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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 professionals.

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

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

  • Identify current concepts and key issues involved in the diagnosis and treatment of lipid disorders
  • Evaluate the new NCEP guidelines and address possibilities for more successful implementation of risk reducing practices
  • Describe the recommended approaches for both primary and secondary prevention of CHD

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

This program is approved for 1 hour of credit (.1 CEUs) and is sponsored by The University of Tennessee College of Pharmacy, is approved by The American Council on Pharmacy Education as a provider of continuing pharmacy education. Credits will be awarded until March 31, 2004. ACPE Program #064-999-02-222-H01.

This continuing education activity was produced under the supervision of Roger S. Blumenthal, MD, 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; Kathleen H. Sabatier, MS, RN, Director, The Institute for Johns Hopkins Nursing; and Glen E. Farr, PharmD, Associate Dean for Continuing Education, University of Tennessee College of Pharmacy.

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.

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.

PROGRAM CHAIRPERSONS

    Roger S. Blumenthal, MD
    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; receiving 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 and receiving honoraria from Merck, Sankyo Pharma, and Kos.

PARTICIPATING FACULTY

    Sherita Hill Golden, MD, MHS
    Faculty - 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; 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 for 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; 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 Association
    Atlanta, Georgia
    • Dr Robertson reports serving as a consultant for Kos, and Abbott; receiving honoraria from Pfizer, Bristol-Myers Squibb, and Sankyo Pharma.

    Dennis L. Sprecher, MD
    Section Head Preventive Cardiology
    The Cleveland Clinic Foundation
    Cleveland, Ohio
    • Dr Sprecher reports no financial or advisory relationships with any corporate organization.

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.

Dyslipidemia remains a major contributor to the incidence of coronary heart disease (CHD), which causes 500 000 deaths and 1.1 million heart attacks each year in the United States. More than 70 million adult Americans have total cholesterol levels that exceed 200 mg/dL, and approximately 40 million have cholesterol levels greater than 240 mg/dL, the current definition of hypercholesterolemia.

Clearly, cholesterol control continues to be a major health concern within the American population. Elevations in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are independent risk factors for CHD regardless of a patient's age or gender. Without interventions, lifestyle and/or pharmaceutical, approximately one half of all Americans will die of CHD.

Since 1988, The National Cholesterol Education Program (NCEP) has convened a panel of experts, the Adult Treatment Panel (ATP), to develop guidelines to help healthcare providers better manage dyslipidemia in their patients. The newest issuance, ATP III, was released in May 2001, calling for even more stringent control of cholesterol levels than its predecessors, ATP I and ATP II. ATP III emphasizes the importance of intervening with the metabolic syndrome and the need for a more aggressive approach to testing and management of low density lipoprotein cholesterol (LDL-C), with a new focus on CHD prevention in people with multiple risk factors and diabetes mellitus. Despite a more vigorous emphasis on therapeutic lifestyle interventions, the new guidelines are expected to substantially expand the number of Americans being treated for high LDL-C with pharmaceutical interventions, when lifestyle modification fails to achieve necessary results.

This publication, based on the proceedings of a roundtable symposium of national authorities on cholesterol management that took place in Baltimore, Maryland, on December 4, 200l, is the first in a series of 3 issues that will focus on specific ATP III recommendations and their implications for clinical practice. In this issue, Roger S. Blumenthal, MD, Director of Preventive Cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, outlines the new guidelines and addresses possibilities for more successful of implementation of risk-reducing practices by offering a checklist, "ABCs of Preventive Cardiovascular Disease Risk Factor Management." In the roundtable discussion and case study that follow, several authorities in the field of dyslipidemia discuss current concepts and some of the key issues involved in the diagnosis and treatment of lipid disorders. These experts share their knowledge and experience from clinical practice, including views on how best to achieve lipid and triglyceride goals, the implications of emergent research for practicing physicians, and the possibilities of combination therapy. This issue includes a candid interview with Dr Dennis L. Sprecher, Section Head of Preventive Cardiology at the Cleveland Clinic, who discusses the underlying reasons for poor compliance among patients and their providers with previous iterations of ATP.

The next 2 installments of this series will explore, in detail, the implications of the guidelines for the treatment of patients with diabetes, and other special populations, possible considerations for the next release of ATP guidelines, and in-depth reports on the role of pharmacotherapy in achieving LDL goals.

*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.





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.