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

INTERHEART

Waist-Hip Ratio Superior to BMI

Further analysis of the INTERHEART confirms the importance of the waist-hip ratio as a measure of obesity. Importantly, the INTERHEART study also provides evidence of the importance of overweight and obesity across different poplulations.

A one standard deviation increase in the waist-hip ratio is more hazardous than a one standard deviation increase of BMI.

A progressive increase of risk of myocardial infarction was seen with the higher waist-hip ratios even for those with a BMI between 20-25.

Increasing waist-hip ratio was associated with greater hazard in all subgroups and regions, with the exception of the Chinese population.

The impact of obesity is likely to have been underestimated with the use of the BMI.

If BMI is used for assessment of obesity than different ethnic populations will require different thresholds for the definition of "overweight" and "obesity".

For South Asians obesity is defined as body mass index >27 kg/m², truncal obesity may be defined as waist/hip ratio >0.9 in males and >0.8 in females).

Hitesh Patel, Cardiologist
15/06/07