Podcasts about fibrates

Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow-up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn't enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”! Get the original show notes here! Prior lipid episodes:  #37 Lipids, PCSK9, and ezetimibe: Lower is better. #10 Cholesterol, lipids, statins, fish oil. Become a Master Lipidologist. Sorry, no CME for this reboot episode, but claim CME for past episodes at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro Getting to know Dr. Erin Michos Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel Digging into ASCVD Risk Calculator Who should get 10 year ASCVD Risk assessment and what are the categories? How Dr. Michos discusses healthy lifestyle and “Primordial Prevention” What are “Risk Enhancing Factors”? Who should get biomarker testing vs CAC scoring? How Dr. Michos discusses statin therapy with her patients How to address risks of side effects Primary vs Secondary Prevention “What should my cholesterol be?” How often to follow-up labs? Differences between stain intensity How to manage side effects PCSK9 inhibitor discussion Aspirin, Fibrates and Icosapent Ethyl High Risk vs Stable ASCVD Take home points and the future Outro Credits Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli MD Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA Infographic: Beth “Garbs” Garbitelli MD Cover Art: Kate Grant MBChB DipGUMed Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP    Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest: Erin Michos MD MHS Sponsor: Better Help Visit BetterHelp.com/curb to 10% off your first month. Sponsor: Green Chef Go to GreenChef.com/curb135 and use code curb135 to get $135 off across five boxes and your first box ships free. Sponsor: Medmastery Listeners of this show can claim a 15% lifetime discount on any of their subscriptions. Just go to www.medmastery.com/curbsiders claim your discount and use the code curbsiders15.

Drs. Nicholas Farber, M. Ali Khan, and Safa Rahmani join for a journal club discussion of four recent publications in major ophthalmology journals:Fibrates and Diabetic Retinopathy (https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2790668)Natural History of Epiretinal Membranes (https://www.ophthalmologyretina.org/article/S2468-6530(22)00087-2/fulltext#%20)COVID-19 and Vascular Occlusions (https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2790988)Google Searches for Thyroid Eye Disease and Teprotumumab (https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2791596)Financial Disclosures: Dr. Sridhar is a consultant for Alcon, Allergan, Dorc, Genentech, and Regeneron. Dr. Khan, Dr. Farber, and Dr. Rahmani have no relevant disclosures.You can claim CME credits for many podcast episodes via the AAO website. Visit https://www.aao.org/browse-multimedia?filter=Audi

Podcast Notes Key Takeaways Atherogenic lipoproteins are now widely recognized as the driver of atherosclerosisSmoking and hypertension are two of the biggest risk factors for cardiovascular disease“The causal relationship between apoB and atherosclerosis is as strong as anything we see in medicine.” – Peter AttiaThe overwhelming majority of people with low HDL have a high apoB which drives atherosclerosis Lp(a) represents the single greatest driver of atherosclerosisEveryone should be tested for Lp(a) once in their lifeStatin contribution to atherosclerosis reduction is likely because of apoB reductionRead the full notes @ podcastnotes.orgWorld-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents. We discuss: The latest in the field of lipidology and cardiovascular disease [3:45]; Apolipoproteins—the key to understanding lipid biology [9:30]; ApoB as a preferred metric over LDL-P [16:30]; Therapeutic goals for apoB concentration [21:45]; Drivers of atherosclerosis [34:15]; Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00]; Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00]; Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15]; Tom’s preferred lab measurements [1:17:45]; The latest in lipid-lowering therapies [1:21:30]; The different pathways among various lipid-lowering drugs [1:30:45]; The latest on EPA and DHA [1:38:15]; Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6  Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents. We discuss: The latest in the field of lipidology and cardiovascular disease [3:45]; Apolipoproteins—the key to understanding lipid biology [9:30]; ApoB as a preferred metric over LDL-P [16:30]; Therapeutic goals for apoB concentration [21:45]; Drivers of atherosclerosis [34:15]; Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00]; Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00]; Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15]; Tom’s preferred lab measurements [1:17:45]; The latest in lipid-lowering therapies [1:21:30]; The different pathways among various lipid-lowering drugs [1:30:45]; The latest on EPA and DHA [1:38:15]; Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6  Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”!  ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Rate our infographics! Tell us what you think in this brief survey. Credits Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli  Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA Infographic: Beth “Garbs” Garbitelli Cover Art: Kate Grant MBChB DipGUMed Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP    Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest: Erin Michos MD MHS Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Time Stamps 00:00:00 Intro 00:01:52 Getting to know Dr. Erin Michos 00:O6:50 Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel 00:11:50 Digging into ASCVD Risk Calculator 00:16:12 Who should get 10 year ASCVD Risk assessment and what are the categories? 00:18:13 How Dr. Michos discusses healthy lifestyle and “Primordial Prevention” 00:19:42 What are “Risk Enhancing Factors”? 00:22:36 Who should get biomarker testing vs CAC scoring? 00:29:35 How Dr. Michos discusses statin therapy with her patients 00:32:18 How to address risks of side effects 00:37:57 Primary vs Secondary Prevention 00:39:40 “What should my cholesterol be?” 00:42:03 How often to follow-up labs? 00:46:00 Differences between stain intensity 00:47:57 How to manage side effects 00:52:05 PCSK9 inhibitor discussion 00:55:06 Aspirin, Fibrates and Icosapent Ethyl 01:02:13 High Risk vs Stable ASCVD 01:06:50 Take home points and the future 01:10:50 Outtro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will feel comfortable managing both primary and secondary prevention for ASCVD among different patient scenarios.  Learning objectives After listening to this episode listeners will…   Recognize the different risk levels and further ways to hone risk-stratification. Describe primary prevention management including how to discuss lifestyle changes, statins, and managing common statin-related complaints. Recognize the importance of lipid reduction for secondary prevention and different medications to achieve this. Disclosures Dr Erin Michos reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Michos E, Devgun J, Garbitelli B, Chiu C, Berk J, Williams PK, Watto MF. “#191 Lipids Update with Erin Michos MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 20, 2020.

Douleurs musculaires aiguës ou chroniques. Les causes sont infectieuses (MNI, grippe, paludisme, toxoplasmoses, brucellose...), rhumatismales (polyarthrite rhumatoïde, pseudo-polyarthrite rhizomélique, maladie Horton, maladie de Waldenström, spondylodiscite, Périatrite noueuse, Gougerot-Sjögren, sclérodermie, amylose), endocrinienne (hypothyroïdie, hyperthyroïdie, maladie d'Addison), syndrome de Guillain Barré, poliomyélite, hypocholestérolémiants (Statines, Fibrates...), corticoïdes, effort, fibromyalgies...

Dr Carolyn Lam:                Welcome to Circulation On The Run, your weekly podcast summary and backstage pass to the journal and it's editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr Greg Hundley:             And I'm Greg Hundley, associate editor from the Pauley Heart Center in Richmond, Virginia at VCU Health.                                                 Well, Carolyn, we've got a great feature article to discuss later in our interview today. We're going to compare surgical versus percutaneous aortic valve replacement, but now with coronary artery revascularization. So, very exciting results from the SURTAVI trial.                                                 