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Landmark study
New FIELD analysis: Fenofibrate has similar cardioprotective effects in women and men
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Hypertriglyceridaemia: the clinical and economic burden of undertreatment
PCSK9 slidekit
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.
1 December 2014
R3i publishes new Call to Action paper: Residual Microvascular Risk in Type 2 Diabetes in 2014: Is it Time for a Re-Think?
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

The Residual Risk Reduction Initiative (R3i) is pleased to announce the publication of this new Call to Action statement, authored by 41 international experts in the fields of diabetes, atherosclerosis and cardiovascular disease prevention. The R3i makes two clear recommendations for reducing the burden of residual microvascular risk in patients with type 2 diabetes.
The paper is free to download here...
R3i Education Channel
      MSDA 2014 - Experts interviews - Part 2 / 3

Pr Takashi Kadowaki

Pr Ira Tabas

Pr Maj Faraj

Adiponectin is a hormone secreted by the adipose tissue which is reduced in obesity. What is its principal role?
Takashi Kadowaki
You looked at the effect of adiporon (adiponectin receptor agonist) what's are your preliminary results?
Takashi Kadowaki
How did your research into cell signalling in macrophages provided a rationale for new thinking into the regulation of insulin signalling?
Ira Tabas
How did you integrate your knowledge in macrophage signalling to obesity and diabetes?
Ira Tabas
What is hyperApoB and why is it important to clinical practice?
Maj Faraj
More from PREDI-MED: Mediterranean diet can reverse metabolic syndrome
The PREDI-MED study previously showed the benefit of a Mediterranean diet in reducing cardiovascular disease (CVD) events in high-risk patients without pre-existing CVD.1 New findings from this group indicate that long-term adherence to a Mediterranean diet may also reverse the metabolic syndrome, specifically reducing obesity and hyperglycaemia. Subjects in the PREDI-MED trial were randomly assigned either a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts, or advice on following a low-fat diet (the control group). In total, 5,801 subjects were followed over a mean of 4.8 years. In 3,392 subjects who had metabolic syndrome at baseline, 958 (28%) no longer had this phenotype at follow-up. Notably, subjects on a Mediterranean diet supplemented with either olive oil or nuts were more likely to undergo reversion (by 35% [15-58%] or by 28% [8-51%], respectively compared with control, p < 0.001 for each comparison). Subjects on either Mediterranean diet shown significant decreases in central obesity (p<0.05); those allocated to olive oil supplementation also showed a significant decrease in glycaemia (p = 0.02). In 1,919 subjects who did not have metabolic syndrome at entry to the study, there was no difference in the risk of developing metabolic syndrome between the three groups. In conclusion, a Mediterranean diet supplemented with either extra virgin olive oil or nuts is more likely to lead to reversion of the condition, suggesting potential benefit as part of lifestyle intervention in the management individuals with central obesity. 1. Estruch R, Ros E, Salas-Salvadó J et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279-90.
Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial.
Babio N Toledo E, Estruch R et al; for the PREDIMED Study Investigators.
Triglycerides: a key predictor of mortality in type 2 diabetes
This study from Italy highlights the need to improve the management of elevated triglycerides in patients with type 2 diabetes. The study included 1,917 patients with type 2 diabetes (mean age 58 years, 59% male), attending the hospital-based outpatient clinic. Over a mean follow-up period of 10 years, there were 95 deaths. Cox proportional hazard analysis showed a direct significant association between triglycerides levels during follow-up and all-cause mortality, independent of confounding factors such as low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, HbA1c, blood pressure, body mass index, fasting glucose, and antihypertensive and glucose-lowering treatment (III vs I tertile: HR:1.87;95% confidence intervals: 1.12-3.12, p=0.016). The authors concluded that more attention should be given to managing elevated triglycerides as part of the cardiovascular risk profile in type 2 diabetes patients.
Plasma triglycerides predict ten-years all-cause mortality in outpatients with type 2 diabetes mellitus: a longitudinal observational study.
Miselli M-A, Dalla Nora E, Passaro A, Tomasi F, Zuliani G.
FATS-Observational Study: combination lipid therapy reduces atherosclerotic burden
