International Atherosclerosis Society Research Articles

Editorial introductions

Current Opinion in Lipidology was launched in 1990. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of lipidology is divided into six sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Erik S.G. StroesErik S.G. Stroes is Chair of the Department of Vascular Medicine at the Academic Medical Center, Amsterdam, The Netherlands. After gaining his Doctor of Medicine degree from Erasmus University, Rotterdam, The Netherlands, he then specialized in internal medicine at University Medical Center, Utrecht, The Netherlands, and later in vascular medicine at the Academic Medical Center, Amsterdam. Professor Stroes’ research interests include the role of the vessel wall in atherosclerosis development and lipid disorders in relation to atherogenesis. He has been an investigator in numerous lipid-lowering trials using various surrogate markers, such as intima-media thickness and flow-mediated dilation, and more recently 3T magnetic resonance imaging as a surrogate marker for vascular disease progression. He has also been involved in the development of novel therapeutic moieties for dyslipidemia, such as lipoprotein lipase gene therapy, antisense oligonucleotide inhibition of apolipoprotein B synthesis, and reconstituted high-density lipoprotein infusion. He has been the recipient of numerous research grants and several awards. Professor Stroes is Chair of the Dutch Atherosclerosis Society, member of the Vascular Biology Working Group, member of the American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology, and former Chair of the Dutch Internist Vascular Society. He has published more than 300 papers in various peer-reviewed journals and authored several book chapters in the field. Gerald F. WattsGerald F. Watts (DSc, DM, PhD, FRCP, FRACP) trained at Imperial College (St Mary's Hospital) and King's College (St Thomas’ Hospital) in the University of London. He is a consultant physician, specializing in lipid disorders and cardiovascular medicine, within the department of cardiology at Royal Perth Hospital, as well as Winthrop Professor of Cardiometabolic Medicine in the University of Western Australia. He is Chair of The Familial Hypercholesterolaemia (FH)-Australasia Network and executive board member of the International Atherosclerosis Society. His research interests include lipid disorders and cardiovascular prevention, with clinical interest focusing on delivering improved health care for patients and families with FH. Professor Watts is actively involved in undergraduate medical education and supervisors PhD students and post-doctoral fellows. He has authored over 500 published works, including scientific articles, reviews, book chapters and monographs, and is associate editor of Atherosclerosis, Journal Clinical Lipidology and Metabolism.

Coronary heart disease mortality in severe vs. non-severe familial hypercholesterolaemia in the Simon Broome Register

Background and aimsThe International Atherosclerosis Society (IAS) has proposed that patients with “severe” FH (SFH) would warrant early and more aggressive cholesterol-lowering treatment such as with PCSK9 inhibitors. SFH is diagnosed if LDL-cholesterol (LDLC) > 10 mmol/L, or LDLC >8.0 mmol/L plus one high-risk feature, or LDLC >5 mmol/L plus two high-risk features. Here we compare CHD mortality in SFH and non-SFH (NSFH) patients in the UK prospective Simon Broome Register since 1991, when statin use became routine. Methods2929 definite or possible PFH patients (51% women) aged 20–79 years were recruited from 21 UK lipid clinics and followed prospectively between 1992 and 2016. The excess CHD standardised mortality ratio (SMR) compared to the England and Wales population was calculated (with 95% confidence intervals). Results1982 (67.7%) patients met the SFH definition. Compared to the non-SFH, significantly (p < 0.001) more SFH patients had diagnosed CHD at baseline (24.6% vs. 17.5%), were current smokers (21.9% vs 10.2%) and had a BMI > 30 kg/m2 (14.9% vs. 7.8%). The SMR for CHD mortality was significantly (p = 0.007) higher for SFH (220 (184–261) (34,134 person years, 129 deaths observed, vs. 59 expected) compared to NSFH of 144 (98–203) (15,432 person years, 32 observed vs. 22 expected). After adjustment for traditional risk factors, the Hazard Ratio for CHD mortality in SFH vs. NSFH was 1.22 (0.80–1.87) p = 0.36, indicating that the excess risk was largely accounted for by these factors. ConclusionsCHD mortality remains elevated in treated FH, especially for SFH, emphasising the importance of optimal lipid-lowering and management of other risk factors.