So, Carolyn, do you have a couple papers to discuss? Dr Carolyn Lam:                For sure. Actually, it's exactly a couple, and it's a couple of GWAS papers. The first is a GWAS of the cardiac magnetic resonance imaging derived left ventricular phenotypes of the UK bio bank. It comprises almost 17,000 European-UK bio bank participants without prevalent myocardial infarction or heart failure. So this was led by professors Petersen and Monroe from Queen Mary University of London, and colleagues who found that prognostically important left ventricular imaging phenotypes were highly heritable, with a heritability of 22 to 39%. A total of 14 genetic susceptibility low PSI, eight of which were unique, enriched in the cardiac developmental pathways and regulation of contractile mechanisms were discovered, and the polygenic risk scores of left ventricular phenotypes were predictive of heart failure events independently of clinical risk. Dr Greg Hundley:             Well, Carolyn, knowing me and MRI, something I really am interested in. So tell us a little about what are the clinical implications? Dr Carolyn Lam:                Well, the findings not only enhance our understanding of the genetic basis of prognostically important left ventricular phenotypes in the general population, but they also underscore the intricate genetic relationship between these endo phenotypes and the pathogenesis of heart failure. The prioritized genes in the genome whites significant load size should be followed up in the functional studies to aid the development of potential novel therapies in future. The polygenic risk scores of left ventricular phenotypes may have a role in personalized risk stratification. But this, of course, is dependent on further validation of the clinical robustness in future studies.                                                 I want to skip onto my second GWAS paper, and this time dealing with bicuspid aortic valve. So, first a little reminder that bicuspid aortic valve disease is a congenital defect that affects 0.5 to 1.2% of the population, and is associated with comorbidities including ascending aortic dilatation and calcific aortic stenosis. To date, while a few causal genes have been identified, the genetic basis for the vast majority of bicuspid aortic valve cases remains unknown. Today's paper from Dr Lipschultz from Medical University of South Carolina reports novel human genetic based models, which developed bicuspid aortic valve and aortic stenosis with high penetrance. Dr Greg Hundley:             Very interesting. So, how did the authors do this, Carolyn? Dr Carolyn Lam:                Yeah, it is interesting. What they did is they performed a GWAS and replication study using cohorts of more than 2,000 patients with bicuspid aortic valve and more than 2,700 controls, which identified the primary Celia genes as associated with the bicuspid aortic valve phenotype. Specifically the most associated snips were identified in or near genes that are important in regulating Ciliogenesis through the exocyst, which is a shuttling complex that chaperone Celia cargo to the membrane. Genetic dismantling of this exocyst resulted in impaired Ciliogenesis through the XO CIS, disrupted Ciliogenic signaling, and resulted in a spectrum of cardiac defects in zebra fish and aortic valve defects including bicuspid aortic valve, valve stenosis, and Velveeta calcification in murine models as well. So this data really supports that the exocyst is required for normal Ciliogenesis during aortic valve morphogenesis and really implicates the disruption of Ciliogenesis, and its downstream pathways may contribute to bicuspid aortic valve and its associated comorbidities. Dr Greg Hundley:             Wow. Very interesting. Learning more and more about bicuspid valves through our journal. I'm going to shift Carolyn and talk about an article from Dr Marc Sabatine from the TIMI study group at Brigham and Women's hospital. This study performed a systematic review and a trial level meta regression analysis of three classes of lipid lowering therapies that reduce triglycerides to a greater extent than they do LDLC. Fibrates, Niacin, and Marine derived Omega-three fatty acids and key inclusion criteria were a randomized, controlled trial that reported on major vascular events. The study also incorporated data from a previous Meta-regression of 25 Statin trials, and the main outcome measure was the risk ratio for major, vascular events associated with absolute reductions in lipid parameters. Dr Carolyn Lam:                Oh, very interesting. So did the study show that it was beneficial to lower triglycerides or not? Dr Greg Hundley:             Let me tell you a little more about it. The study encompass 374,358 patients that sustained 46,180 major cardiovascular events, and in their multi-variable Meta-regression model, that included terms for both LDLC and triglyceride surrogates for LDL and VLDL. The risk ratio was 0.8 per one millimole per liter reduction in LDLC, and 0.84 per one millimole liter reduction in triglycerides. Therefore, a reduction in non-HDLC, a measure of atherogenic LDL and VLDL particles, is strongly associated with lower risk of major vascular events regardless of the lipid lowering drug class, and triglyceride lowering is associated with a lower risk of cardiovascular events, but to a lesser extent per absolute amount of reduction then with LDLC. Interesting, Carolyn one study reduce it and impacted the study results, and nearly all non-statin trials did not achieve significant non-HDLC lowering to detect a clinical difference in major vascular events. Now how about in regards to Omega- three dose?                                                 