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

ASEANZ 2009

Session on complex dyslipidaemia

Measuring Apo-B levels may help differntiate between the different types of mixed dyslipidaemias- in particular identify patients that have higher levels of atherogenic lipoproteins.

The lab measurements of HDL cholesterol are not well standardised and apo-B measurements are more reliable. The variability in total and HDL cholesterol levels means that one would ideally use the average of four measurements for best assessment, but only a single apo-B measurement is required.

The use of mixed chain fatty acids in the diet can be useful in patients with mixed dyslipidaemia.

Fish oils can be useful in those with raised VLDL cholesterol levels- fish oils in this setting increases the processing of VLDL to LDL and consequentially lowers triglyceride levels but can raise apo-B levels (since more LDL particles are produced). Fibrates may act in the same manner in this situation.

Some patients are very alcohol sensitive and elevate total cholesterol levels quite markedly in response to consumption of even small amounts of alcohol.

Some data was presented that showed that Apo-B risk stratification may be superior to LDL cholesterol based or non-HDL cholesterol based therapy.

Metformin has not been proven to be cardioprotective but has been found to decrease the rate of progression to diabetes in the presence of impaired glucose tolerance.