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International Atherosclerosis
January 2008


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International Chair on Cardiometabolic Risk
Metabolic Syndrome Institute
Society of Atherosclerosis Imaging and Prevention

Scott M. Grundy, MD, PhD
Dallas, TX, USA
Associate Editors
Stefano Bellosta
Milan, Italy
Emanuela Folco
Milan, Italy
Ann Jackson
Houston, TX, USA
Website Editors
Gianpaolo Bagnato
Milan, Italy
Annamaria Scimone
Milan, Italy
Mandi Wong
Dallas, TX, USA


What's New on the International Atherosclerosis
Society Website

In the News - ENHANCE Trial
(Posted: January 18, 2008)

Merck and Schering-Plough Pharmaceuticals released an unpublished summary of the ENHANCE trial (Effect of Combination Ezetimibe and High-Dose Simvastatin vs. Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia). This trial was designed to prove that Vytorin (simvastatin 80 mg + ezetimibe 10 mg) could slow the progression of carotid artery thickening more than simvastatin 80 mg alone. 720 patients with familial hypercholesterolemia were treated over a two-year period. There was virtually no progression of carotid thickening in either treatment arm and there was no difference between the therapies. Some media reports implied from the study, addition of ezetimibe to simvastatin therapy gives no medical benefit. However, in the considered views of the American College of Cardiology and the American Heart Association the current study is not particularly informative. A final assessment of the benefit of combination simvastatin + ezetimibe must await the results of larger morbidity/mortality studies.

IAS Affiliation News

Metabolic Syndrome Institute - Scientific Committee Meeting
Paris, France
December 14-15, 2007

The latest meeting of the Metabolic Syndrome Institute (MSI), held in Paris on 14 and 15 December 2007, focused on microvascular and macrovascular disease. Professor Stevo Julius opened the Friday morning session by addressing the thorny issue of how early we should treat hypertension or its pre-states, to prevent hypertensive macrovascular disease. He argued that there are good reasons to treat early, including the observation that the natural history of blood pressure elevation and morbidity in hypertension is not linear, but rather exponential, and the fact that borderline phase hypertension is already associated with numerous pathophysiologic and metabolic abnormalities. Professor Julius views prehypertension and stage 1 hypertension as the deadliest forms of hypertension. In the next presentation, “Microvessels and atherosclerosis in humans”, Professor Valentin Fuster reported imaging work that shows how vasa vasorum–derived microvessels nurture atherosclerotic plaque, and considered whether such plaque neovessels could in the future be used for risk stratification.

The afternoon session began with a presentation by Professor Paul Dodson on prevention of diabetic retinopathy, which causes 11% of blindness in the Western World, and the case for lipid-modifying therapy with fibrates in the light of data from the FIELD trial. Professor George King then spoke about protein kinase C activation in mechanisms of the metabolic syndrome, and cardiovascular pathologies in diabetic subjects, such as atherosclerosis, restenosis, cardiomyopathy, and cardiac fibrosis, which may result from increased expression of the potent pro-fibrotic factor, connective tissue growth factor, as reported in the myocardium of diabetics. Professor Masayuki Yoshida then reviewed the roles of apoliprotein CIII and protein kinase C in insulin resistance and endothelial cell dysfunction. He presented evidence that apoliprotein CIII not only modulates lipoprotein metabolism, but may also contribute directly to atherogenesis through insulin resistance and endothelial dysfunction. The afternoon session was completed by a presentation by Professor Frank Sacks, on the role of apoliprotein CIII in atherogenic dyslipidemia and vascular pathology. He reported evidence that apoliprotein CIII has direct pro-inflammatory and pro-atherogenic effects in vascular cells.

Professor Paola Fioretto opened the Saturday morning session with a talk on the histopathology of diabetic nephropathy, in which she presented the first evidence in humans that established lesions of diabetic glomerulopathy are reversible after ten years of euglycemia. Professor Bart Staels concluded the session with a presentation on vascular inflammation, microvascular disease, and peroxisome proliferator-activated receptor ?, which improves endothelial function by lowering leukocyte recruitment, enhancing vasorelaxation, and reducing vasoconstriction. It also affords microvascular protection through its action on macrophages (inflammation control, cholesterol homeostasis), smooth muscle cells (vascular remodeling), and endothelial cells.

The meeting was also the occasion for the selection of the winning applications for the 2007 MSI Awards. Professor Michel Hermans presented a preselection of six research proposals, and an anonymous vote among the MSI Scientific Committee members selected the three winners: 1) a Mexican study of the effects of simultaneous intervention using a school-based program and primary care-based multidisciplinary clinical intervention on obesity rates and major obesity co-morbidities; 2) a South African study of biological markers associated with higher sympathetic activity in urbanized black teachers; and 3) an Australian study of the impact of metabolic syndrome and its components on cardiovascular disease development, cause-specific mortality, diabetes and other outcomes, and comparison of cardiovascular and mortality outcomes in Europid, South Asian Indian, Chinese, and Creole patients. These three 10 000 US $ awards are intended to encourage young researchers and clinicians to do original research in the fight against the metabolic syndrome.

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New Books Related to Atherosclerosis

The International Atherosclerosis Society has added a new section to the website called "New Books Related to Atherosclerosis". It will feature recent textbooks, medical references and other publications from prominent figures in the atherosclerosis community.

How to Prevent Your Stroke
View Details

This book is written in the hope of preventing strokes, based on advice Dr. J. David Spence has given to the more than 16,000 at-risk patients he has seen. It is divided into two sections -- “What Your Doctor Can Do” and “What You Can Do.”

Quitting smoking, following a Mediterranean diet, taking appropriate drugs to reduce blood pressure, cholesterol, and blood clotting, and appropriate surgery for severely narrowed arteries in the neck can reduce stroke by as much as 75 percent in high-risk people.

  • Especially among African Americans, but in anyone with blood pressure that is difficult to control, two simple blood tests (measuring renin and aldosterone) make all the difference to successful treatment.
  • A Mediterranean diet will reduce stroke by nearly half in high-risk people. Dr. Spence provides a collection of gourmet "anti-stroke" recipes that he prepares for himself.
  • Vitamin treatment with folic acid, B6, and B12 may prevent stroke by lowering levels
    of a new risk factor called homocysteine.
  • Advanced imaging methods are improving management of arteries by providing feedback on the effectiveness of therapy.
  • Transcranial Doppler embolus detection can identify, among patients with narrowing of the carotid arteries who do not yet have symptoms, the ones who are likely to benefit from surgery or stenting.