Atherogenic Dyslipidemia in Latin America: Prevalence, causes and treatment: Expert’s position paper made by The Latin American Academy for the Study of Lipids (ALALIP) Endorsed by the Inter-American Society of Cardiology (IASC), the South American Society of Cardiology (SSC), the Pan-American College of Endothelium (PACE), and the International Atherosclerosis Society (IAS)

This is an executive summary made by a group of experts named Latin American Academy for the study of Lipids (ALALIP). In the current clinical guidelines, atherogenic dyslipidemia (AD) is a poorly recognized entity. Due to the frequent lipid alterations associated with AD in Latin America (LA), we organized a group of experts named (ALALIP) to generate a document in order to analyze their prevalence and to offer practical recommendations. Methodology: using the Delphi methodology, we conducted a comprehensive literature review with emphasis on those publications related to LA. Subsequently, we developed key questions for discussion. As a convention, those recommendations that had a 100% of acceptance were considered unanimous, those with >80% were consensual, and those with <80% were in disagreement. Results: a systematic analysis of national health surveys and regional cohort studies showed a consistently high prevalence of the lipid abnormalities that define AD: low levels of high-density lipoprotein cholesterol (HDL-C) range from 34.1% to 53.3% and elevated triglycerides (TG) range from 25.5% to 31.2%. These abnormalities could be related to high consumption of food with a high caloric density, cholesterol and trans fats, a sedentary lifestyle and perhaps epigenetic changes Conclusionslipid abnormalities that define AD have a high prevalence in LA. The interaction between an unfavorable lifestyle, inheritance and epigenetic changes is probably their cause. It is important to design a global study of risk factors in LA to know its true prevalence in the region, its consequences and to derive from its treatment strategies.

Value of the Definition of Severe Familial Hypercholesterolemia for Stratification of Heterozygous Patients

Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol with co-dominant transmission and high risk of cardiovascular disease (CVD), although with high variability among subjects. Currently, CVD stratification tools for heterozygous FH (HeFH) are not available. A definition of severe HeFH has been recently proposed by the International Atherosclerosis Society (IAS), but it has not been validated. Our study aims to see clinical characteristics and prevalence of CVD in subjects defined as severe HeFH by IAS criteria. Probable or definite HeFH introduced in the Dyslipidemia Registry of Spanish Arteriosclerosis Society were analyzed by the IAS criteria. Univariate and multivariate analysis was used to assess the association of CVD with the IAS criteria. About 1,732 HeFH cases were analyzed. Severe HeFH had higher prevalence of familial history of CVD, personal history of tendon xanthomas, LDL cholesterol, and CVD than nonsevere HeFH. A total of 656 (77.1%) and 441 (50.1%) of men and women, respectively, fulfilled the IAS criteria of severe HeFH. In the univariate analysis, subjects defined as severe HeFH showed odds ratio 3.016 (95% CI 3.136 to 4.257, p <0.001) for CVD. However, when traditional risk factors were included in the multivariate analysis, only the presence of cholesterol >400mg/dl had a statistically significant association with CVD odds ratio 8.76 (95% CI 3.90 to 19.69, p <0.001). In conclusion, the IAS definition of severe HeFH is not significantly associated with CVD when adjusted for classic risk factors. Risk stratification in HeFH is an important issue, but the proposed criteria do not seem to solve this problem.

