Science, Sun and SELA 2000

Scientific sessions and sunny weather welcomed 200 SELA members and their guests Aug. 11-13, 2000, to the Association's 2000 Annual Scientific Forum at Amelia Island Plantation in Fernandina Beach, Florida.

The Forum - organized by SELA Program Chairman MacRae F. Linton, M.D. - featured a reception and dinner Friday evening, supported by Bayer Pharmaceutical and SmithKline Beecham. Saturday morning, participants enjoyed a buffet breakfast and time to meet representatives from 16 different pharmaceutical companies for networking and informal discussion of issues.

SELA President John R. Guyton, M.D. and Dr. Linton welcomed members. Dr. Linton opened the forum with a session designed to stimulate dialogue about novel and emerging risk factors, entitled: Atherosclerosis, Inflam-mation, C-Reactive Protein. Dr. Linton is Associate Professor of Medicine and Pharmacology; Co-director, Atherosclerosis Research Unit; and Director, Vanderbilt Lipid Clinic at Vanderbilt University Medical Center in Nashville, TN.

Dr. Guyton, director of the Duke Lipid Clinic at Duke University Medical Center in Durham, NC, took the platform next to address The Dyslipidemia Triad: High Tri-glycerides, Small Dense LDL cholesterol, and Low HDL Cholesterol. High triglycerides, low HDL-cholesertol and increased small dense LDL cholesterol particles characterize the atherogenic phenotype associated with a marked increase in coronary disease risk. This complex array of metabolic factors involves several mechanisms including systemic physiology, intracellular metabolism and signaling, and patterns of gene expression. Abnormal clotting factors, increased glucose levels, insulin resistance, abdominal obesity, hypertension, and possible abnormal arterial wall effects all are expressed at differentially greater levels in people with the triad. Treatment includes reduction in LDL cholesterol, targeting of therapy to optimize HDL cholesterol, and reduction of triglycerides to 100-200 mg/dl. Lifestyle approaches are key and include weight reduction, exercise, a Step 2 or even more rigorous diet, and a reduction in simple sugars and rapidly absorbed carbohydrates. Drug therapy includes the statins, fibrates, or niacin monotherapy. Combinations of two agents are possible in specific circumstances. Fish oil may be of some assistance.

Steven N. Blair, P.E.D., completed the morning lineup with his session: Exercise and Coronary Heart Disease Prevention. Dr.Blair is Director of Research and Epidemiology and Clinical Application at the Cooper Institute for Aerobic Research in Dallas, Texas. Dr. Blair focused on the marked benefits of lifelong exercise habits in lower mortality rates from coronary heart disease. Low fitness is an important predictor of mortality. The protective effects of fitness persist for people who smoke, those with high blood cholesterol, and people with other comorbidities.

A provocative and thoughtful mini-symposium - Guidelines for the New Millennium: Considerations for ATP III - rounded out the morning session. Neil J. Stone, M.D., Professor of Clinical Medicine at Northwestern University School of Medicine in Chicago, spoke on Beyond the Step Two Diet: New Issues in Nonpharmacologic Treatment for NCEP ATP III Management of Hypercholesterolemia: Issues for NCEP ATP III Guidelines - was presented by Donald B. Hunninghake, M.D., Professor of Pharmacology at the University of Minnesota in Minneapolis. These two presentations will become the subject of a future issue of Lipid Spin as the Guidelines are made public.

James M. McKenney, PharmD, offered an organized approach to Enhancing Compliance in the Management of Hypercholesterolemia. Dr. McKenney, President and CEO of the National Clinical Research Center in Richmond, Virginia and a member of the NCEP Adult Treatment Panel, focused on the array of problems associated with compliance. Persistence with chronic therapy with the statins, for example, decreases from 100% in the first month to less than 40% over the year, including persons who discontinue the medication, take it sporadically, or take prolonged "drug holidays." Of people with existing coronary disease eligible for drug treatment , only 13% were receiving treatment as reported in a recent study. No one factor is responsible for noncompliance and Dr. McKenney suggested that no one solution is sufficient. Most patients do not follow therapeutic regimens without some intervention. Among successful strategies for improving adherence, those that are multimodal and that target the whole health system are most effective, including nurse managed clinics, involvement of pharmacists and multidisciplinary units, and creation of a supportive office environment. The optimal structure includes chart audits, monitoring progress, identifying and designating a patient "champion" or advocate, direct patient education, and an appointment management system.

The Saturday evening schedule included a reception and dinner supported by Parke-Davis/Pfizer and a special lecture - Surprising Results with Statins -presented by W. Virgil Brown, M.D., SELA's founding president. Dr. Brown is Professor of Medicine at Emory University Medical Center and Chief of Medical Services at the Atlanta VA Medical Center in Atlanta, Georgia.

A series of well-attended workshops concluded the Forum on Sunday morning. Each session featured a discussion of illustrative cases and an open exchange among the multiple disciplines represented at the Forum.

These workshops offered a rich opportunity for multidisciplinary discussions of both science and the pragmatic issues confronting practitioners in a rapidly evolving cardiovascular disease prevention and treatment milieu.