Focus on Prevention

The first presentation in this multi-part session, “Current Status of Lipid Lowering Therapy in CAD, PAD, and CKD,” was delivered by Rita Redberg, MD, professor of medicine and director women’s cardiovascular services, University of California, San Francisco. According to Dr Redberg, a heart-healthy diet, regular physical activity, weight management, medications, and smoking cessation are mainstays of prevention. She reviewed American College of Cardiology recommendations for lipid lowering in coronary artery disease and peripheral arterial disease. Dr Redberg noted that smoking is the strongest risk factor for PAD. While associations with LDL cholesterol have been weak, associations have been found with other biomarkers such as hs-CRP and D-dimer. In regard to chronic kidney disease, the literature has shown that lowering lipids did not prevent progression of kidney disease but there was a benefit in cardiac mortality and CV events. Given the possible harm associated with statins, she emphasized the need to have a balanced discussion of risks and benefits with patients.

“New Lipid Lowering Drugs on the Horizon” was presented by Constantine E. Kosmas, MD, PhD, assistant professor of medicine, Mount Sinai School of Medicine. He described a class of lipid-lowering drugs, CETP inhibitors, that markedly increase HDL cholesterol. One agent (torcetrapib) was found to be unsafe, but another, safer agent (anacetrapib) will be tested in the upcoming REVEAL trial of 30,000 patients. Another class, PCSK9 inhibitors, has shown promise for reducing LDL cholesterol. Its mechanism involves increasing the number of LDL receptors. Other agents undergoing evaluation are apolipoprotein C-III inhibitors, lipoprotein(a) inhibitors, apolipoprotein A-I mimetic peptide, and liver X receptor agonists.

Next, Gervasio A. Lamas, MD, chief of the Columbia University division of cardiology, Mount Sinai Medical Center, Miami Beach, FL, presented “Chelation Therapy and High Dose Vitamin Therapy: Results and Perspectives on the Controversy.” According to Dr Lamas, ethylenediaminetetraacetic acid (EDTA) is an artificial amino acid that chelates multiple metals, and the literature suggests that heavy metals are associated with cardiovascular disease. He reviewed recent results of the trial to assess chelation therapy (TACT), which suggested that EDTA chelation infusion was associated with incremental treatment benefit in post-MI patients already on evidence-based therapy. “Results and scientific debate will allow us to decide how or whether we incorporate this into our daily practice,” stated Dr Lamas.

The final presentation, “The Mediterranean Diet: Should This Be a Mainstay of Prevention?” was delivered by Piera Capranzano, MD, of the University of Catania in Catania, Italy. Dr Capranzano began her presentation by discussing the components of a cardioprotective diet, which are as follows: 4 to 5 servings of fruits and vegetables per day, 3+ servings of whole grains per day, 4 to 5 servings per week of nuts, 2+ servings of fish per week, and fewer than 2 servings of meat per week. A Mediterranean diet includes wine in moderation during meals, low consumption of red meat and meat products, and high consumption of olive oil and nuts. It is rich in fiber and fish-derived polyunsaturated fatty acids. According to Dr Capranzano, the available literature supports this diet based on its cardioprotective properties: it has been associated with reduction in cardiovascular death and stroke. She concluded that the Mediterranean diet should be considered when giving dietary recommendations to patients.