Physicians' Academy for Cardiovascular Education

SNAPSHOT meeting: Novel interventions in CVD: Controversies & hot issues

Sep. 10, 2013

This PACE snapshot meeting aimed to provide expert physicians with a state of the art and comprehensive overview of different novel interventions in the future management of cardiovascular disease, and a platform for discussion, debate and exchange. Indeed it proved to be an informative and fruitful meeting; the perfect warming up for an inspiring congress.


Update • 15-9-2013 • Novel interventions in CVD

Snapshot 2013 Lectures online

Did you  miss the PACE 2013 Snapshot session held in Amsterdam? As a service for PACE members the full (15 minute) lectures are made available to view online

Update • 15-9-2013

Snapshot 2013 webcasts

Did you  miss the PACE 2013 Snapshot session held in Amsterdam? Watch 3 minute webcast with faculty members
 
After a word of welcome by the chairmen John Kastelein and John Deanfield, the first session discussed  ‘New concepts in management of CV risk’.
John Deanfield, MD (London, UK) started the meeting with his talk onCardiovascular management: What are the strategic changes?’, by illustrating the current status of cardiovascular medicine and much-needed preventive approaches. He underlined the need to consider lifetime risk and the need for early intervention and pointed out which new promising therapeutic strategies are under development.
 
Ulf Landmesser, MD (Zurich, Switzerland) continued with ‘The Inflammatory process and cardiovascular events: What are the targets for intervention?’. He outlined the available evidence from both experimental animal studies and human genetic data that points towards a causal role for inflammation in the development of CV disease. He illustrated how these mechanistic insights provide targets for novel therapeutic strategies, such as modulating the tight balance of inflammation and atherogenesis mediators IL-6 and IL-1β.
 
Luis Ruilope, MD (Madrid, Spain) gave an update on therapy-resistant hypertension, discussing novel pharmacotherapy and renal denervation. He suggested a step-wise approach to identify true therapy-resistant hypertension. He stressed the importance of compliance when giving pharmacotherapy, and when patients can benefit from renal denervation or when it should not be applied. Dr. Ruilope showed data on the efficacy of renal denervation in patient with or without true hypertension, which led to a position paper in the European Heart Journal. However, predictors of response and long-term safety and efficicay data are needed.
 
In the next session on  ‘Innovations in LDL and HDL cholesterol management, Kees Hovingh, MD (Amsterdam, The Netherlands) discussed new insights into the prevalence, phenotype and management of HoFH. Based on a large database study, he estimates the actual prevalence of heterozygous FH to be 1/250 as opposed to the commonly acknowledged 1/500. Furthermore he outlined therapeutic options, which are currently aimed not at curing the disease, but at redirecting the phenotype.

Evan Stein, MD (Cincinnati, OH, USA) summarised novel concepts and novel promises of lowering of LDL-C, indicating where we stand in the development of new therapeutic strategies, including the efficacy and safety results that have been obtained with the first clinical trials of monoclonal antibodies. These preliminary data show that monoclonal antibodies seem a well-tolerated and effective approach, without major adverse effects.  
 
John Kastelein, MD (Amsterdam, The Netherlands) zoomed in on CETP inhibition and discussed somewhat disappointing results of several clinical trials that tested CETP inhibitors. Dr. Kastelein stressed that although HDL-c increases should be beneficial, both HDL-c and LDL-c changes are needed to achieve real benefits. Despite earlier struggles and wrong decisions in the development of CETP inhibitors, a novel agent is now being tested that seems to affect both HDL-c and LDL-c levels. Initial studies are promising.
 
Bryan Brewer, MD (Washington, DC, USA) delineated the options left in targeting HDL-c, including Apo A-1-inducers, CETP-inhibition, HDL-c infusions and increasing LCAT enzyme activity. He emphasized that HDL-c metabolism is complex and that raising of HDL-c may or may not reduce CV risk, depending on how it is raised and depending on the type of patients.
 
John Betteridge, MD (London, UK) spoke about the challenges that come with management of CV risk in diabetic patients. Since plaque burden is higher in diabetics, and hypoglycaemia appears to induce CV events, diabetes doctors need to be CV prevention doctors. Dr. Betteridge discussed therapeutic options that are being explored in trials.
 
