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AAS
Quarterly E-Newsletter
March
2008
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Welcome to 2008, a busy year
particularly for the NSW contingent with AAS ASM 2008 being held in Bondi in
late October. Members should also consider registering for the International
Vascular Biology Meeting in Sydney in June.
No feature article in this newsletter but an extended FH Corner from Gerald
regarding the NICE initiatives and also FH-AAS’s plans. |
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President's Report I
am pleased to report that plans for this year’s meeting at Bondi are well
under way. Our local organising committee comprises of Jeff Cohn, Wendy
Jessup, David van Reyk and Len Kritharides. A great deal of thought and
effort has been put into the programme and other components and we look
forward to announcing overseas speakers in the next edition. Wendy is getting
plenty of practice through her involvement in the International Vascular
Biology Symposium, which will be of interest to a substantial number of
members (please see separate notice). The
AAS 2008 meeting will provide an opportunity to pay tribute to the
contributions of Leon Simons. Leon intimated that he was present at and
integral to the genesis of the Australian Atherosclerosis Society, so we look
forward to his reflections on the history of our organisation. This will be
timely because the meeting will also represent the inauguration of an
expanded educational format. This is based on the concept of an industry
“roundtable” of support for independent educational presentations that will
underpin the development of suitable syllabuses for specific groups. In the
first instance, it is anticipated that a one-day meeting will be held after
the ASM to better inform medical specialists about the finer points of lipid
metabolism and atherosclerosis. This
initiative is occurring in a rapidly changing environment for scientific and
medical education. The executive committee is taking due care to retain the
well-established values and traditions of the society as it embarks on this
transition, which is felt to be necessary to retain its relevance and vitality. |
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Familial
Hypercholesterolaemia (FH) Corner: Being Nice to FH The Scope of NICE In February 2008 a Draft Guideline concerning
Familial Hypercholesterolaemia (FH) was published by the National Institute
for Health and Clinical Research (NICE) in the UK (www.nice.org.uk).
This was commissioned by the National Collaborating Centre for Primary
Care in the UK, and its scope was the patient-centered diagnosis and
management of FH in primary, secondary and tertiary settings. The Process A Guideline Development Group derived from a broad
spectrum of relevant disciplines was established to review existing evidence
and to make recommendations, the overall process being monitored by an
Independent Review Panel. Key
clinical questions were identified and these were interrogated employing a
systematic search of the literature, with subsequent extraction and critical
appraisal of the evidence, including economic evaluations where
possible. Key recommendations were
then made based on priorities that were likely to have the highest impact on
patient outcomes, lead to more efficient use of resources, and allow patients
to more rapidly reach important points in care pathways. Some Highlights NICE recommends that the diagnosis of FH should be
based on Simon-Broome Criteria modified for age-adjusted LDL cholesterol
levels. The latter should be the sole criteria for the phenotypic diagnosis
of FH in children. Cascade screening
employing lipid and DNA testing is the recommended approach to detect new cases of FH, with health economic
modeling suggesting that DNA is more cost-effective than lipid testing. Lifestyle measures directed at dietary
modification, physical activity, weight regulation, alcohol intake and
smoking cessation are underscored as the backbone to management of all
patients with FH. Pharmacotherapy
(statins with or without ezetimibe) is recommended in adult patients to
achieve an LDL cholesterol reduction of at least 50%; monitoring CK is not
routinely recommended in asymptomatic patients. An important aspect of
management is the need to provide clear and appropriate information to
patients concerning FH and the process involved in cascade screening, as well
as information concerning the availability of FH support groups. A specific
recommendation is made that all patients with FH should receive a regular
structured review at least annually. Special groups NICE recommends that children should be tested for
FH after the age of 10 years and should be referred to a Paediatric Clinic
specializing in FH. The use of drugs
(chiefly statins) in children should be guided by age, family history, other
cardiovascular risk factors and level of LDL cholesterol (> 6 mmol/L
pointing to the need for a statin).
Homozygous FH should be managed in specialist centres and should
receive early drug therapy. Women and
girls are identified as a special management group, with careful advice
required concerning use of contraception and special risk to foetus and to
pregnancy when on drug therapy. Referring to specialists Whilst managing FH is encouraged in primary care,
referral to a specialist is required if a patient has coronary heart disease,
a family history of premature cardiovascular disease, at least two other
cardiovascular risk factors, is intolerant to pharmacotherapy, and/or
requires radical therapy for homozygous FH.
Referral to a cardiologist is also recommended if there are signs and
symptoms of coronary disease, family history of early adult coronary disease
and the presence of other cardiovascular risk factors. Screening for coronary heart disease is
not recommended in asymptomatic children and young adults with heterozygous
FH. Related Guidelines The FH guideline is supported by other NICE
guidelines concerning the use of statins, ezetimibe, reversible long-term
contraception, secondary prevention of cardiovascular disease and smoking
cessation. All of these are critical
of the overall management of FH. Implementation? Appropriately and successfully implementing
guidelines is a challenge for all organizations. NICE has therefore developed tools to assist this process (www.nice.org.uk) based on practical advice, slide
material, costing and auditing instruments, and availability of local and
national support groups. Commentary This NICE Guideline on FH is certainly most
welcomed, but the real challenge is implementation. If a fraction of the
recommendations are followed there will be a significant favorable impact on
the life of patients with FH. But more resources are needed to provide this
service. But there are also clear deficiencies with the NICE
Guideline. For example, there is lack of specificity on how best to identify
index cases prior to cascade screening, how to establish and efficiently run
a DNA service, how to optimize the process of cascade screening, and what the
recommended lipid treatment targets should be in different clinical settings.
