23-25 April 2015
Merida, Yucatan
1a Cumbre Internacional de Aterosclerosis
del Mayab
Friday April 24, 2015

10:00 - 10:15 R3i importance in Latinoamerica Dr Cesar Rodriguez Gilabert, Mexico
10:15 - 10:30 Remnant Particles as markers of cardiovascular risk Dr Carlos Calvo, Chile
10:30 - 10:45 Residual risk in atherogenic dyslipidemia Dr Ruben Yza, Mexico
10:45 - 11:00 Discussion
Landmark study
Atherogenic dyslipidaemia is associated with higher residual cardiovascular risk in patients with previous stroke
Focus on...
Do emerging risk factors contribute to residual cardiovascular risk?
The National Lipid Association (NLA)
The National Lipid Association (NLA) is a nonprofit, multidisciplinary medical society focused on enhancing the practice of lipid management in clinical medicine.
9 March 2015
Call for action on stroke
Prof. Jean Charles Fruchart, Prof. Jean Davignon, Prof. Michel Hermans, Prof. Pierre Amarenco
Prof. Jean Charles Fruchart, Prof. Jean Davignon, Prof. Michel Hermans, Prof. Pierre Amarenco
An Editorial from the R3i Trustees

Stroke, predominantly ischaemic stroke, is a leading cause of mortality, morbidity and serious long-term disability. Moreover, the fact that one in four strokes occur in individuals who have previously had a stroke, highlights the need for urgent action to reduce the residual risk of recurrent events.
Guidelines recommend low-density lipoprotein cholesterol (LDL-C) as the primary lipid target for reducing the risk of recurrent stroke. However, mounting evidence suggests that other lipid parameters might be also predictive of cardiovascular risk and provide additional benefit. Little is so far known about the effects of non-traditional lipid factors or emerging biomarkers on recurrent stroke risk.
R3i Education Channel
      MSDA 2014 - Experts interviews - Part 3 / 3

