Updates to Canadian Recommendations for Lipid Management Reinforce Importance of Screening and Treating to Targets

    - 2009 Guidelines published in Canadian Journal of Cardiology by the
    Canadian Cardiovascular Society -

MONTREAL, Oct. 29 /CNW/ - The management of dyslipidemia continues to evolve and despite improvements in recurrent cardiovascular events and a decrease in cardiac mortality, cardiovascular disease (CVD) still represents the major burden of disease in this country. In order to provide a standard of care and treatment for CVD that is current and uniform across the country, the Canadian Cardiovascular Society (CCS) recently updated the Canadian guidelines for the management and treatment of dyslipidemia (the 2009 lipid guidelines).

The 2009 lipid guidelines, published in the October issue of Canadian Journal of Cardiology, reinforce the importance of screening and treating to targets.

"It's important that Canadians who are at risk for cardiovascular disease be proactive and visit their doctors for regular screening, but it's equally important for treating physicians to recommend screening more frequently," says Dr. George Honos, Chief of Cardiology, Centre hospitalier de l'Université de Montréal (CHUM). "The 2009 lipid guidelines provide the foundation for screening as well as uniform cardiovascular care in Canada."

Although the major principles of screening and risk stratification in the last updated 2006 Canadian lipid guidelines are retained in the 2009 version, there are several important updates:

    -  The high-risk population has been better defined, including patients
       with diabetes, end-stage heart failure and renal disease;
    -  Risk-stratification tools now take into consideration total
       cardiovascular disease rather than coronary artery disease;
    -  The importance of genetic factors and family history of premature CVD
       is taken into account in the determination of risk;
    -  The importance of obesity (especially abdominal obesity) as a major
       modifiable CVD risk factor is emphasized by including the
       International Diabetes Federations (IDF) classification of the
       metabolic syndrome and including overweight and obesity in the
       screening strategy;
    -  Risk stratification for several inflammatory diseases (e.g.,
       rheumatoid arthritis and psoriasis) is now included; and,
    -  Simplified target lipid levels are provided.

SCREENING AND LIPID TREATMENT TARGETS

The 2009 lipid guidelines recommend that all patients with evidence of atherosclerosis, regardless of age, should be treated as being a high-risk patient. Similarly, all adults with diabetes should have a complete lipid profile as most adults with diabetes are considered to be at high risk for CVD events. Individuals with abdominal obesity, autoimmune chronic inflammatory conditions, chronic kidney disease and a family history of premature CVD should receive earlier screening.

Low-density lipoprotein cholesterol (LDL-C) continues to be the primary target for therapy. Data from several clinical trials, including PROVE-IT,(1) TNT(2) and IDEAL,(3) have confirmed that lowering LDL-C to levels below 2.0 mmol/L is associated with the lowest risk of recurrent CVD events in secondary prevention patient populations.

The 2009 lipid guidelines recommend that for high-risk patients - and now, for moderate-risk patients as well - target levels should be an LDL-C of less than 2.0 mmol/L or a more than 50 per cent reduction from baseline LDL-C. The alternate primary target is apolipoprotein (apo) B. The good news is that the majority of patients will be able to achieve target LDL-C levels on statin monotherapy, thus reducing both cost of therapy and pill burden for the patients.

"With more than 10 years of scientific and clinical experience around the world, statins have become a cornerstone for effective cholesterol management, dramatically improving our ability to manage and prevent heart disease," says Dr. Honos. "Several clinical trials involving LIPITOR(R)(1) have driven the guidelines and demonstrate its effectiveness in reducing both LDL-C and apoB to the target levels recommended in all patient types, whether at low, moderate or high risk of CVD."

As with any medication for asymptomatic diseases, adherence to statin therapy is very important as their effectiveness is significantly compromised by poor adherence.

CARDIOVASCULAR DISEASE AND HIGH CHOLESTEROL IN CANADA

Cardiovascular disease accounts for the death of more Canadians than any other disease.(4) Unfortunately, Canadians run a high risk of developing cardiovascular disease as nine-in-ten (90 per cent) have at least one risk factor for heart disease or stroke (including smoking, alcohol use, physical inactivity, obesity, high blood pressure, high cholesterol and diabetes).(5)

High cholesterol affects millions of Canadians(6) and is one of the major risk factors for heart disease and stroke.(7) In fact, almost 40 per cent of Canadians have high cholesterol.(8) Medical research continues to show that lowering LDL cholesterol reduces the risk of developing heart disease and stroke.

