Program Overview

The reduction of cardiovascular event risk with reduced low-density lipoprotein cholesterol (LDL-C) levels is well documented, and LDL-C remains the main target of lipid-lowering therapy. However, not all patients with coronary heart disease have elevated LDL-C levels, and there is increasing recognition that non-high-density lipoprotein cholesterol (non–HDL-C) also plays a role in determining cardiovascular risk. Non–HDL cholesterol may be especially important in certain populations, such as patients with diabetes, in whom dyslipidemia is characterized by low HDL-C levels and elevated triglycerides. Even in non-diabetic patients, non–HDL-C has been shown to correlate with the severity of atherosclerosis and obesity, as well as an association with cardiovascular morbidity and mortality. The non–HDL-C value is readily calculated, and assessment of non–HDL-C may in fact be more practical, accurate, and easier to achieve than assessment of LDL-C.

Currently available lipid-lowering therapies lower non–HDL-C to varying degrees. Statins are most effective at lowering non–HDL-C levels in patients whose non–HDL-C is within 30 mg/dL of the treatment goal. Combination therapy with triglyceride-lowering medications may become necessary in those patients whose non–HDL-C levels are higher than 30 mg/dL above goal.

This program will provide clinicians with important insights into the significance of non–HDL-C levels, as well as practical strategies for the assessment, interpretation, and implications of this value.

Learning Objectives

At the conclusion of this activty, participants should be able to:

• Define non–HDL-cholesterol, including its composition and the methods used to measure its levels
• Recognize the implications of non–HDL-C on cardiovascular risk
• Identify recommended non–HDL-C levels in selected patient populations
• Outline practical strategies for medical and nonpharmacologic treatment of patients with elevated levels of non–HDL-C

Agenda

• Introduction (5 min)
  • Roger S. Blumenthal, MD
• Non-HDL Cholesterol: Measurement, Interpretation, and Significance (20 min)
  • Vera Bittner, MD, MSPH
• Non-HDL Cholesterol: Implications for Treatment of Dyslipidemia (20 min)
  • Michael H. Davidson, MD
• Panel Discussion (15 min)

• Accreditation Statement — The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
• Credit Designation Statement — The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
  Release Date: February 15, 2007. Expiration Date: February 15, 2008
• Statement of Responsibility — The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
• Intended Audience — This activity is designed for primary care physicians. There are no prerequisites for attendees.
• Americans with Disabilities Act — The Johns Hopkins University School of Medicine fully complies with the legal requirements of the ADA and the rules and regulations thereof. Please notify us if you have any special needs.
• Full Disclosure Policy Affecting CME Activities — It is the policy of the Johns Hopkins University School of Medicine that the faculty and provider disclose real or apparent conflicts of interest relating to the topics of this educational activity, and also disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentation(s). Johns Hopkins University School of Medicine OCME has established policies in place that will identify and resolve all conflicts of interest prior to this educational activity. Detailed disclosure will be made in the course handout materials.