Secondary Prevention of Cardio-Vascular Disease

• NZ Guidelines Group

---

• Overview

---

• 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

---

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

---

• 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

---

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

---

• Supplements
• Folic Acid

---

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

Lipid Modifying Therapy for Secondary Prevention

Do Raised CRP Levels Warrant More Intensive LDL Cholesterol Lowering Therapy?

The REVERSAL trial compared high dose atorvastatin vs standard dose pravastatin and assessed the rate of atheroma progression with intravascular ultrasound.

This analysis found that after making adjustments for the reduction in lipid levels, the decrease in CRP levels was significantly correlated with reduced rates of atheroma progression.

These findings and those of the PROVE-IT trial indicate that lowering of CRP levels provides benefit over and above that obtained by lowering of LDL cholesterol levels.

• Nissen SE, Tuzcu EM, Schoenhagen P, et al. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med 2005; 352:29-38