R3i SYMPOSIUM
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
LATEST
Landmark study
Meta-regression analysis nails HDL-C
Focus on...
Utility of triglycerides/HDL-C ratio in acute coronary syndrome patients
LINKS
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.
EDITORIAL
18 May 2015
Do we need new lipid biomarkers for residual cardiovascular risk?
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

Cardiovascular disease burden continues to escalate, despite advances in diagnosis, management and pharmacotherapy over the last few decades. The latest news from the Global Burden of Disease 2013 shows that worldwide cardiovascular death rates are increasing, driven by both increasingly aging populations (accounting for more than half of this increase), together with population growth. Western and Central Europe stands alone in that, despite an aging population, decreases in age-specific cardiovascular mortality rates have culminated in a decline in the number of cardiovascular deaths.
In part this decrease may relate to reduction in the prevalence of cardiovascular risk factors, such as smoking, as well as improved medical and surgical treatments. However, evidence from surveys such as EUROASPIRE IV shows that even with increased prescription of efficacious treatments, attainment of lipid targets continues to be suboptimal...
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
RECENT PUBLICATIONS
Diabetes and cardiovascular disease in China
Evidence from the Da Qing study highlights diabetes as a major cause of cardiovascular disease, predominantly stroke, in China. This report included data from 630 people with newly-diagnosed diabetes (NDD) and 519 with normal glucose tolerance (NGT) who were included in the study in 1986. Over a 23 year follow-up period, 338 (57%) of those with NDD and 100 (20%) with NGT died. CVD was the cause of death in nearly half of those with diabetes (48% in men and 50% in women), the majority due to stroke (52% in men and 42% in women). Furthermore, the age-standardised incidence of all-cause mortality was 3-fold higher in subjects with NDD compared with those with NGT (incidence per 1,000 person-years: 36.9, 95% CI 31.5-42.3 versus 13.3, 95% 10.2-16.5 in men; and 27.1, 95% CI 22.9-31.4 vs. 9.2, 95% CI 7.8-10.6 in women, both p < 0.0001). These data highlight an urgent need for action to address escalating rates of diabetes and cardiovascular disease in China.
Cardiovascular and All-Cause Mortality Over a 23-Year Period Among Chinese With Newly Diagnosed Diabetes in the Da Qing IGT and Diabetes Study.
An Y, Zhang P, Wang J et al.
Lowering triglycerides to modify cardiovascular risk: new review
A new review discusses the potential of specific therapeutic strategies that directly target hypertriglyceridaemia to reduce vascular risk. A growing evidence-base, including cohort studies and meta-analyses, supports an association between increases in fasting and nonfasting triglycerides levels and cardiovascular risk. Furthermore, genomic and biomarker studies show that the metabolism of triglyceride-rich lipoproteins plays an important role in atherosclerosis. These data support resurgence in the use of omega-3 fatty acids for therapeutic lowering of triglycerides levels, including in patients with moderately elevated levels. Specifically, the review discusses data for icosapent, containing only eicasopentaenoic acid (EPA). Definitive evidence is awaited from the ongoing outcomes study, REDUCE-IT.
Lowering triglycerides to modify cardiovascular risk: will icosapent deliver
Scherer DJ, Nicholls SJ.
More insights into PCSK9 inhibitor therapy and cardiovascular outcomes
A new systematic review and meta-analysis provides further insight suggestive of clinical benefits with monoclonal antibody therapy targeting PCSK9 (proprotein convertase subtilisin/kexin type 9). This analysis included data from 10,159 patients included in 24 Phase II and III randomised controlled trials.
 
Not surprisingly, treatment with PCSK9 antibody therapy reduced low-density lipoprotein cholesterol to a significantly greater extent than in patients who did not receive this treatment (by 47%, p <0.001). Additionally, PCSK9 inhibitor treatment was associated with reduction in all-cause mortality by 55% (odds ratio 0.45, 95% CI 0.23 to 0.86, p = 0.015); and cardiovascular mortality by 50% (odds ratio 0.50, 05% CI 0.23 to 1.10, p = 0.084). Treatment was well tolerated with no increase in serious adverse events.
 