John Camm, MD (London, UK) then discussed new developments in the field of atrial fibrillation and stroke prevention with anticoagulation. He pointed out the added value of the CHA2DS2-VASc score, over the CHADS-score, in assessing thromboembolic risk. Furthermore he showed the evidence that all oral anticoagulants are superior to warfarin, although thus far no direct comparisons have been done.
 
The last session focused on breakthroughs in lipid management. Daniel Gaudet, MD (Montréal, Canada) spoke about emerging therapies for the management of triglycerides, specifically antisense therapy that targets apoC3. Lowering apoC3 production by antisense oligonucleotides causes triglyceride levels to go down. Its efficacy needs to be confirmed  in larger studies, but the first results are promising.
 
Erik Stroes, MD (Amsterdam, The Netherlands) continued the session by discussing HDL mimetics and plaque regression. Several recent studies have challenged the protective role of HDL-c, by showing the absence of an association between genetic or drug-induced HDL-increases and CV risk. Evidence exists that the number of HDL-c particles may be more relevant than HDL-c concentration. Therefore, apoA-I increasing strategies are being explored. Preliminary data on treatment with a recombinant human ApoA-I particle indeed show an HDL-c increase, without affecting LDL and VLDL, by promoting plasma efflux capacity and fecal cholesterol excretion and reducing carotid wall thickness in patients with genetically low HDL-c levels.
 
Joanne M Donovan, MD (Cambridge, MA, USA) showed data on a novel approach to target fasting and postprandial triglycerides. The newly developed compound CAT2003 is an oral PCSK9 inhibitor that lowers LDL, and which also modulates the intestinal catabolism of triglyceride-rich lipoproteins. It has been shown to positively affect fasting and postprandial triglyceride levels in phase I studies. It is currently being tested in phase II trials.


Slides of the preparations in the SNAPSHOT meeting have been prepared and shared for educational purposes by the presenters.

SNAPSHOT 2013 - CV Risk management: What are the strategic changes? Slides prepared and shared for educational purposes by prof. John Deanfield, University College London, United Kingdom Presented at PACE Snapshot session, August 31, Amsterdam  


SNAPSHOT 2013 - The inflammatory process and CV events: What are the targets for interventon? Slides prepared and shared for educational purposes prof. Ulf Landmesser, University Hospital Zurich, Presented at PACE Snapshot session, August 31, Amsterdam  


SNAPSHOT 2013 - Update on therapy resistant hypertension: Novel pharmacotherapy or renal denervation? Slides prepared and shared for educational purposes by prof. Luis Ruilope, Madrid, Spain, Presented at PACE Snapshot session, August 31, Amsterdam, The Netherlands


SNAPSHOT 2013 - Lowering of LDL-c: Novel concepts and novel promises Slides prepared and shared for educational purposes by prof. Evan Stein, Cincinnati, Ohio, USA, Presented at PACE Snapshot session, August 31, 2013, Amsterdam, The Netherlands


SNAPSHOT 2013 - CETP inhibition: Where are we now? Slides prepared and shared for educational purposes by prof. John Kastelein, Amsterdam, The Netherlands, Presented at PACE Snapshot session, August 31, 2013, Amsterdam, The Netherlands



SNAPSHOT 2013 - Targeting HDL-c: What are the options left? Slides prepared and shared for educational purposes by dr. Bryan Brewer, Washington DC, USA Presented at PACE Snapshot session, August 31, 2013, Amsterdam, The Netherlands



SNAPSHOT 2013 - Managing diabetes to reduce CV events: Where are we now? Slides prepared and shared for educational purposes by prof. John Betteridge, UCL, London, United Kingdom. Presented at PACE Snapshot session, August 31, 2013, Amsterdam, The Netherlands


SNAPSHOT 2013 - Targeting triglycerides: New insights from antisense therapy Slides prepared and shared for educational purposes by prof. Daniel Gaudet, Universite de Montreal, Quebec, Canada. Presented at PACE Snapshot session, August 31, 2013, Amsterdam, The Netherlands


HDL-cholesterol versus apoA-I and Atherosclerosis Regression Slides prepared and shared for educational purposes by prof. Erik Stroes, AMC, Amsterdam, The Netherlands. Presented at PACE Snapshot session, August 31, 2013, Amsterdam, The Netherlands