Pr Peter Libby

Pr Jean-Pierre Deprés

Pr Liping Zhao

What is inflammation relevant to the pathogenesis of insulin resistance?
Peter Libby
What is the mechanistic link between inflammation and the metabolic cluster?
Peter Libby
What are the criteria for overweight and obesity in Japan?
Jean-Pierre Després
What is the level of cardiovascular residual risk in Asian population?
Jean-Pierre Després
What is the value of BMI as a marker of risk?
Jean-Pierre Després
Gut microbiota is a complex ecological system how does it interact with our metabolism?
Liping Zhao
PCSK9 associated with atherogenic dyslipidaemia
PCSK9 plays a key role in cholesterol homeostasis by regulating the availability of low-density lipoprotein (LDL) receptors and in turn catabolism of LDL, thus influencing circulating levels of plasma LDL cholesterol. Moreover, there is also evidence that PCSK9 influences the metabolism of other lipoproteins including very low-density lipoprotein (VLDL), with high levels of PCSK9 shown to down-regulate VLDL receptor expression.1 This study investigated the relationship between PCSK9 and the lipoprotein profile using nuclear magnetic resonance (NMR) in 267 patients with diabetes and metabolic syndrome who were not receiving any lipid-lowering therapy. Levels of plasma PCSK9 levels were significantly and positively correlated with circulating levels of triglycerides (r=0.136, p=0.033), total cholesterol (r=0.219, p<0.001), and apolipoprotein B (r=0.226, p=0.006) and with an atherogenic lipoprotein profile. There was a positive association between circulating PCSK9 levels and large VLDL particles (r=0.210, p=0.001), and their remnants, specifically, proatherogenic circulating remnant lipoprotein cholesterol levels (r=0.171, p=0.006). In conclusion, these data highlight that PCSK9 is not only associated with LDL homeostasis, but also atherogenic lipoproteins such as VLDL, and remnant lipoprotein levels.
1. Roubtsova A, Munkonda MN, Awan Z et al. Circulating proprotein convertase subtilisin/kexin 9 (PCSK9) regulates VLDLR protein and triglyceride accumulation in visceral adipose tissue. Arterioscler Thromb Vasc Biol 2011;31:785-91.
Circulating PCSK9 levels are positively correlated with NMR-assessed atherogenic dyslipidemia in patients with high cardiovascular risk.
Guardiola M, Plana N, Ibarretxe D, Cabré A, González M, Ribalta J, Masana L
Triglyceride-rich lipoproteins and their remnants; a key driver of dyslipidaemia in type 2 diabetes;
This review in Atherosclerosis brings together new evidence that conclusively shows that the different components of diabetic dyslipidaemia are not isolated abnormalities but closely linked metabolically. Of note, the underlying disturbances are hepatic overproduction and delayed clearance of triglyceride-rich lipoproteins. Recent findings clearly show that triglyceride-rich lipoproteins and their remnants are atherogenic. Thus, understanding of the pathophysiology of dyslipoproteinaemia in humans reinforces the importance of targeting triglyceride rich lipoproteins for the prevention and treatment of dyslipidaemia.
New insights into the pathophysiology of dyslipidemia in type 2 diabetes.
Taskinen MR, Borén J.
EUROASPIRE IV: attainment of lipid targets still falls short
Latest findings from EUROASPIRE survey, a cross-sectional study of secondary prevention patients from 24 countries in Europe shows that achievement of guideline-recommended lipid goals is still far from optimal. This latest report from EURASPIRE include 7,998 patients (24.4% females) aged <80 years with coronary disease, who had coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome. Of the 74% of patients with dyslipidaemia, only 17% of women and 22% of men achieved the recommended low-density lipoprotein cholesterol goal of <1.8 mmol/L (70 mg/dL). This was despite 86.6% of patients receiving lipid-lowering therapy, principally statins. Moreover, there was also room for improvement with management of blood pressure, glycaemia, stopping smoking and lifestyle intervention. Nearly 50% of patients smoking at the time of the event were still smoking, 60% reported no or little physical activity, 38% of patients were obese (body mass index ?30 kg/m2), 43% had blood pressure ?140/90 mmHg and 27% had diabetes. Despite prescription of cardioprotective medication in >75% patients (anti-platelets 94%; beta-blockers 83%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75%; and statins 86%), most coronary patients did not achieve guideline standards for secondary prevention. Clearly, much remains to be done in terms of achieving healthier lifestyles, better risk factor control and adherence with cardioprotective medication in these patients.
EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.
Kotseva K, Wood D, De Bacquer D et al.
Fibroblast growth factor 21: a contributor to residual cardiovascular risk?
A new report from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, implicates fibroblast growth factor 21 (FGF21) levels in cardiovascular risk in patients with type 2 diabetes. FGF21 has already been shown to be elevated in obesity, dyslipidaemia, insulin resistance and type 2 diabetes. The investigators evaluated baseline plasma FGF21 levels in 9,697 individuals with type 2 diabetes in the FIELD study. The primary outcome was total cardiovascular disease (CVD) events. In analyses adjusted for confounding factors, higher baseline FGF21 levels were associated with higher risk for total CVD events (hazard ratio [HR] and 95% confidence interval [CI] 1.28, 1.10, to 1.50). Moreover, addition of FGF21 levels to a model including established CVD risk factors for predicting total CVD events led to significant improvement in discrimination and net reclassification of CVD risk. Taken together, these data add to emerging evidence for FGF21 as a contributor to cardiovascular risk in type 2 diabetes patients.
The relationship of fibroblast growth factor 21 with cardiovascular outcome events in the Fenofibrate Intervention and Event Lowering in Diabetes study.
Ong KL, Januszewski AS, O'Connell R et al.
Atherogenic index: simple measure for assessing the risk of type 2 diabetes
Atherogenic dyslipidaemia, the combination of elevated triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) is an important driver of cardiovascular risk in type 2 diabetes. This meta-analysis of 15 studies, with a total sample size of 4,010, showed a positive association between the Atherogenic Index, defined as log(TG/HDL-C) and type 2 diabetes. Indeed, the standardised mean difference (SMD) for the AIP was 1.78 (95% confidence interval (CI): 1.04-2.52), which was higher than for other parameters, including triglycerides (0.93, 95% CI: 0.78-1.09) and low-density lipoprotein cholesterol (LDL-C) ( 0.44, 95% CI: 0.11-0.77). Taken together, these results suggest AIP may be more closely associated with the risk of type 2 diabetes than other lipid parameters.
Meta-analysis of Atherogenic Index of Plasma and other lipid parameters in relation to risk of type 2 diabetes mellitus.
Zhu XW, Deng FY, Lei SF.
Diabetic retinopathy signs related to an increased risk of ESRD
In a multi-ethnic Asian population, diabetic retinopathy was associated with prevalent and incident end-stage renal disease (ESRD). Data from 5,763 subjects (aged at least40 years) from the Singapore Malay Eye Study and the Singapore Prospective Study) were evaluated. Retinopathy was graded using the modified Airlie House classification system. Retinal vascular parameters were measured using computer-assisted programs to quantify the retinal vessel widths (arteriolar and venular caliber) and retinal vascular network (fractal dimension). Data on ESRD was obtained by record linkage with the ESRD cases registered by National Registry of Diseases Office, Singapore. Retinopathy was associated with prevalent ESRD (odds ratio [OR], 3.21, 95% confidence interval [CI]: 1.28–8.05) and incident ESRD (hazard ratio [HR], 2.51, 95%CI:1.14–5.54). This association was largely seen in subjects with diabetes and not in those without diabetes. However, other microvascular changes in the retina were not associated with ESRD.
Retinal microvascular abnormalities and risk of renal failure in Asian populations.
Yip WF, Sabanayagam C, Teo BW et al.