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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EWhen the results of the Investigation of Lipid Level Management Using Coronary Ultrasound to Assess Reduction of Atherosclerosis by CETP Inhibition and HDL Elevation [ILLUSTRATE] trial [Nissen SJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007] called into question the efficacy of the cholesteryl ester transfer protein (CETP) inhibitor torcetrapib, many thought it signaled the end of the pursuit of these compounds for the treatment of dyslipidemia. This article discusses new data from ILLUSTRATE, which provide hope for the future of CETP inhibitors.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Elipid disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EWhen the results of the ILLUSTRATE (Investigation of Lipid Level Management Using Coronary Ultrasound to Assess Reduction of Atherosclerosis by CETP Inhibition and HDL Elevation) trial [Nissen SJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007] called into question the efficacy of the cholesteryl ester transfer protein (CETP) inhibitor torcetrapib, many thought it signaled the end of the pursuit of these compounds for the treatment of dyslipidemia. Steven E. Nissen, MD, Cleveland Clinic, OH, discussed new data from ILLUSTRATE, which provide hope for the future of CETP inhibitors.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAlthough ILLUSTRATE showed that the CETP inhibitor torcetrapib increased HDL-C levels, the primary analysis did not show an effect on atherosclerotic progression. A new secondary analysis of the ILLUSTRATE data has shown that when percentages of HDL-C elevation are viewed as incremental quartiles, there is a progressive decrease in rate of progression of coronary atherosclerosis relative to the extent of HDL-C elevation. Patients who reached the highest HDL-C level (\u0026gt;86 mg\/dL) actually achieved atherosclerosis regression (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/29\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Torcetrapib Results: Quartiles of HDL-C Elevation.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1144918695\u0022 data-figure-caption=\u0022Torcetrapib Results: Quartiles of HDL-C Elevation.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/29\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/29\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/2\/29\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10871\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ETorcetrapib Results: Quartiles of HDL-C Elevation.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ESeveral new CETP inhibitors are entering clinical trials, and Dr. Nissen expressed hope that the newer drugs might prove to be clinically useful, because they do not appear to cause an increase in blood pressure, as was shown with torcetrapib.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EJohan W. Jukema, MD, Leiden University Medical Center, Amsterdam, The Netherlands, spoke about statin therapy in three subgroups of patients who are known to be at risk for cardiovascular (CV) events: patients with chronic kidney disease, older patients with moderate to severe ischemic systolic heart failure, and the at-risk elderly.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAccording to Prof. Jukema, study results are mixed for the first two groups. For patients with chronic kidney disease, he cited results from a meta-analysis that showed that the use of statins can significantly reduce lipid concentrations (total cholesterol \u221242.28 [95% CI, \u221247.25 to \u221237.32]; LDL-C \u221243.12 [95% CI, \u221247.85 to \u221238.40]; HDL-C +0.41 [95% CI, \u22120.78 to 1.60]; and triglycerides \u221223.71 [95% CI, \u221233.52 to \u221213.90]), as well as mortality (RR 0.81; 95% CI, 0.73 to 0.90), but that they provide no benefit for all-cause mortality (RR 0.92, 95% CI, 0.82 to 1.03) [Strippoli GFM et al. \u003Cem\u003EBr Med J\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EFor older patients with ischemic systolic heart failure, Prof. Jukema cited new data from CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure), which showed that although the use of rosuvastatin 10 mg daily significantly decreased the number of related hospitalizations (2564 vs 2193, placebo vs rosuvastatin, respectively; p\u0026lt;0.001), there was no effect on the primary composite endpoint of death, non-fatal MI, or non-fatal stroke (HR 0.92; 95% CI, 0.83 to 1.02; p=0.12) [Kjekshus J et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007]. These findings were surprising because prior retrospective analyses with atorvastatin 80 mg [Scirica BM et al. \u003Cem\u003EJ Am Col Cardiol\u003C\/em\u003E 2006; Khush KK et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2007] had suggested that such patients might benefit from high-dose statin therapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EProf. Jukema also discussed the results of a meta-analysis that examined the effect of statin therapy for secondary prevention in elderly patients with coronary heart disease, which showed that not only do statins reduce all-cause mortality in these patients (15.6% with statins vs 18.7% with placebo, RR reduction 22% over 5 years; 95% CI, 0.65 to 0.89), but the extent of the effect is much larger than originally thought [Afilalo J et al. \u003Cem\u003EJ Am Col Cardiol\u003C\/em\u003E 2008; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10874\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10874\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10874\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EEffect of Statin Therapy for Secondary Prevention in the Elderly.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003ERobert S. Rosenson, MD, University of Michigan, Ann Arbor, MI, reviewed several studies that evaluated the relationship between obesity and mortality, noting that while obese individuals (BMI 30\u201335) may not have an increased risk for mortality (RR 0.97; 95% CI, 0.82\u20131.15), the risk is increased for the severely (BMI \u0026gt;35) obese (RR 1.88; 95% CI, 1.05\u20133.34) [Romero-Corral A et al. \u003Cem\u003ELancet\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EInvestigators who evaluated the differences in risk among obese and severely obese individuals have suggested that insulin sensitivity may be a better predictor than obesity alone in predicting risk (\u003Ca id=\u0022xref-table-wrap-1-2\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 2\u003C\/a\u003E; McLaughlin T et al. \u003Cem\u003EArch Int Med\u003C\/em\u003E 2007; Reaven G. \u003Cem\u003EDiab Vasc Dis Res\u003C\/em\u003E 2005).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10877\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10877\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10877\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ECV and Diabetes Risk Factors in Obese Individuals Based on Tertile of SSPG Concentration.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EDr. Rosenson noted that cardiovascular risk is heterogeneous among obese individuals and that more emphasis should be placed on identifying individuals at risk for cardiovascular disease based on their level of insulin resistance versus obesity alone.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/2\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmgpp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmgpp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmgpp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}