Compared with statin monotherapy, the combination of statin plus niacin was associated with less progression of carotid intima-media thickness (CIMT) when given long-term in patients with coronary artery disease. Patients who completed the Familial Atherosclerosis Treatment Study (FATS) either received usual care with statin therapy alone (n=26) or were enrolled in the 20-year FATS-Observational Study (n=43) and received lovastatin (40 mg/day), niacin (2-3 g/day), and colestipol (20 gm/day) for 11 years, followed by simvastatin (10-80 mg/day) or lovastatin (40-80 mg/day) plus niacin (2-4 g/day). At follow-up (mean 17.8 years with combination therapy and 19.0 years with usual care), combination therapy was associated with improved lipid control, as shown by greater decreases in total cholesterol (by 42% versus 31% with usual care, p=0.008), low-density lipoprotein cholesterol (by 57% versus 38%, p<0.001), as well as a greater increase in high-density lipoprotein cholesterol (by 38% versus 15%, p = 0.02). These lipid changes were also associated with significantly less CIMT progression (0.902 ± 0.164 versus 1.056 ±- 0.169 mm, p <0.001). These findings support the value of statin combination therapy in providing more comprehensive lipid control and reduced atherosclerosis progression in patients with established coronary artery disease.
Prolonged combination lipid therapy is associated with reduced carotid intima-media thickness: A case-control study of the 20-year Familial Atherosclerosis Treatment - Observational Study (FATS-OS).
Phan BA, Moore AB, Davis J et al.
Chemokine ligand 2: a potential target in diabetic retinopathy?
Accumulating evidence indicates a role for retinal inflammation in the pathogenesis of diabetic retinopathy. Chronic inflammation in the diabetic retina leads to leukocyte activation, via the action of specific chemokines, adhesion to the vascular endothelium and extravasation into the retinal tissues. One of the most potent chemotactic factors for monocytes is CCL2, also known as monocyte chemoattractant protein (MCP-1). In this experimental study, expression of CCL2 was significantly up-regulated in the retinas of the streptozotocin-treated rats (a well established model of diabetes), as well as in human retinal endothelial cells treated with high glucose and glucose flux. Subsequent studies in Cx3cr1-GFP mice showed that intraocular injection of CCL2 increased retinal monocyte/macrophage infiltration; when these mice were made diabetic and CCL2 injected, there was increased infiltration of monocytes/macrophages in retinal tissues, as well as activation of retinal microglia. Cell culture impedance sensing studies showed that while purified CCL2 was unable to modify the integrity of the human retinal endothelial cell barrier, monocyte conditioned medium led to significant reduction in cell resistance, implying that CCL2 may take part in early immune cell recruitment leading to subsequent changes in the blood-retinal-barrier. Taken together, these findings suggest that chemokine CCL2 plays an indirect role in mediating the increase in retinal vascular permeability brought about by hyperglycaemia, and thus may represent a potential therapeutic target for reducing the residual risk of this complication in diabetic patients.
Chemokine mediated monocyte trafficking into the retina: role of inflammation in alteration of the blood-retinal barrier in diabetic retinopathy.
Rangasamy S, McGuire PG, Franco Nitta C et al.
CEPHEUS Study: Lipid control far from optimal in Middle East
The CEPHEUS (Centralized Pan-Middle East Survey) evaluated the treatment of hypercholesterolemia in patients aged ?18 years of age in six Middle Eastern countries (November 2009 -July 2010). Lipid goals were those recommended by the joint Consensus Statement of the American Diabetes Association and American College of Cardiology. The study included 5,275 patients (mean age 56?±?13 years, 58% male and 69% at very high cardiovascular risk). In very high-risk patients, there was suboptimal management of LDL-C (only 25% achieved recommended targets), non-HDL-C (36%) and apolipoprotein B (38%); in patients with triglycerides ?2.2?mmol/L, LDL-C and apolipoprotein B goal attainment was even lower (16% and 15%, respectively). Thus, despite being on lipid-modifying therapy, patients at very high cardiovascular risk remain inadequately managed across this region.
Therapeutic lipid target achievements among high and highest risk patients: results from the CEPHEUS study in the Arabian Gulf.
Al-Rasadi K, Al-Zakwani I, Al Mahmeed W et al.
Spain: High prevalence of atherogenic dyslipidaemia in lipid clinics
One in 6 patients treated in lipid and vascular risk units has atherogenic dyslipidaemia, according to a report from EDICONDIS-ULISEA. This observational, retrospective study included patients aged ?18 years who were referred for dyslipidaemia and vascular risk to 43 lipid clinics in Spain. In total, 295 (17.9%) of 1,649 patients with a lipid profile at first visit had atherogenic dyslipidaemia. However, only a minority (44 or 16.1%) of these patients with atherogenic dyslipidaemia were successfully managed at subsequent follow-up. The authors concluded that management of atherogenic dyslipidaemia, characterised by elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C), clearly needs to improve in Spain.
Atherogenic dyslipidemia: prevalence and management in lipid clinics.
Pedro-Botet J, Flores-Le Roux JA, Mostaza JM et al.