While acknowledging that the analysis was based on limited endpoints and study-level rather than patient-level data, the findings do suggest promise with this mode of lipid-modifying therapy for reducing residual cardiovascular risk.
Effects of proprotein convertase subtilisin/kexin type 9 antibodies in adults with hypercholesterolemia: a systematic review and meta-analysis
Navarese EP, Ko?odziejczak M, Schulze V et al.
Is HDL-C a predictor of lower extremity amputation in diabetes?
HDL-C may be implicated as a novel predictor of lower-extremity amputation risk in diabetes patients with foot ulcers, according to this observational study in 163 Japanese patients with diabetic foot ulcers. The primary endpoint was a composite of the worst of the following outcomes for each individual; (1) minor amputation (below the ankle), (2) major amputation (above the ankle), and (3) wound-related death.
 
Over a median follow-up period of 5.1 months, this endpoint was observed in 67 patients (41%): 43 had minor amputations, 16 had major amputations, and 8 had wound-related deaths. Univariate Cox proportional hazard model analysis showed that a lower HDL-C concentration was associated with increased incident primary outcome (hazard ratio 0.16, 95% CI 0.08-0.32, p < 0.001). Multivariate Cox proportional hazard model analysis (hazard ratio 0.30, 95% CI 0.14-0.63, p = 0.002). and categorical variable analysis (HDL-C ?1.03 mmol/L or <1.03 mmol/L) also identified low HDL-C as a predictor of incident lower-extremity amputation.
HDL cholesterol as a predictor for the incidence of lower extremity amputation and wound-related death in patients with diabetic foot ulcers.
Ikura K, Hanai K, Shinjyo T, Uchigata Y.
TG/HDL-C ratio: an important prognostic indicator of risk
Recent studies have highlighted the relevance of this parameter, the ratio of triglycerides/high-density lipoprotein cholesterol (TG/HDL-C), to risk prediction.
 
The TG/HDL-C ratio is an indirect measure of insulin resistance/hyperinsulinemia and an independent predictor of cardiovascular risk. Moreover, in patients with chronic kidney disease (CKD), the TG/HDL-C ratio was also a predictor of poor cardiovascular outcome. In a longitudinal, observational, retrospective study in 197 patients (CKD Stages 1 to 5), there were 11 cardiovascular (CV) deaths and 43 nonfatal CV events over a mean follow-up period of 30 months.1 The TG/HDL-C ratio was a significant independent determinant of CV outcomes (hazard ratio 1.36, 95% CI 1.11-1.67, p = 0.003). Furthermore, the TG/HDL-C ratio was also an independent determinant of flow-mediated vasodilatation of the brachial artery (assessed by high-resolution ultrasonography), a marker of endothelial dysfunction (p = 0.02). Based on these findings, the authors argue for consideration of the TG/HDL-C ratio as a novel predictor of CVD risk in subjects with CKD.
 
Furthermore, there is also evidence that the TG/HDL-C ratio may be a better discriminator of cardiometabolic risk than non-HDL-C in obese children. In a retrospective, cross-sectional study in 5,505 children (aged 5-18 years), 78% were shown to be obese.2 When categorised according to the 75th percentile of non-HDL-C (?130 mg/dl) or TG/HDL-C ratio (?2.2), the odds ratios for insulin resistance, high blood pressure, metabolic syndrome, presence of liver steatosis, increase in carotid intima-media thickness and left ventricular hypertrophy were higher in children with a high TG/HDL-C ratio compared with children with high levels of non-HDL-C.
 
Sonmez A, Yilmaz MI, Saglam M et al. The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease. Lipids in Health and Disease 2015;14:29.
Comparison of non-HDL-cholesterol versus triglycerides-to-HDL-cholesterol ratio in relation to cardiometabolic risk factors and preclinical organ damage in overweight/obese children: The CARITALY study.
Di Bonito P, Valerio G, Grugni G et al.
Aging and population growth key drivers for CVD rates
New analyses from the Global Burden of Disease Study 2013 report that aging and population growth are primarily responsible for increasing global cardiovascular death rates, despite an overall decrease in age-specific death rates in most regions. In 2013, more than 17 million people from 188 countries died from cardiovascular disease.
 
This report shows that over the period 1990-2013, worldwide there was a 41% increase in cardiovascular disease mortality. This was driven both by a 55% increase in mortality due to the aging of populations, together with a 25% increase due to population growth. Only in Central and Western Europe did gains in cardiovascular health offset these demographic sufficiently to cause a decline in the number of cardiovascular deaths.
These data highlight the need for health system planning to understand the absolute burden of disease, also taking account of the effect of population aging.
Demographic and epidemiologic drivers of global cardiovascular mortality.
Roth GA, Forouzanfar MH, Moran AE et al