Secondary Prevention of Cardio-Vascular Disease

• NZ Guidelines Group

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• Overview

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• Treating to New Targets (TNT) trial
• Supports a lower LDL cholesterol target in stable coronary artery disease
• Comparison of the TNT trial with selected studies
• Apo B in TNT and IDEAL

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• PROVE IT
• Supports more intensive lipid lowering after acute coronary syndromes

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• Looking Beyond LDL
• Apolipoprotein-B and A1
  
  • Notes from ASEANZ 2009
  • Apo B in TNT and IDEAL
• HDL Cholesterol
• Non-HDL cholesterol Levels
• CRP in the PROVE IT trial

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• Diabetes
• New targets for management- notes from ASEANZ 2009
• Controversies- notes from ASEANZ 2009
• Macrovascular complications- more than just HbA1C- notes from ASEANZ 2009

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• Supplements
• Folic Acid

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• South Asians
  • Optimal Risk Factor Status for South Asians for Secondary Prevention
  • BMI measurement leads to underestimation of obesity

Assessment and Management of Cardiovascular Risk

Apolipoprotein B/Apolipoprotein A1

Apolipoprotein A-I and B levels and the risk of ischaemic heart disease during a five year follow-up of men in the Quebec Cardiovascular Study, Circulation 1996;94:273-78

This report relates to 2155 men (45 to 76 years of age) without ischaemic heart disease at baseline.

Apo-B concentration was measured at entry and was associated with increased risk of onset of ischaemic heart disease (relative risk 1.4). This risk was independent of covariables such as age, smoking, diabetes mellitus, and systolic pressure.

Controlling for triglycerides, HDLC, and TC/HDLC ratio did not eliminate the relationship between apo-B and ischaemic heart disease.

The table below outlines the relative risk for groups with total/HDL cholesterol above or below the median (5.65) and with apo-B above or below the median (1.16g/l).

Risk increases with apo-B levels, the cut-off used in this study was the median value.

The relationship between Apo-A1 and risk of ischaemic heart disease was lower and adjustment for other variables eliminated this relationship. This implies that we need not routinely measure Apo-A1 levels, but in addition to measuring the standard lipid profile, we might measure apo-B levels in selected cases.

Hitesh Patel, Cardiologist
3 October, 2004