Lower is better: ezetimibe and PCSK9 inhibition join the mainstream of lipid‑lowering therapy

The focus of 2013 cholesterol guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) released by American College of Cardiology (ACC) and American Heart Association (AHA) is the administration of high intensity statin therapy to specific four groups of patients, which were found to benefit the most from such therapy. They no longer promote achieving specific LDL-C goals with a combination therapy involving statins and other drugs, as advocated by the former ATP-III guidelines as well as current guidelines of European Atherosclerosis Society, International Atherosclerosis Society or National Lipid Association. Such approach has been dictated by the strict reliance on randomized controlled trials as the only acceptable level of evidence. However, since publication of the 2013 ACC/AHA guidelines, cardiovascular benefits of ezetimibe added to statin therapy have been established. Moreover, the advent of PCSK9 inhibitors, providing a powerful supplement and/or alternative to statin therapy, further complicates the therapeutic horizon in dyslipdiemias. It is very likely that a new set of ACC/AHA guidelines will be published in 2016, with a return of specific LDL-C and Non-HDL-C goals of therapy as well as integration of drugs other than statins. As the treatment of dyslipidemias becomes more complex, the need for the subspecialty of clinical lipidology to be officially recognized becomes more evident.

Prevalencia del síndrome metabólico en hipertensos estadio I

Introduction and motivationIt is important for recently diagnosed systemic hypertension (HPB) individuals to verify the existence of other cardiovascular risk factors, in order to establish optimal treatment strategies. Knowing the prevalence of metabolic syndrome (MS) in patients with stage 1 HBP. MethodsProspective, observational, cross-sectional study conducted over one year in Bogotá, Medellin, Cali and Barranquilla in individuals of both genders, ≥ 18 and ≤ 60 years old with recently diagnosed stage 1 HBP and without drug therapy. Presence of MS was verified for all subjects according to recent consensus of the International Diabetes Federation, the National Heart, Lung and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society and the International Association for the Study of Obesity. ResultsAverage prevalence of MS in the total population of hypertensive patients was of 16.84%. In Cali it was of 28.8%, in Medellin of 18.9%, in Barranquilla of 12.5% and in Bogotá of 11.4%. Medellin showed the highest prevalence in men (14.7%) and Cali in women (15.2%). ConclusionsIt is recommended to conduct a systematic search for MS in patients who have recently been diagnosed with HBP. Prevalence among MS in the studies Colombian cities varied greatly. More studies are required to find out about the real prevalence of MS in patients with HBP in other Colombian cities and to implement educational studies to minimise its impact.

El papel de la dislipemia aterogénica en las guías de práctica clínica

Background and objectiveAtherogenic dyslipidaemia is underdiagnosed, undertreated, and under-controlled. The aim of the present study was to assess the positioning of clinical guidelines as regards atherogenic dyslipidaemia. Material and methodThe major clinical guidelines of scientific societies or official agencies issued between January 1, 2012 and March 31, 2015 were collected from the MEDLINE database. High-density lipoprotein (HDL) cholesterol, triglycerides, atherogenic dyslipidaemia, non-HDL cholesterol, and apolipoprotein (apo) B were gathered from the 10 selected guidelines, and it was assessed whether these parameters were considered a cardiovascular risk factor, a therapeutic target, or proposed a pharmacological strategy. ResultsAmerican guidelines, except the National Lipid Association (NLA), do not consider HDL cholesterol and triglycerides in cardiovascular prevention. The NLA emphasises the relevance of atherogenic dyslipidaemia. The Canadian guidelines introduced non-HDL cholesterol and ApoB as alternative targets, and proposes non-statin treatment in the presence of low HDL cholesterol and hypertriglyceridaemia. The International Atherosclerosis Society (IAS) and National Institute for Health and Care Excellence (NICE) guidelines promote the importance of non-HDL cholesterol. European, Brazilian and Japanese guidelines highlight HDL cholesterol and triglycerides, but with the limitation that the main evidence comes from sub-analysis of clinical studies. ConclusionsThe clinical guidelines analysed do not consider, or unconvincingly address, the importance of atherogenic dyslipidaemia.

Highlights of the 83rd European Atherosclerosis Society (EAS) annual Congress, Glasgow 22-25 March, 2015.

