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

No Cardiovascular Benefit from Folic Acid Supplementation

The HOPE trial had found no cardiovascular benefit from Vitamin E supplementation. The same investigators designed the HOPE-2 trial to assess the effects of folic acid with B vitamins in high risk patients.

The HOPE-2 trial included a large number of participants with vascular disease. There was no cardiovascular benefit from addition of a combination of folic acid, Vitamin B6 and Vitamin B12.

The NORVIT trial also found a lack of benefit with addition of folic acid or Vitamin B12 or Vitamin B6. This trial included patients early after myocardial infarction.

Hitesh Patel
Cardiologist
15/06/07