Well, each one gram per day of EPA administered was associated with a 7% relative risk reduction in major vascular events, whereas there was no significant reduction in major vascular events with DHA. So the benefits of Marine-derived Omega-three fatty acids, particularly high dose EPA, appear to exceed their lipid lowering effects. Dr Carolyn Lam:                Wow. Interesting. So Greg, take it home for us. What should we do clinically about this information? Dr Greg Hundley:             Carolyn, developing drugs that achieve large reductions in VLDL and triglycerides and are targeting patients with high baseline levels of triglycerides would likely increase the probability of showing a meaningful clinical benefit, and fibrates could be considered in patients needing further non-HDLC lowering, being mindful of side effects, as they should offer clinical benefit proportional to the degree of non-HDLC lowering, and if a disproportionate relationship between lipid lowering and cardiovascular risk reduction is validated in ongoing high dose Omega-three fatty acid trials, it will support the hypothesis that confers a unique benefit of this class of agents beyond simply their lipid lowering.                                                 How about that? Dr Carolyn Lam:                Very nice Greg and I think very balanced and good clinical take home messages. Tell us what else is in the mailbag. Dr Greg Hundley:             We have so many interesting articles in Circulation and let me just run through a quick list of those that are also in this issue. First, Dr Jere Mitchell, from UT Southwestern, reviews the 50th anniversary of the Dallas Bedrest Study that involve five 20-year-olds that underwent several weeks of bedrest, and he discusses how this informs many of our thoughts regarding the benefits of activity today, and one of his major coauthors is Dr Ben Levine. Our own Josh Beckman reviews the ongoing efforts of physicians to understand the role of paclitaxel coated stents for those undergoing peripheral arterial interventions. Dr Berlinde von Kemp, in our case series, identifies that not all cardiomyopathy, after delivery, is simply postpartum cardiomyopathy. In another article, Dr Anurag Agrawal discusses what's on their mind regarding the use of spirometry as a cardiovascular disease risk assessment tool, should it be incorporated into existing cardiovascular disease risk models.                                                 Then, we have a great letter back and forth discussion from Dr Junfeng Wang, Dr Daxin Wang, and our own Naveed Sattar in three separate letters that discussed the relevance of age of onset for type two diabetes relative to cardiovascular risk. Then, finally our own Carolyn Lam reviews the role of biomarkers in heart failure and preserved ejection fraction. Dr Carolyn Lam:                Let's hop on to our feature discussion, shall we? Dr Greg Hundley:             Absolutely. Dr Greg Hundley:             Welcome everyone to the discussion of our featured article today where we're going to review an excellent study comparing TAVR versus SAVR in patients with aortic stenosis, but also now considering simultaneous coronary artery revascularization. Discussing our article today we have Dr Thomas Engstrøm and then our own associate editor, Dharam Kumbhani. Well Thomas, welcome to our podcast featured article discussion. I wonder if you could start us off with a little background regarding your study. What were your hypotheses, and then tell us a little about your study population and your methods. Dr Thomas Engstrøm:     Now, as you know, up to 50% of patients that are treated for aortic stenosis have coronary artery disease, and this may be considered as a bystander disease to develop disease, but definitely also adds to the prognosis for the patients. A priority guideline recommends that if you do SAVR, you'll also have significant coronary artery disease. What we don't know is if the complete percutaneous approach is as good as a surgical approach. Maybe do TAVR plus PCI comply with fiber plus CABG. That's the background for the study.                                                 