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Treatment of Dyslipidaemias
& The New Grampian Guidelines
Professor Iain Broom
Director, Centre for Obesity Research and Epidemiology
The Robert Gordon University
Professor of Metabolic Medicine, University of Aberdeen
Consultant in Clinical Biochemistry and Metabolic Medicine, NHS
Grampian
SECONDARY PREVENTION
PRIMARY PREVENTION
(CV Risk Assessment)
PRIMARY PREVENTION
• GLOBAL RISK
Risk Factors)
SCORE (Cholesterol is only one of many
• RISK ASSESSMENT TOOL
• > 20% RISK OF CV EVENT IN 10 YEARS (40 Years of Age)
What do we know about CV risk?
INTERHEART
• Large, international, standardised,
case-control study of acute myocardial infarction (AMI) in 52 countries
• To determine the strength of association between various risk factors
and AMI
• 15,142 cases and 14,820 controls enrolled to the study
• 9 risk factors were studied
Yusuf S, et al. Lancet 2004; 364: 937–952.
Nine risk factors represent 90.4% of the
risk of AMI
• Current or former smoking
• History of diabetes
• History of hypertension
• Abdominal obesity
• Combined psychosocial stressors
• Irregular consumption of fruits and vegetables
• No alcohol intake
• Avoidance of regular exercise
• Raised plasma lipids
Yusuf S, et al. Lancet 2004; 364: 937–952.
Substantial residual CV risk in statin-treated
patients
The MRC/BHF Heart Protection Study
Patients with major
vascular events (%)
30
20
10
19.8% of statin-treated
patients had a major
CV event by 5 years
0
0
1
BHF=British Heart Foundation
MRC=Medical Research
Council
Risk
reduction=24%
2
3
4
Year of follow-up
Placebo
p<0.0001
Heart Protection Study Collaborative Group. Lancet 2002; 360: 7–22.
Statin
5
6
Abdominal Fat Distribution
Obesity and Risk
BP
Chol
LDL
HDL
TGs
150/95
5.8
4.5
0.8
2.3
BP
Chol
LDL
HDL
TGs
120/70
4.4
2.7
1.6
1.0
Effect of Triacylglycerol & HDL
Cholesterol on Atherogenicity
HDL 
HDL 
TG 
TG 
apo B Lipoprotein 
apo B Lipoprotein 
High/Intensive Doseage with Statins
I.
PROVE-IT
(2004)
•
Acute coronary syndromes
•
80 mg Atorvastatin v 40 mg Pravastatin
•
3.9% Absolute Risk Reduction
•
16% Relative Risk Reduction
High/Intensive Doseage with Statins
II.
TNT (2005)
•
Stable Coronary Disease
•
80 mg Atorvastatin v 10 mg Atorvastatin
•
2.2% Absolute Risk Reduction
•
22% Relative Risk Reduction
•
6 x  in LFT Derangement
High/Intensive Doseage with Statins
III. SPARCL (2006)
•
Post CVA or TIA, no known CHD
•
80 mg Atorvastatin v Placebo
•
2.2% Absolute Risk Reduction in Stroke (5 years) BUT Small
Increase in Haemorrhagic Stroke
•
3.5% Absolute Risk Reduction in CV Event (5 years)
•
No Difference in Mortality
High/Intensive Doseage with Statins
IV. ASTEROID (2006) [Galaxy Studies]
•
Assessment of Coronary Atheroma Burden. 0 & 24 Months
Post-Therapy
•
40 mg Rosuvastatin
•
LDL-CHOL 53.2% Reduction
HDL OHOL 14.7% Increase
•
6.8% Median Reduction Atheroma Volume
Other studies with high dose Rosuvastatin are underway as part
of the GALAXY GROUP
CONCLUSIONS
1. CHOLESTEROL (LDL-CHOLESTEROL) IS IMPORTANT
2. CURRENTLY POWERFUL DRUGS TO REDUCE EFFECTS
3. SHOULD BE USED IN PRIMARY & SECONDARY PREVENTION
4. SIDE-EFFECTS ARE IMPORTANT & CAN MARKEDLY EFFECT
QUALITY OF LIFE
5. LIPID PROFILE IS IMPORTANT FOR CORRECT DRUG USAGE
6. DO NOT FORGET TRIACYLGLYCEROL  STATINS ARE NOT
THE DRUG OF CHOICE