Monday, August 29, 2011

FROM THE ESC, PARIS. 28th-31st 2011.

Well, many of our cardiologist are at present in Paris, attending the European Society of Cardiology, annual scientific meeting. I have not been attending this meeting for quite awhile now, as I feel that it was too time consuming ( ??sour grapes ), nothing big to announce, and that the internet has made the world flat.
Yesterday, the ESC started. From the internet I can see that there is nothing earth shuttering in the program. From my point of view, I think Sunday is dominated by two important papers.
1. The long term followup of ASCOT LLA.
You may remember ASCOT LLA was a study, presented and published in 2003, studying the effects of lowering blood pressure in a 19,000 strong cohort of hypertensives. There was also a 10,000 strong arm of hypertensives who had elevated lipids and was treated with Atorvastatin 10mg ( low dose statins ). In ASCOT LLA, their 3.3 years ( mean follow-up ) results were announced, showing a reduction in those on Lipitor 10 mg of CV events and CV deaths. Now after another 8 years of follow-up ( 11years follow-up in total ), we see that after the initial 3.3 years, there was reduction in all cause mortality, but no further reduction in CV mortality and morbidity. Interesting. What this would mean to me is that in the first 3.3 years of treatment, the CV deaths and suffering was reduced. After 3.3 years, these remain stable in both arms, and the further reduction in death rates in the study group was in non-CV deaths and suffering. A further analysis showed that there was a large reduction in death from Pulmonary infectuons. Interesting. This gives rise to many thoughts. Is it that low dose statins also in crase body resistance to fight infections? or does it act as an adjuvant to increase the potency of antibiotics? Whatever it is, taking 10 mg of lipitor ( at such a small dose, the side effect rates are very, very low ), is still beneficial from the cholesterol lowering point of view, the reduce inflammation point of view, and also in the longer term, in the lung infection point of view.
2. The Era of CETP ( Cholesteryl ester transfer protein ) inhibitors have arrived.
Last year, at the American Heart Association annual scientific meeting in Chicago, we saw the presentation of the DEFINE study, testing the safety and efficacy of Anacetrapid in the management of coronary artery disease. Anacetrapid is manufactured by Merck. The results were good. Anacetrapid was shown to be safe, increasing HDL-C by 138% without a concomitant increase in BP ( as was seen in Torcetrapid- and which cause the death of Torcetrapid ).
In Paris yesterday, Roche announced the result of dal-VESSEL, a study of their Dalcetrapid ( CETP inbitor by Roche ). The lead worker here is Dr Thomas Luscher of Zurich University. Yes, Dalcetrapid is also safe but not as powerful as Torcetrapid and Anacetrapid, in terms of HDL-C increase. Dalcetrapid only increase HDL-C by about 31%, but is was safe, with no increase in BP. However it did not meet its primary end point of improving brachial artery vaso-dilation and flow. The study was called dal-VESSEL because it was a study to show that Dalcetrapid, besides improving HDL-C, would also improve flow in the brachial artery. This is did not do.
Yesterday also saw the announcement of the follow-up study, dal-OUTCOMES, to enroll more patients and study the 18 months outcome ( study results should be know by 2013 ), on the use of Dalcetrapid in CV mortality and morbidity.
Yesterday, the boys from Mount Sinai hospital led by Dr Zahi Fayad, also presented their results on dal-PLAQUE, a study on the use of dalcetrapid on plaque inflammation and regression. This is a small study of 100 odd patients given dalcetrapid over 24 months, showed that there was no further plaque progression with MRI and also no pro-infammatory response in the plaque with the use of positron emission tomography.
All in all, there was plenty of CETP on the first day.
Well, lets see what day 2 brings.
To all my friends there, please learn much and come home and share with us , so that we can also learn from you.

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