risks associated with dyslipidemia, including the development of the new class of specific cholesterol absorption inhibitors. Other new classes of compounds are in various stages of development and evaluation and include combination therapy that builds on the therapeutic efficacy established by statins.

The presentations included in this issue reflect both the progress in coronary risk management associated with dyslipidemia and the challenges that remain. Specifically, Dr Evan A. Stein provides a concise overview of the current status of coronary disease epidemiology, the advances that have helped reduce the morbidity and mortality from coronary disease, and the need for further treatment advances.

Dr Peter Libby discusses the emergence of inflammation as a key factor in the evolution and progression of coronary disease. C-reactive protein may offer an especially useful tool for assessing inflammation and the effects of therapy on inflammation. Whether inflammation itself can be targeted for treatment to reduce coronary risk remains to be determined.

Diabetes and the metabolic syndrome have a major impact on coronary risk, which is addressed by Dr H. Bryan Brewer, Jr, in this supplement. Both conditions involve dyslipidemia, which differs substantially from classic hypercholesterolemia typified by elevated total and LDL cholesterol. Again, the most recent update of the NCEP guidelines recognizes diabetes as a coronary disease risk equivalent and establishes the metabolic syndrome as a high-risk clinical condition.

Dr John M. Dietschy reviews recent advances and the current understanding of cholesterol metabolism. He delineates potential opportunities for intervention and discusses ongoing research aimed at the development of new therapeutic agents based on the evolving knowledge base related to the body’s processing of lipids.

Finally, Dr Christie M. Ballantyne discusses the emerging body of clinical data related to ezetimibe, the first member of the new drug class known as specific cholesterol absorption inhibitors. Available data suggest that the agent has considerable potential for the treatment of dyslipidemia, particularly in combination therapy with a statin or other available lipid-lowering therapy.

Collectively, the following articles reflect the translation of basic research into clinical practice. Physicians in all types of practice settings will find these articles informative and clinically relevant.

*Associate Professor of Medicine, Director of Preventive Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
†Professor of Medicine and Pediatrics, Chief, Lipid Clinic, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 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. ASiM is a registered trademark of The Healthcare Media Group, LLC.