ABOUT LIPITOR

LIPITOR is indicated to lower total cholesterol, LDL cholesterol and other fats in the blood (such as triglycerides) when response to diet and other lifestyle measures alone have been inadequate, in both adults and pediatric patients (boys and postmenarchal girls, 10 to 17 years of age, with heterozygous familial hypercholesterolemia).

LIPITOR is also indicated to reduce the risk of myocardial infarction in adult hypertensive patients without clinically evident coronary heart disease, but with at least three additional risk factors for coronary heart disease. In addition, LIPITOR is also indicated to reduce the risk of myocardial infarction and stroke in adult patients with type 2 diabetes mellitus and hypertension without clinically evident coronary heart disease, but with other cardiovascular risk factors.

LIPITOR is generally well-tolerated. Adverse reactions have usually been mild and transient. The most common adverse events were gastrointestinal complaints, headache, pain, muscle pain and fatigue.

LIPITOR benefits from 12 years of clinical experience in Canada and is the most widely prescribed statin in the world.

ABOUT PFIZER CANADA INC.

Pfizer Canada Inc. is the Canadian operation of Pfizer Inc., the world's leading biopharmaceutical company. The company is one of the largest contributors to health research in Canada. Our diversified health care portfolio includes human and animal biologic and small molecule medicines and vaccines, as well as nutritional products and many of the world's best-known consumer products. Every day, Pfizer Canada employees work to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. We apply science and our global resources to improve the health and well-being of Canadians at every stage of life. Our commitment is reflected in everything Pfizer does, from our disease awareness initiatives to our community partnerships, to our belief that it takes more than medication to be truly healthy. To learn more about Pfizer's More than Medication philosophy and programs, visit morethanmedication.ca. To learn more about Pfizer Canada, visit www.pfizer.ca.

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    References:

    (1) (R)Pfizer Ireland Pharmaceuticals, owner/Pfizer Canada Inc., Licensee

    (1) Cannon CP, Braunwald E, Mccabe CH, et al. Intensive versus moderate
        lipid lowering with statins after acute coronary syndromes. N Engl J
        Med 2004;350:1495-504.
    (2) Larosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with
        atorvastatin in patients with stable coronary disease. N Engl J Med
        2005;352:1425-35.
    (3) Pederson TR, Faergeman O, Kastelein JJP, et al. High-dose
        atorvastatin vs usual-dose simvastatin for secondary prevention after
        myocardial infarction: The IDEAL study: A randomized controlled
        trial. JAMA 2005;294:2437-45.
    (4) Statistics Canada, Mortality Summary List of Causes 2005 (released
        March 2009).
        http://www.statcan.gc.ca/pub/84f0209x/84f0209x2005000-eng.pdf.
        Last accessed October 23, 2009.
    (5) Canadian Heart Health Strategy-Action Plan Steering Committee.
        Building a Heart Healthy Canada (released February 2009).
        http://www.chhs-scsc.ca/web/?page_id=464.
        Last accessed October 23, 2009.
    (6) Heart and Stroke Foundation. Statistics. Blood cholesterol.
        http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Sta tistics.htm. Last accessed October 26, 2009.
    (7) Heart and Stroke Foundation. High cholesterol.
        http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484027/k.5C04/Hig h_blood_cholesterol.htm?src=home. Last accessed October
        23, 2009.
    (8) Living with Cholesterol. Prepared by the Heart and Stroke Foundation
        of Canada.
        http://www.heartandstroke.com/atf/cf/(99452D8B-E7F1-4BD6-A57D-B136CE6C95BF)/Living_with_Cholesterol_ENG.pdf. Last accessed October 23, 2009.

For further information: or to arrange an interview with Dr. Honos, please contact: Laura Espinoza, Edelman, laura.espinoza@edelman.com, (416) 979-1120 ext. 245; For more information about Pfizer Canada, please contact: Maureen McConnell, Pfizer Canada Inc., maureen.mcconnell@pfizer.com, (514) 426-6985, 1-866-9Pfizer (1-866-973-4937)