While awaiting more evidence what should clinicians do? They should also
follow other published guidelines (NCEP, Australian NHF) on lipid management
for high-risk patients such as FH. In
recognition of the need for further research NICE has, however, identified
questions relating to, for example, the value of clinical registers in
identifying index cases, the efficacy and safety of drug therapy in children
and pregnancy, and the routine assessment of cardiovascular disease in
asymptomatic patients. Accordingly,
the guidelines will be reviewed and updated at two yearly intervals after the
formal date of publication, due in August 2008. In parallel with the publication of the draft NICE guideline,
FH-AAS is developing its own model of care for FH which from the initial
consultations and discussions (Adelaide Meeting, January 2008) appear to be
more progressive than the UK recommendations and of course are being
developed within an Australian context. Please continue to watch this space! |
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International Vascular
Biology Meeting Just calling in to remind you about registering now for
the International Vascular Biology Meeting (IVBM2008, June 1-5, Sydney).
Please check out the outstanding draft final Scientific Programme at www.ivbm2008.com. The 5 day IVBM Scientific Programme features 128 separate Talks
spanning the latest developments in Vascular Biology, through -
7
Plenary Sessions (with 14 confirmed Plenary Speakers); -
18 x 2
hour Symposia Workshops (with 38 confirmed Invited Speakers and 68 Oral
Presentations from submitted Abstracts); -
2
Satellite Symposia (8 Invited Speakers); -
3
separate Poster Sessions. Please register via www.ivbm2008.com With many thanks in advance, Levon Khachigian IVBM2008 Chair |
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Membership News If
you have not renewed your membership, please click here to
visit the Meetings First website and renew online. Alternatively, please click here to download a copy of the
paper registration form. New members who joined the Australian
Atherosclerosis Society in 2007
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The Australian Atherosclerosis Society always welcomes new
members. Please encourage your students and work colleagues to join the AAS.
Remember, that members receive thew following: -
A
monthly email that includes, job opportunities, information on meetings
relating to atherosclerosis and regular updates on similar interests. -
A new
quarterly newsletter that will feature different articles each quarter. -
Discounted
rates to attend AAS Annual Scientific Meetings. -
Networking
opportunities and involvement. -
Opportunity
to receive student travel grants and present your research at the Annual
Scientific Meeting. -
Opportunity
to apply for AAS Trust travel grants |
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Cardiovascular and Lipid Research Grants Grants of up to $55,000 (incl. GST) to be awarded for 2009 The Pfizer Australia Cardiovascular and Lipid
Research Grants program is looking for medical graduates who have entered the
field of research (or have returned to research after an appropriate break)
within the last 5 years. Applicants must be Australian citizens or permanent
residents and the majority of research must be conducted within Australia. Research funding is awarded for clinical research across
the fields of (but not necessarily confined to): -
Cardiovascular Disease -
Stroke -
Lipid Disorders Applications close May 23, 2008. For more information or to obtain an application form
visit: www.cvlgrants.com.au
Pfizer Australia Neuroscience Research Grants Grants of up to $44,000 (incl. GST) to be awarded for 2009 The Pfizer Australia Neuroscience
Research Grants program invites applications from medical graduates who have
obtained specialist qualifications within the last 5 years, are currently in
advanced training, or have returned to research after an appropriate break.
Applicants must be Australian citizens or permanent residents and the
majority of the research must be conducted within Australia. Research funding is awarded for basic
and clinical research across the broad field of neuroscience including: -
Pain Medicine -
Psychiatry -
Neurology Applications close May 1, 2008. For more information or to obtain an application form visit: www.nsrgrants.com.au
Pfizer Australia Pty. Ltd. ABN: 50 008 422 348, 38-42 Wharf Road,
West Ryde, NSW, 2114 |
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Forthcoming Meetings International Vascular Biology Meeting 2008 1-5 June 2008, Sydney, Australia Please click here for
more information on this meeting. The 2nd World Congress on Controversies in Diabetes, Obesity
and Hypertension (CODHy) 30 October – 2 November 2008, Barcelona,
Spain Please click here
for more information on this meeting. APSAVD Congress 2008 25 – 28 September 2008, Hong Kong To be on the mailing list to
receive updates on this meeting, please send your contact details through to apsavd@meetingsfirst.com.au. APSAVD Congress 2010 The 7th APSAVD Congress will be
hosted by the Australian Atherosclerosis Society in Australia in 2010. |
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International
Atherosclerosis Society Please click here to
view the November E-Newsletter. Please click here to
view the November Literature E-Newsletter. |
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E-News The next E-News will be sent out on 18 April 2008.
If there is information you would like to include, please email it to aas@meetingsfirst.com.au by Monday
14 April 2008. Please do not hesitate to contact me
if you have any queries. Kind Regards, AAS Secretariat 4/184 Main Street Lilydale VIC 3140 Phone +61 3 9739 7697 Fax +61
3 9739 7076 Email aas@meetingsfirst.com.au |
