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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 New Developments for the Clinical Management of High Blood Cholesterol


GOAL
To provide an in-depth analysis of the newly released Adult Treatment Panel III Cholesterol Guidelines, what they dictate, as well as the impact they have on cardiologists, internists, primary care physicians, and other health care providers.

TARGET AUDIENCE
This activity is designed for cardiologists, internists, primary care physicians, nurses, pharmacists, and other health care providers.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Identify which compliance issues prevent patients from achieving the full benefit of combination therapy in the treatment of hypercholesterolemia
  • Understand the value of additional markers, beyond the standard lipid profile, in determining a global risk assessment and overall approach to patient management
  • Discuss the clinical evidence supporting the benefits of combination therapy in treating hypercholesterolemia

ACCREDITATION STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 1 hour in Category 1 credit toward the American Medical Association Physicians' Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of September 30, 2004.

This continuing medical education activity was produced under the supervision of Roger S. Blumenthal, MD, Associate Professor of Medicine, Johns Hopkins University School of Medicine, and Director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, and Peter O. Kwiterovich, Jr, MD, Professor of Medicine and Pediatrics, Johns Hopkins University School of Medicine, and Director of the Johns Hopkins University Lipid Clinic.

This program is approved for 1 hour of credit (0.1 CEUs) and is co-sponsored by The University of Tennessee College of Pharmacy who is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education. ACPE Program #064-999-02-222-H01.

This continuing pharmacy education activity was produced under the supervision of Glen E. Farr, PharmD, Associate Dean of Continuing Education, University of Tennessee College of Pharmacy.

CONTINUING NURSING EDUCATION ACCREDITATION
This educational activity has been approved for 1 contact hour by the Institute for Johns Hopkins Nursing, which is accredited as a provider of continuing education in nursing by the American Nurses' Credentialing Center's Commission on Accreditation. Credit will be awarded until September 30, 2004. This continuing nursing education activity was produced under the supervision of Kathleen H. Sabatier, MS, RN, Director, The Institute for Johns Hopkins Nursing.

This program is supported by an unrestricted educational grant from Sankyo Pharma.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

CHAIRS

    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
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Blumenthal reports receiving grants and/or research support from Merck, Pfizer, Wyeth-Ayerst, Bristol-Myers Squibb, and Novartis; and has received honoraria from Merck, Pfizer, Medcom, and Physician's World.

    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 grants and/or research support from AstraZeneca, Merck, Kos, and Pfizer; serving as a consultant to and receiving honoraria from Merck, Sankyo Pharma, and Kos.

PARTICIPATING FACULTY

    Bassem El-Masri, MD
    Assistant Professor of Clinical Medicine and Cardiology
    Director, Cardiac Prevention and Intervention Center
    Weill Medical College of Cornell University and New York Presbyterian Hospital
    New York, New York
    • Dr El-Masri reports serving as a consultant to Merck, Bristol-Myers Squibb, Pfizer, Novartis, GlaxoSmithKline, Sankyo, KOS, AstraZeneca, Bayer, Atherotec, and Lipomed; serving on the speakers bureau for KOS, GlaxoSmithKline, and Sankyo; and receiving grant/research support from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Liposome, Merck, Novartis, and Schering-Plough.

    Sherita Hill Golden, MD, MHS
    Assistant Professor of Endocrinology
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Golden reports receiving grants and/or research support from The Robert Wood Johnson Foundation.

    Howard Knapp, MD, PhD
    Executive Director
    Deaconess Billings Clinic
    Billings, Montana
    • Dr Knapp reports receiving grants and/or research support from Pfizer, Merck, Novartis, Knoll, Amgen, Bayer, Bristol-Myers Squibb, SmithKline Beecham, Pharmacia, Aventis, Wyeth-Ayerst, Schering-Plough, and Sankyo Pharma; and receiving honoraria from Roche, Bayer, and Sankyo Pharma.

    William C. Little, MD
    Chief, Cardiology Section
    Wake Forest University Baptist Medical Center
    Winston-Salem, North Carolina
    • Dr Little reports receiving grants and/or research support from Merck; and serving as a consultant to Merck and Sankyo.

    James J. Maciejko, MD, PhD
    Director of Preventive Cardiology
    St. Johns Hospital
    Detroit, Michigan
    • Dr Maciejko reports receiving grants and/or research support from Merck, Pfizer, Beckman-Coulter, and Roche; and receiving honoraria from Sankyo Pharma, Pfizer, Merck, Kos, DuPont, and Abbott.

    David G. Robertson, MD
    Assistant Clinical Professor
    Emory University School of Medicine
    Physician, Atlanta Diabetes Associates
    Atlanta, Georgia
    • Dr Robertson reports serving as a consultant for Kos and Abbott; and receiving honoraria from Pfizer, Bristol-Myers Squibb, and Sankyo Pharma.

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.

In the treatment of hypercholesterolemia, medical evidence suggests that although combination therapy is safe and effective, compliance issues continue to prevent patients from achieving full benefit. This issue of Advanced Studies in Medicine, based on the proceedings of a roundtable symposium of national authorities on cholesterol management that took place in Baltimore, Maryland, on December 4, 200l, presents recent clinical evidence supporting the benefits of combination therapy in the treatment of hypercholesterolemia in addition to its potential as a prophylactic measure in delaying cardiac events for patients with normal lipid profiles. In an overview article, David G. Robertson, MD, an endocrinologist with Atlanta Diabetes Associates in Georgia, reviews findings from clinical trials of HMG-CoA reductase inhibitor (statin) and combination therapy and explores issues surrounding compliance.

Dr Robertson also explores clinical evidence supporting the use of combination therapy as a means of achieving even more significant reductions in low-density lipoprotein cholesterol (LDL-C) levels without the side effects associated with high-dose statin monotherapy. Dr Robertson suggests that in patients undergoing statin monotherapy, if the maximum achievable or tolerated dose does not reduce LDL-C levels to below 130 mg/dL, providers are obligated to add a second agent to therapy. Furthermore, he presents clinical evidence that suggests additional therapeutic benefits can be achieved by reducing LDL-C levels to an even lower goal of below 100 mg/dL, with or without combination therapy. He goes on to explore intriguing questions within the medical literature about the role of triglycerides, particle size, and particle numbers as predictors of medical benefit.

In the roundtable discussion and case study that follow, several authorities in the field of dyslipidemia further discuss current concepts and some of these key issues. Emergent findings from clinical evidence identifying opportunities to address multiple contributors to risk, beyond LDL-C, are discussed, pointing to even higher risk reduction with the use of combination therapy. A cost-benefit analysis puts these findings in even sharper perspective.

An additional article includes an interview with Bassem El-Masri, MD, Director of the Cardiac Prevention and Intervention Center at Cornell Medical Center. Dr El-Masri provides additional insights about aggressive approaches to interventions in patients of all ages.

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