Now, the population involved in this study is the population from the search TAVR trial, which as you know compared TAVR to SAVR in patients that were clinically at intermediate risk and in patients that had severe aortic stenosis. If patient had additional coronary artery disease with a syntax called Bob 22, they were excluded from the trial. We are talking about intermediate risk patients with low syntax score. Of the patients in the TAVR trial, 20% had additional coronary artery disease and were resterilized. In the paper, we compare TAVR plus PCI versus SAVR plus CABG in those patients with significant coronary artery disease. Dr Greg Hundley:             How did you define the presence or absence of coronary disease? Just real quickly before we get to your results. Dr Thomas Engstrøm:     This was at the discretion of your operator to define where the patients had coronary artery disease or not. In the paper, patients were defined as having significant diseases. More than 70% of stenotic lesions were present in one or more coronary arteries. Dr Greg Hundley:             And so can you tell us, Thomas a little about the results of your study? Dr Thomas Engstrøm:     First of all, the patients that had additional coronary artery disease had a poor prognosis than those that only had valve substitution, which is probably not a surprise. Within those that also had coronary artery disease, TAVR plus PCI appeared to be as good as CABG plus SAVR in terms of the primary endpoint, which was all because mortality or disabling stroke after two years. Then, if you dive more deeply into the endpoint and the number of secondary endpoints were pre-specified, there were no differences regarding any stroke myocardial infraction and in total no differences between what you could call major heart end points. If you look more into detail of the secondary endpoint, there are subtle differences. Patients that were in the SAVR plus CABG had more atrial fibrillation as they also had more acute kidney injury following that treatment. Whereas, in the TAVR plus PCR, more patients had vascular complications and of course had the need for pacemaker implantation. There are differences between the outcome in the two groups, but not in regard of pre-specified primary and more important secondary endpoints. Dr Greg Hundley:             Dharam, I was wondering if you could help us think about what this means for the field in terms of both from aortic valve replacement, and then also the concomitant management of coronary disease in patients that require aortic valve replacement. Dr Dharam Kumbhani:   As Thomas just pointed out, I think this is a very important question. This comes up all the time in patients with severe aortic stenosis, being evaluated for best options, and the guidelines have stayed true to this that if somebody has concomitant coronary artery disease, then the guidelines typically would recommend SAVR as the first option because then they can have CABG at the same time. This study really seeks to address a very important knowledge gap in the field, and as he very well pointed out, this does restrict itself a little in terms of the population, because they couldn't have a high syntax score, actually an intermediate or high syntax score, and they need in the trial...I think the main syntax score was eight or nine. I think that is important, but having said that, more than 50% of the patients had multi-vessel disease, and it was really impressive that nearly 15 or 17% still had three vessel PCI even in this arm.                                                 I think it's important for people to recognize that although this was the lowest syntax score, multivessel PCI was still pursued. I think that's definitely an important takeaway from the strike. It's a really important trial. It's one of the very few pieces of information that we have that is prospectively done under the auspices of a big trial like SURTAVI, and with low risk approval in and what this means for patients going forward I think will be very exciting to see how this few devolves.                                                 