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The IDEAL Cholesterol

The IDEAL Cholesterol. Christopher Cannon, M.D. TIMI Study Group Brigham and Women’s Hospital. Cannon CP. JAMA 2005;294:2492-4. Four trials: “Lower is Better”. LDL-C Reduction, Risk Reduction Risk Reduction in Trial’s in CHD

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The IDEAL Cholesterol

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  1. The IDEALCholesterol Christopher Cannon, M.D. TIMI Study Group Brigham and Women’s Hospital Cannon CP. JAMA 2005;294:2492-4.

  2. Four trials: “Lower is Better” LDL-C Reduction, Risk Reduction Risk Reduction in Trial’s in CHD Trial Population Duration, y mg/dL Primary End Point, % Death or MI, % PROVE IT–TIMI 22 ACS (N = 4162) 2 33 6 16 A to Z ACS (N = 4497) 2 14 11 15 TNT Stable CAD (N = 10 001) 5 24 22 22 IDEAL Stable CAD (N = 8888) 5 23 11 12 Cannon CP. JAMA 2005;294:2492-4.

  3. IDEAL S20/40 IDEAL A80 Coronary Heart Disease (CHD) Event Rates in Secondary Prevention and ACS Trials 30 y = 0.1629x · 4.6776R² = 0.9029p < 0.0001 4S-P 25 20 HPS-P LIPID-P 4S-S CHD Events (%) 15 HPS-S A2Z 20 CARE-P A2Z 80 TNT 10 LIPID-S 10 TNT 80 PROVE-IT-AT CARE-S PROVE-IT-PR 5 0 30 50 70 90 110 130 150 170 190 210 LDL Cholesterol (mg/dl) Updated from - O’Keefe, J. et al., J Am Coll Cardiol 2004;43:2142-6.

  4. Take Home Messages: Physicians (1) • For LDL cholesterol, “lower is better” for preventing CV events. Mounting evidence (HPS, ASCOT, PROVE IT-TIMI 22, TNT, and now IDEAL) should likely prompt future changes in National Cholesterol Education Program and ACC/AHA cholesterol treatment guidelines. • Benefit in both ACS and stable CAD Cannon CP. JAMA 2005;294:2492-4.

  5. Take Home Messages: Physicians (2) • Benefit dramatic on stroke: • CTT – 17% reduction in stroke with standard dose vs. placebo • IDEAL, TNT – ADDITIONAL ~20% reduction in stroke • 4. Provides support to adopt the NCEP update in 2004 • < 100 mg/dL for individuals with risk factors • < 70 mg/dL if heart disease is present. • 5. Continue research on novel approaches (HDL, CRP etc) Cannon CP. JAMA 2005;294:2492-4.

  6. Take Home Messages: Patients (1) • For LDL cholesterol, “lower is better” for preventing heart attacks, strokes and death. Mounting evidence may prompt future changes in National Cholesterol Education Program cholesterol-level guidelines. • Know your numbers ! For both “bad” (LDL) and “good” (HDL) cholesterol Cannon CP. JAMA 2005;294:2492-4.

  7. Take Home Messages: Patients (1) • Work with your doctor to try to reduce their LDL cholesterol to new guideline suggested levels – • < 100 mg/dL for individuals with risk factors • < 70 mg/dL if heart disease is present. This strategy is key to prevent future cardiovascular events. Cannon CP. JAMA 2005;294:2492-4.

  8. Take Home Messages: Patients (3) • Statins are considered safe with side effects usually resolving with dose changes or switching to a different drug. • A good diet and exercise is part of the overall “heart healthy” plan. • In addition, raising the “good” (HDL) cholesterol may be beneficial on top of lowering the bad cholesterol. Cannon CP. JAMA 2005;294:2492-4.

  9. IDEAL Editorial - JAMA • “There are now four trials and more than 27,000 patients showing that high-dose statins lower cholesterol more than regular-dose statins and provide additional benefit in preventing heart attacks,” • “These studies reaffirm the central role of lowering cholesterol as a means of reducing morbidity and mortality from heart disease.” Cannon CP. JAMA 2005;294:2492-4.

  10. October 19th 2005 Articles, slides, Video presentation Available on: www.cardiosource.com/trialfocus

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