Anthony Killeen's List: Coronary artery disease

• In the INTERHEART study, the single most powerful CV risk factor was dyslipidemia; the ratio of apolipoprotein B to apolipoprotein  A-1 (a more precise measure of the total cholesterol/HDL-C ratio) accounted for greater than 50% of the attributable risk  of MI.
• • The lipid "hypothesis" is much stronger than just a hypothesis!
• The lipid hypothesis has been  repeatedly confirmed, demonstrating conclusively that lowering low-density lipoprotein cholesterol (LDL-C) improves the prognosis  of patients with CHD.
• Inflammation is a key element in the pathogenesis of CHD. A plaque with extensive inflammation and a thin fibrous cap that  renders it susceptible to ulceration, rupture, and thrombosis is typically the underlying cause of an acute coronary syndrome.
• In patients with established CHD or a CHD risk equivalent, the American College of Cardiology (ACC) and the American Heart  Association (AHA) have promoted a target LDL-C level below 100 mg/dL with an optional goal of 70 mg/dL for high-risk patients  as a class 1A indication
• • This is critically important to know!!!
• Patients with DM are at markedly increased risk of CHD, cerebrovascular disease, and peripheral arterial disease and thus  are considered to have a CHD risk equivalent. Cardiovascular disease continues to be the leading cause of mortality and morbidity  among the DM population, accounting for 70% of all deaths
• For patients with type 2 DM, optimizing the lipid profile is the single most important intervention for reducing the risk  of CHD death, MI, stroke, and revascularization    procedures. The Adult Treatment Panel III update recommends treatment to reduce LDL-C levels by at least 30% to 40% for patients  with type 2 DM, regardless of the baseline LDL-C level
• The toxic effects of long-term tobacco smoking on CV and general health are profound.¹⁰³ A graded relationship exists between the number of cigarettes smoked and the risk of MI
• Among 360,000 European adults, waist circumference was strongly associated with the risk of death

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