Thomas, as this field matures, could you walk us through, in terms of did you do the valve first and then the coronaries, or where the coronaries worked on first and then the valve? That's sort of the first question. Can you walk us through how you make those decisions? Dr Thomas Engstrøm:     It was up to the discretion of the operator whether to do a concomitant procedure, both PCI and TAVR, or to state the procedures in that way that PCI was done first, and this could be done up to seven days before the TAVR. If you compare those two groups, and now numbers become a little bit few, so we can't be conclusive here. It appears that patients that had stage procedures did poorer than those that had concomitant procedures done. Of course, it raises some questions. The prioritization as to do it in one way or the other was that through concomitant procedure, you may introduce too much of stress to the patient. Otherwise, if you do a stage procedure, it's best to do the PCI first, because the actual appearance of the valve may make it more difficult and cumbersome to address the coronary arteries. To sum this up, in the patients that we have, it appeared that a concomitant procedure is safe. Dr Greg Hundley:             Dharam, tell us, what do you think is the next step forward for this field? What do see as the next study moving forward here? Dr Dharam Kumbhani:   I think this study really sets the stage for, I think future trials where perhaps we would have... So I'm doing this in this trial. The stratification was done based on whether or not they need to revascularization. I think going forward, again with LOTUS approval here and proliferation of the number of TAVR procedures that are being offered everywhere, I think it will be helpful. This study would set the stage for future studies, where I think you would prospectively have patients with needing an aortic valve replacement and perhaps even complex revascularization, and how that was kind of actually the randomization, which is the stratification strategy, which again was very helpful. These are really among the first few data that we have of this, but I think this kind of sets the stage for future investigations in this space. And then as I briefly alluded to, I think this may help evolve or this may help in the evolution on the guidelines as well.                                                 Thomas, would you like to add anything to that? Dr Thomas Engstrøm:     Yeah, I completely echo that. Going back to the old syntax trial, it would be very interesting to see if PCI holds through, even in high tunes, syntax scores with newer drug eluting stents, and also of course the question of the diabetics is totally unsolved in this cohort. CABG plus SAVR may turn out to be the best solution, but we still are waiting to see data that can support any of the two strategies in those patient cohorts. Dr Greg Hundley:             We want to thank Thomas Engstrøm and also our own Dharam Kumbhani. We look forward to seeing you next week. Dr Carolyn Lam:                This program is copyright American Heart Association, 2019.  

In October's podcast, James Cave (DTB Editor-in-Chief) and David Phizackerley (DTB Deputy Editor) discuss wide variation in the use of fibrates and the need for clinicians to consider whether their prescribing of fibrates is up to date and appropriate for their patients. The editors also talk about the evidence for fibrates in primary and secondary prevention of cardiovascular disease, highlight recent changes in the BNF and review a case of severe acute ocular hypertension following pulsed methylprednisolone. Read the full October issue: https://dtb.bmj.com/content/57/10

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part IV, Peter and Tom review the history and current use of drugs to prevent cardiovascular disease. They also discuss why some drugs appear to be more effective than others, an in-depth conversation about niacin, cholesterol and brain health, and the futility of using CKs (creatinine kinase) and liver function tests to identify adverse effects in statins, to name a few topics in this episode. We discuss: Bile acid sequestrants and statins [2:00]; Ezetimibe (Zetia) [15:00]; PCSK9 inhibitors [27:30]; Fibrates [41:00]; Fish oil, DHA, and EPA [1:01:00]; Niacin [1:05:15]; PCSK9 inhibitors [1:23:45]; Cholesterol, statins, and the brain [1:30:00]; Elevated creatine kinase (CK) and liver function tests (LFTs) on statins [1:50:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

