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TABLE OF CONTENTS

  • INTRODUCTION
  • Characteristics of the Aging Process Relevant to Lipid Intervention
  • Physiologic characteristics of aging:
  • Socio-economic characteristics of aging:
  • Ethical considerations in the very old:
  • LIPOPROTEINS & AGING
  • Biochemistry and Metabolism of Lipoproteins
  • Chylomicron metabolism:
  • VLDL metabolism:
  • LDL metabolism:
  • HDL metabolism:
  • Lipoprotein (a):
  •  LIPIDS, CARDIOVASCULAR RISK AND AGING
  • Total Cholesterol, LDL Cholesterol and Non-HDL Cholesterol as Risk Factors
  • Other Lipids and Lipoproteins as Risk Factors
  • Inflammatory Markers as Risk Factors
  • LIPID INTERVENTION FOR CARDIOVASCULAR PREVENTION
  • Lifestyle Changes and Lipoproteins
  • Lipid Lowering Drugs and Cardiovascular Risk
  • Statins
  • PPAR activators
  • Bile Acid Binding Resins
  • Niacin
  • Cholesterol absorption inhibitors
  • Omega-3 fatty acids
  • Combination therapy
  • LIPID LOWERING DRUGS AND CARDIOVASCULAR PREVENTION
  • Statin Cardiovascular Clinical Trials
  • The number needed to treat (NNT) to prevent an event in healthy elderly
  • Significance of CRP elevation in the elderly
  • Frailty and the spectrum of conditions associated with elevated CRP
  • Implications of frailty for primary prevention in the elderly.
  • Can the selection of elderly patients for primary prevention be improved?
  • Cholesterol lowering in patients with vascular calcification
  • Statins in patients with ESRD and CHF
  • Statin clinical trials with outcomes other than cardiovascular acute events
  • Peripheral Arterial Disease
  • Preoperative use
  • Use prior to percutaneous revascularization
  • Renal endpoints
  • Anti-inflammatory effects
  • Anti-arrhythmic effects
  • Prevention and treatment of Alzheimer’s disease.
  • Cardiovascular Trials with Other Lipid Lowering Drugs
  • Fibrates
  • Niacin
  • Lovaza
  • Probucol
  • Treatment of Hyperlipidemia-induced Pancreatitis
  • Diet
  • Insulin and Heparin
  • Plasmapheresis
  • Fibric Acid Derivatives
  • Niacin
  • Fish Oil
  • Anti-oxidants
  • Acipimox
  • Pioglitazone
  • SAFETY OF LIPID LOWERING DRUGS IN THE ELDERLY
  • Pathophysiology of Drug Interaction and Toxicity
  • Muscle toxicity of lipid lowering drugs
  • Myalgia
  • Elevation of CK levels without symptoms
  • Myopathy
  • Rhabdomyolysis
  • Hepatotoxicity of lipid lowering drugs
  • Other toxicity of lipid lowering drugs
  • Renal toxicity
  • Central and peripheral nervous system
  • Cancer and lipid lowering drugs
  • Risk attributable to drug interaction
  • EPIDEMIOLOGY OF PRESCRIBING LIPID LOWERING DRUGS FOR THE ELDERLY
  • SHOULD LIPID LOWERING DRUGS BE PRESCRIBED FOR THE ELDERLY?
  • INITIATION OF LIPID INTERVENTION
  • Evaluation of goals
  • Choice of atherogenic particle targeted
  • Non-HDL cholesterol as target for lipid intervention
  • Apolipoprotein B as target for lipid intervention
  • Guidelines and consensus panels for choice of target lipid intervention
  • Choice of statin
  • Other targets for lipid intervention
  • HDL cholesterol as target for lipid intervention
  • C Reactive Protein as target for lipid intervention
  • Any role for triglyceride targeting?
  • Choice of additional or alternative drugs
  • Targeting atherogenic particles
  • Is gemfibrozil monotherapy an alternative to statin therapy?
  • INITIATION OF LIPID PREVENTION