The EAS has already highlighted the underdiagnosis and undertreatment of familial hypercholesterolaemia (FH) in the 2013 EAS Consensus Panel Position Paper [1]. This paper has driven numerous initiatives, including FH-Connect [2], under the umbrella of the International Atherosclerosis Society. However, to make policymakers aware of issues in FH care, as a precursor to initiating change, it is essential to obtain information on the contemporary burden of FH. In response, the EAS launched the FH Studies Collaboration (FHSC) [http://www.eas-society.org/fhsc.aspx], an international registry of observational studies on FH. According to EAS President Professor Alberico L. Catapano, University of Milan, Italy: ‘The FH Studies collaboration shows that the Society has the capability to rise to the challenge posed by the unmet clinical needs of this common genetic condition.’ The FHSC aims to provide information on how patients are currently screened and managed, what are the barriers to effective treatment, as well as the impact of patient-specific, genetic, and societal factors on treatment efficacy. The FHSC is led by Professor Kausik Ray, Imperial College, London UK; to date more than 30 countries have already agreed to take part. A substudy of the FHSC will focus on homozygous autosomal dominant hypercholesterolaemia (hoADH), to evaluate the true prevalence and phenotypic and genetic characterisation of this severe form of FH. This substudy (HoADH International Clinical Collaboration, HICC), is jointly led by Professor Derick Raal, University of the

Cholesterol-lowering therapy: Old evidence, new guidelines – Which one to follow? A critical appraisal

Current guidelines of the European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS), of the American College of Cardiology and the American Heart Association (ACC/AHA), and of the International Atherosclerosis Society (IAS) are all based on the same body of evidence, but come to strikingly different conclusions with regard to lipid lowering therapy. While the ESC/EAS guidelines assign appropriate treatments to distinct lipid disorders, the ACC/AHA guidelines focus exclusively on evidence from randomized controlled trials for statins, but lack advice for those lipid disorders without evidence from randomized trials. Thus, evidence based medicine in its strict sense may leave a clinically significant gap. In striking contrast, the position paper of the IAS suggests the most advanced evidence-based innovative concept of a goal of one and the same healthy cholesterol level for anyone.

Guidelines in the USA, a viewpoint contrary to those guidelines in Europe, Canada, Britain and the International Atherosclerosis Society.

Management of dyslipidaemia is crucial for the reduction in the risk of atherosclerotic cardiovascular disease in the population. Optimum control of this risk factor in both primary and secondary care will not only help reduce cardiovascular disease, but also help reduce long-term healthcare costs for hospital stays, clinic visits and morbidity due to a chronic disease. The purpose of this review is to compare the recent American College of Cardiology/American Heart Association 2013 guidelines with those in Europe, Britain, Canada and the International Atherosclerosis Society position paper. The American College of Cardiology/American Heart Association Task Force have published new guidelines on the management of LDL cholesterol for the reduction in atherosclerotic cardiovascular disease risk, which are in variance with the European Society of Cardiology/European Atherosclerosis Society and other country guidelines and have significant repercussions in different populations. Significant variance between the guidelines can make it difficult for healthcare providers to provide standardized care in different countries, and their long-term implications are uncertain.

Editorial introductions

Current Opinion in Lipidology was launched in 1990. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of lipidology is divided into six sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anton F. StalenhoefAnton F. StalenhoefDr Anton F. Stalenhoef is Emeritus Professor of Medicine in the Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands, and until the end of last year, head of the Section Vascular Medicine of the Department of Internal Medicine. Anton Stalenhoef received his MD degree at the Radboud University of Nijmegen, the Netherlands in 1974. He trained in internal medicine at the University Medical Centre Nijmegen, and qualified as internist in 1979. Following his clinical training, he received his PhD in lipid metabolism in 1982. Dr Stalenhoef continued his research as Visiting Professor at UCSF, San Francisco, USA, between 1982 and 1983. Since 1984 he has been on the faculty of the University Medical Center St. Radboud, Nijmegen, Department of Medicine, first as associated professor and from 1997 as Professor of Medicine. He was named as the first Clinical Investigator of the Dutch Heart Foundation (from 1988 to 1992). His research is in the area of atherosclerosis, lipoprotein metabolism, hyperlipidemia, cardiovascular disease, diabetes mellitus and cytokines and inflammation. Dr Stalenhoef has (co-) authored over 300 peer-reviewed publications in international journals. He has been member of several Dutch and European scientific societies, Dutch Health Council and a variety of scientific advisory councils, including Dutch Heart Foundation and Dutch Research Council. He was member of the Executive Committee of the European Atherosclerosis Society (2005–2008) and has been the Chairman of the EAS 2007 Helsinki Scientific Program Committee. In June 2006 he was named Fellow of the Royal College of Physicians. He was Editor-in-Chief of the Netherlands Journal of Medicine (2005–2008). John J.P. KasteleinJohn J.P. KasteleinJohn J.P. Kastelein is Professor of Medicine at the Department of Vascular Medicine at the Academic Medical Center (AMC) of the University of Amsterdam, the Netherlands, where he holds the Strategic Chair of Genetics of Cardiovascular Disease. He received his medical degree in Amsterdam in 1980 where he subsequently received specialty training in internal medicine. Then, between 1986 and 1988, he was trained in medical genetics, lipidology and molecular biology at the University of British Columbia, Vancouver, Canada, under the guidance of Prof.Dr M.R. Hayden. In 1997 and 1998 he served a visiting Professorship at the Center for Molecular Medicine and Therapeutics at the University of British Columbia, Vancouver, Canada. Upon his return to the Netherlands, he was awarded a doctorate (Cum Laude) and in 1989 he founded the Lipid Research Clinic at the Academic Medical Centre in Amsterdam, which is currently serving as a tertiary referral centre for over 5000 patients each year and has become part of the department of Vascular Medicine. The most important concept in Dr Kastelein's research career is the “extreme genetics” approach. This approach teaches that the study of rare human disorders that are associated with premature coronary disease have broader relevance for the understanding of the etiology of heart disease in general and will yield therapeutic targets that are valid for all patients. Professor Kastelein's current research interests can be found in the etiology, diagnosis, prevention and treatment of hypertriglyceridemia, hypercholesterolaemia and low HDL cholesterol, all conditions associated with atherosclerosis and cardiovascular disease. Dr Kastelein was president of the Dutch Atherosclerosis Society (DAS) and chairs the National Scientific Committee on Familial Hypercholesterolemia (EHC). He also is a member of the Royal Dutch Society for Medicine & Physics, the Council for Basic Science of the American Heart Association and the European Atherosclerosis Society. He also is a boardmember of the International Task Force for CHD Prevention and was recently appointed to the Executive Board of the International Atherosclerosis Society (IAS) and is a recognized world leader in the significance of lipoprotein metabolism for the development of atherosclerotic vascular disease. He has published over 700 research papers in peer reviewed journals, including Nature Genetics, Lancet, New England Journal of Medicine, JAMA and Circulation and has a Hirsch index of 73 and his total citations are at 22847 in October 2011.

Comment to the position paper on global recommendations for the management of dyslipidemia developed by the International Atherosclerosis Society (IAS)

In a previous issue of Atherosclerosis a summary of the position paper on Global Recommendations for the Management of Dyslipidemia, developed by the International Atherosclerosis Society (IAS) was published. The European perspective on the treatment of dyslipidaemia was recently published in the guidelines on dyslipidaemia developed by EAS and ESC (EAS/ESC Guidelines for the Treatment of Dyslipidaemia) [1], followed by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice [2].

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia-Full report

An international panel of the International Atherosclerosis Society has developed a new set of recommendations for the management of dyslipidemia. The panel identifies non--high-density lipoprotein cholesterol as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins are derived for the two forms of prevention. For primary prevention, the recommendations emphasize lifestyle therapies to reduce atherogenic lipoproteins; drug therapy is reserved for subjects at greater risk. Risk assessment is based on estimation of lifetime risk according to differences in baseline population risk in different nations or regions. Secondary prevention emphasizes use of cholesterol-lowering drugs to attain optimal levels of atherogenic lipoproteins.

From the Editor: An interview with Dr. Scott Grundy

During the American Heart Association's Scientific Sessions in November 2014, this Editor had the opportunity to interview Dr. Scott Grundy regarding the new recommendations for guideline development that was issued by the International Atherosclerosis Society. (The full document is published in this issue of the journal). In developing this report, Dr. Grundy chaired a panel of international experts who spent 1 year in consideration of new evidence and regional concerns regarding the clinical management of lipoprotein disorders and vascular disease prevention. His experience in developing the Adult Treatment Panel Reports from the National Cholesterol Education Program in the United States and his extensive research in lipoprotein physiology and related disorders makes him unique in offering the expertise for worldwide leadership in this effort.

International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia

I am proud to announce the completion of a new and important International Atherosclerosis Society (IAS) Position Paper entitled ‘‘Global Recommendations for the Management of Dyslipidemia’’. This paper has been developed as an aid to the management of the dyslipidemia that is driving a worldwide epidemic of atherosclerotic cardiovascular disease. The position paper is the result of more than a year of deliberations by a group of international experts led by Scott Grundy. Members of this group are listed at the end of this editorial. These experts were representatives of many different regions of the world. Questions relating to lifestyle and drug management of dyslipidemia were addressed in an iterative process that culminated in a final draft that was provided to the IAS Executive Committee for comment and suggestion. This final draft was also shared with IAS member societies for comment and ratification. Many of our member societies provided valuable feedback with suggestions that were incorporated into the final version of the document. This IAS Position Paper provides background rationale, panel deliberations, and IAS recommendations. It reviews existing evidence-based recommendations and consolidates them into an overall set of recommendations. These recommendations aremeant to inform clinical judgment and not to replace it. The report is divided into primary and secondary prevention. For secondary prevention, priority is given to randomized, controlled clinical trials (RCTs) because of a wealth of data. For primary prevention, RCT evidence is

Editorial introductions

Current Opinion in Lipidology was launched in 1990. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of lipidology is divided into six sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Anton F. StalenhoefAnton F. StalenhoefDr Anton F. Stalenhoef is Emeritus Professor of Medicine in the Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands, and until the end of last year, head of the Section Vascular Medicine of the Department of Internal Medicine. Anton Stalenhoef received his MD degree at the Radboud University of Nijmegen, the Netherlands in 1974. He trained in internal medicine at the University Medical Centre Nijmegen, and qualified as internist in 1979. Following his clinical training, he received his PhD in lipid metabolism in 1982. Dr Stalenhoef continued his research as Visiting Professor at UCSF, San Francisco, USA, between 1982 and 1983. Since 1984 he has been on the faculty of the University Medical Center St. Radboud, Nijmegen, Department of Medicine, first as associated professor and from 1997 as Professor of Medicine. He was named as the first Clinical Investigator of the Dutch Heart Foundation (from 1988 to 1992). His research is in the area of atherosclerosis, lipoprotein metabolism, hyperlipidemia, cardiovascular disease, diabetes mellitus and cytokines and inflammation. Dr Stalenhoef has (co-) authored over 300 peer-reviewed publications in international journals. He has been member of several Dutch and European scientific societies, Dutch Health Council and a variety of scientific advisory councils, including Dutch Heart Foundation and Dutch Research Council. He was member of the Executive Committee of the European Atherosclerosis Society (2005–2008) and has been the Chairman of the EAS 2007 Helsinki Scientific Program Committee. In June 2006 he was named Fellow of the Royal College of Physicians. He was Editor-in-Chief of the Netherlands Journal of Medicine (2005–2008). John J.P. KasteleinJohn J.P. KasteleinJohn J.P. Kastelein is Professor of Medicine at the Department of Vascular Medicine at the Academic Medical Center (AMC) of the University of Amsterdam, the Netherlands, where he holds the Strategic Chair of Genetics of Cardiovascular Disease. He received his medical degree in Amsterdam in 1980 where he subsequently received specialty training in internal medicine. Then, between 1986 and 1988, he was trained in medical genetics, lipidology and molecular biology at the University of British Columbia, Vancouver, Canada, under the guidance of Prof.Dr M.R. Hayden. In 1997 and 1998 he served a visiting Professorship at the Center for Molecular Medicine and Therapeutics at the University of British Columbia, Vancouver, Canada. Upon his return to the Netherlands, he was awarded a doctorate (Cum Laude) and in 1989 he founded the Lipid Research Clinic at the Academic Medical Centre in Amsterdam, which is currently serving as a tertiary referral centre for over 5000 patients each year and has become part of the department of Vascular Medicine. The most important concept in Dr. Kastelein's research career is the “extreme genetics” approach. This approach teaches that the study of rare human disorders that are associated with premature coronary disease have broader relevance for the understanding of the etiology of heart disease in general and will yield therapeutic targets that are valid for all patients. Professor Kastelein's current research interests can be found in the etiology, diagnosis, prevention and treatment of hypertriglyceridemia, hypercholesterolaemia and low HDL cholesterol, all conditions associated with atherosclerosis and cardiovascular disease. Dr. Kastelein was president of the Dutch Atherosclerosis Society (DAS) and chairs the National Scientific Committee on Familial Hypercholesterolemia (EHC). He also is a member of the Royal Dutch Society for Medicine & Physics, the Council for Basic Science of the American Heart Association and the European Atherosclerosis Society. He also is a boardmember of the International Task Force for CHD Prevention and was recently appointed to the Executive Board of the International Atherosclerosis Society (IAS) and is a recognized world leader in the significance of lipoprotein metabolism for the development of atherosclerotic vascular disease. He has published over 700 research papers in peer reviewed journals, including Nature Genetics, Lancet, New England Journal of Medicine, JAMA and Circulation and has a Hirsch index of 73 and his total citations are at 22847 in October 2011.

Improving the care of high-risk patients: The potential of PCSK9

This month's commentary highlights the potential of novel agents that target proprotein convertase subtilisin/kexin type 9 (PCSK9). Adding to the monoclonal antibody therapies, the most advanced now in Phase III development, is a proof of concept study for a small interfering RNA (siRNA) that inhibits PCSK9 synthesis. If shown to be safe and effective in the long-term, these agents will play an important role in the management of patients at increased risk of accelerated atherosclerosis and cardiovascular disease, including those with familial hypercholesterolaemia (FH), who are often undertreated. This issue has been highlighted by the European Atherosclerosis Society (EAS) Consensus Statement [ [1] Nordestgaard B.G. Chapman M.J. Humphries S.E. et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: Consensus Statement of the European Atherosclerosis Society. Eur Heart J. 2013; 34: 3478-3490 Crossref PubMed Scopus (1794) Google Scholar ]. Recently, the International Atherosclerosis Society recommended that: ‘…the paper should be compulsory reading for all who are committed to reducing the worldwide burden of atherosclerosis and its associated cardiovascular disease [ [2] International Atherosclerosis SocietyFrom the IAS President’s desk. September 2012http://www.athero.org/MsgFromThePresident20130916.pdf Google Scholar ].’

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

An international panel of the International Atherosclerosis Society has developed a new set of recommendations for management of dyslipidemia. The panel identifies non-high density lipoprotein cholesterol (non-HDL-C) as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins are derived for the two forms of prevention. For primary prevention, the recommendations emphasize lifestyle therapies to reduce atherogenic lipoproteins; drug therapy is reserved for higher risk subjects. Risk assessment is based on estimation of lifetime risk according to differences in baseline population risk in different nations or regions. Secondary prevention emphasizes use of cholesterol-lowering drugs to attain optimal levels of atherogenic lipoproteins.

Sleep Apnea and Cardiometabolic Risk in South Asians

Sleep Apnea and Cardiometabolic Risk in South Asians

SAT0077 Severity of Periodontal Disease is Indenpendently Associated with Metabolic Syndrome in Rheumatoid Arthritis Patients

BackgroundChronic inflammatory diseases such as Rheumatoid Arthritis (RA) and periodontal disease (PD) havebeen associated with accelerated cardiovascular disease and Metabolic Syndrome (MS) is also strongly associatedwith this condition. No previous...