Today I am joined by A/Professor David Colquhoun, Cardiologist, Lipidologist, President of the QLD Heart Foundation, Co-President of the Clinical and Preventative Council of the Cardiac Society of Australia and New Zealand, and Senior Lecturer at the University of Queensland School of Medicine.  He has dedicated his life to reducing cardiovascular disease, and pleasingly with a strong focus on improving lifestyle factors.   Risk assessment and importance of using overall risk instead of single factors, Calcium score scan use, Risk calculation in those >75 years, Risk assessment and treatment options including mediterranean diet, exercise, mental health, social isolation, even owning dogs versus cats! Fibrates and triglycerides Post production: Mediterranean Diet detail and benefits Statins - efficacy, indication, side effects (fatigue, myalgia, diabetes, memory/cognitive impairment, rhabdomyolysis, haemorrhagic stroke) and bias in statin studies   Calcium Score Scans - http://www.csanz.edu.au/wp-content/uploads/2016/11/CAC_Position-Statement_Exec-Summary_ratified-4-August-2016.pdf Mediterranean Diet: https://academic.oup.com/eurheartj/article/37/39/2999/2414995/2016-ESC-EAS-Guidelines-for-the-Management-of    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684076/ https://www.ncbi.nlm.nih.gov/pubmed/26528631 http://www.bmj.com/content/337/bmj.a1344   Statins: https://www.ncbi.nlm.nih.gov/pubmed/27838722 Fatigue - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285455/  Memory - https://www.ncbi.nlm.nih.gov/pubmed/24247674  Diabetes - https://www.ncbi.nlm.nih.gov/pubmed/25887679  Myalgia/stroke -  http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31357-5.pdf,  https://www.mja.com.au/system/files/issues/ham00039.pdf Bias - http://www.bmj.com/content/349/bmj.g5949

Today I am joined by A/Professor David Colquhoun, Cardiologist, Lipidologist, President of the QLD Heart Foundation, Co-President of the Clinical and Preventative Council of the Cardiac Society of Australia and New Zealand, and Senior Lecturer at the University of Queensland School of Medicine.  He has dedicated his life to reducing cardiovascular disease, and pleasingly with a strong focus on improving lifestyle factors. Part 1 - Cholesterol and CVD risk, Lipid "hypothesis" - is it still a hypothesis? Cholesterol physiology, Measuring sub-fractions and receptor ratios - is there a point? Reducing cholesterol LDL and CVD risk with medication statins, ezetemide and lifestyle, Measuring fasting vs non fasting cholesterol, Cholesterol relevance in age - is it a risk or protective factor? Do statins reduce risk regardless of cholesterol? Part 2 - CVD risk assessment and treatment, Risk assessment and importance of using overall risk instead of single factors, Calcium score scan use, Risk calculation in those >75 years, Risk assessment and treatment options including mediterranean diet, exercise, mental health, social isolation, even owning dogs versus cats! Fibrates and triglycerides, Statins and side effects = what's the evidence?   Further reading: https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf  CVD risk, low LDL and artherosclerosis regression https://www.mja.com.au/system/files/issues/ham00039.pdf Fasting vs non-fasting cholesterol testing - https://www.rcpa.edu.au/getattachment/0961c6d1-ec80-4500-8dc0-de516500e05b/Lipid-and-lipoprotein-testing.aspx Mediterranean Diet and CVD - https://www.ncbi.nlm.nih.gov/pubmed/26528631 https://academic.oup.com/eurheartj/article/37/39/2999/2414995 http://www.bmj.com/content/337/bmj.a1344 Calcium Score Scans - http://www.csanz.edu.au/wp-content/uploads/2016/11/CAC_Position-Statement_Exec-Summary_ratified-4-August-2016.pdf Evidence and resources for part 2 will be placed in part 2 show notes   Cheers all  

We explore pieces of important evidence that offer a contrasting view on lipid control from the national guidelines. We are also introducing a new EBM resource available to CMA members: InfoPOEMs, which highlights clinical studies that the editorial team finds relevant.  http://www.cma.ca/clinicalresources/infopoems Treatment group Tools for Practice 2013: “Is Diabetes a Coronary Heart Disease Equivalent?” http://www.acfp.ca/Portals/0/docs/TFP/20131021_093004.pdf […] The post Dyslipidemia 4: EBM Special appeared first on Family Pharm Podcast.

In this episode, we listed the life-style management of dyslipidemia and lowering cardiovascular disease risk, and dived into the main classes of medications for lipid lowering: statins, niacin, fibrates, resins, and cholesterol absorption inhibitors. As an important side note, the signs and symptoms of statin-induced myopathies were discussed as well. CCS 2012 guidelines: http://www.onlinecjc.ca/article/S0828-282X(12)01510-3 DASH diet […] The post Dyslipidemia 2: Lipid Lowering Medications appeared first on Family Pharm Podcast.

Guest: James Mckenney, PharmD Host: Larry Kaskel, MD Dr. Larry Kaskel welcomes Dr. James Mckenney to Lipid Luminations. Dr. Mckenney is Professor emeritus with Virginia Commonwealth University and founding member of the National Cholesterol Education Program. They will discuss Niacin, Fibrates and Omega 3 Fatty Acids. Brought to you by: