Page 9 - Specialist
P. 9
special feature
The Future Of Cardiovascular Medicine
Phenotypic prevention is the approach for the new term future
Reviewed by:
Dr. S S Iyengar
Prof. & Head, Department of Cardiology, St. John’s Medical College Hospital, Bangalore.
A specialty as the future lowering of low-density lipoprotein (II) JUPITER trial
unfolds (LDL), although at modest levels. These
genes are present as variants. The JUPITER trial, a preventive trial led
To attain greater clinical excellence by Paul M Ridker was presented at the
without compromising patient care, When the variant of this gene was American Heart Association Scientific
the next twelve years, called the new absent, as seen with large majority Sessions 2008. Middle aged or elderly
term future, beginning from 2008 to of the population, there was a 10% patients with no prior cardiovascular
2020, is going to see an increase in sub incidence of coronary heart disease, the disease, LDL <130 mg/dL and increased
specialization within cardiology. LDL cholesterol averaged at 138mg/dL. hsCRP were studied. Almost 18,000
However, when the variant was present, patients were distributed equally between
The future anticipates a marked the LDL cholesterol was 100 mg/dL. patients treated with a placebo or a
increase in the number of patients with statin.
coronary artery disease (CAD). The world Except for this genetic variation,
wide epidemic of obesity and diabetes, which is congenital, all other parameters The patients were later followed
are often associated with an increased in these patients were the same. From up with. The primary endpoint was the
vulnerability to CAD. this study it can be seen that a modest occurrence of a major cardiovascular
28% reduction in LDL cholesterol was event defined as stroke, MI,
Therefore, phenotypic prevention associated with an 89% reduction in hospitalization for unstable angina or
will be a very important part of the plan coronary artery disease. arterial revascularization; each of these
for the new term future, for the oncoming endpoints including cardiovascular death
12 years. Two lessons from this that will and all cause mortality were seen to be
influence medical practice and cardiology reduced significantly.
A. Phenotypic prevention practice enormously are:
The trial was prematurely stopped due
(I)PCSK gene and its association with • Life style reduction of LDL, even if to a marked benefit in the Rosuvastatin
LDL: modest, can have profound effect group. Although this trial was for a period
of four and a half years, the average
One of the large population-based • Interest in trying to produce this variant duration the patient was in the trial was
studies from the University of Texas, as a drug only about 2 years, a marked decrease of
Dallas showed that a genetic change in 44% in the time taken.
the PCSK gene is associated with the As far as phenotypic prevention is
concerned, the phenotype is therefore a
risk factor.
JANUARAY 2009
