Rockpointe: The confluence of medical science and clinical need

Provided by: The Consortium for Southeastern Hypertension Control (COSEHC)

Click on the page to read or
print the COSEHC Newsletter

PROGRAM PURPOSE

The purpose of this COSEHC educational activity is to provide support for physicians' continuous improvement of clinical competency and performance to optimize cardiovascular care. The desired result is to improve physicians'/healthcare providers' management of cardiometabolic risk factors with evidence-based therapies to increase the percentage of patients being treated to therapeutic goals.

Needs Assessment

There is a complex inter-relationship between hypertension, hyperlipidemia, and insulin resistance mediated Type 2 diabetes (1-3). The current ever-increasing epidemic of obesity centered in the Southeast is further increasing the CV burden for the region. Excessive body weight leads to all three of these major CV risk factors, i.e. hypertension, hyperlipidemia and insulin resistance. The Renin-Angiotensin System (RAS) plays a central and integrated pathophysiology role in the lethal triangular pathophysiological process known as the cardiometabolic syndrome. Numerous clinical trials have confirmed the benefit that interruption of the RAS can have on the symptoms and progression of CV disease including angiotensin converting enzyme inhibitors, angiotensin II receptor blocking drugs, and more recently a renin-blocking drug. Additionally, there is a significant gap between guidelines and practice in regards to lipid treatment and the degree to which patients reached treatment target levels. Schrott, et al. (4) showed that while 96% of subjects qualified for lipid therapy, only 47% received treatment. In outpatients with cardiovascular disease or risk factors, almost 50% of US patients were not reaching target goals for blood pressure or LDL cholesterol, and 35-85% of patients in each of the three disease categories (hypertension, hyperlipidemia, and diabetes) both in the US and Europe, were not reaching therapeutic goals (5).

Basile J, Houston M, Ferrario CM. Treating the cardiometabolic syndrome: an opportunity to provide comprehensive cardiovascular risk reduction. J Cardiometab Syndr 2006; 1(5):358-361.
Basile J, Houston M, Ferrario C. Incremental risk-factor reduction improves overall cardiovascular benefit: is it time to abandon the silos? J Clin Hypertens 2006; 8(10):686-688.
Bestermann W, Houston MC, Basile J, Egan B, Ferrario CM, Lackland D et al. Addressing the global cardiovascular risk of hypertension, dyslipidemia, diabetes mellitus, and the metabolic syndrome in the southeastern United States, part II: treatment recommendations for management of the global cardiovascular risk of hypertension, dyslipidemia, diabetes mellitus, and the metabolic syndrome. Am J Med Sci 2005; 329(6):292-305.
Schrott HG, Bittner V, Vittinghoff E, Herrington DM, Hulley S. Adherence to National Cholesterol Education Program Treatment goals in postmenopausal women with heart disease. The Heart and Estrogen/Progestin Replace Study (HERS). The HERS Research Group. JAMA 1997; 277(16):1281-1286.
Steinberg BA, Bhatt DL, Mehta S, Poole-Wilson PA, O’Hagan P, Montalescot G et al. Nine-year trends in achievement of risk factor goals in the US and European outpatients with cardiovascular disease. Am Heart J 2008; 156(4):719-727.

Faculty

	Michael A. Moore, MD, FACP, FAHA, FASH (Chair) COSEHC President and Co-Founder Director of Continuing Medical Education, COSEHC ASH Hypertension Specialist & Fellow Danville, VA Read Biography Michael A. Moore, MD, FACP, FAHA, FASH is a nephrologist, medical educator and a Clinical Professor of Medicine/Nephrology at the Hypertension & Vascular Disease Center of Wake Forest University School of Medicine. After receiving his medical education at the University of North Carolina, his internal medicine and nephrology training were completed at The Johns Hopkins Hospital. He is a Fellow of the American Society of Hypertension which recognizes Dr. Moore as a Hypertension Specialist. He participated in the preparation of the Fourth, Fifth, Sixth and Seventh Joint National Committees Reports on the Detection, Evaluation and Management of High Blood Pressure (JNCs). Dr. Moore was chosen as the American Heart Association 2004 Physician of the Year. His research efforts have included defining the role of the renin-angiotensin II-aldosterone system in hypertension, developing methods to improve patient compliance, and public health strategies to reduce cardiovascular morbidity and mortality. Dr. Moore is currently the President of the Consortium for Southeastern Hypertension Control (www.COSEHC.org), a non-profit voluntary healthcare organization.
	David G. Carmouche, MD COSEHC CME Committee Member ASH Hypertension Specialist Diplomate, American Board of Clinical Lipidology Baton Rouge Clinic Baton Rouge, LA Read Biography Dr. David Carmouche is the Director of the Center for Cardiovascular Disease Prevention at the Baton Rouge Clinic. After completing his undergraduate degree at Tulane University, he attended medical school at LSU-New Orleans. He completed an internship and residency in internal medicine at the University of Alabama at Birmingham where he then served as Chief Resident. Dr. Carmouche has been in practice at the Baton Rouge Clinic, a Consortium of Southeastern Hypertension Control (COSEHC) CV Center of Excellence^TM, since 1997. He directs the Center for Cardiovascular Disease Prevention and specializes in the treatment of difficult hypertension and severe cholesterol disorders. Dr. Carmouche is one of the first physicians in the United States to become board-certified in clinical lipidology. In addition to his practice responsibilities, Dr. Carmouche has given over 400 lectures to medical professionals across the state and southeastern United States on topics related to preventing heart attack and stroke.
	Carlos M. Ferrario, MD, FACA, FACC, FAHA, FASH COSEHC Founder COSEHC Vice President of Development ASH Hypertension Specialist & Fellow Dewitt-Cordell Professor of Surgical Sciences Professor of Physiology and Pharmacology Professor of Internal Medicine-Nephrology Wake Forest University School of Medicine Winston-Salem, NC Read Biography Carlos M. Ferrario, MD, FAHA, FACA, FASH, FACC is an Argentine-born physician scientist cardiologist and the Founder of COSEHC. Throughout his professional career as the Cleveland Clinic Foundation in Cleveland, Ohio and then as the Founder and Director of the Hypertension and Vascular Research Center at the Wake Forest University School of Medicine, Ferrario has produced a corpus of work that significantly moved forward the field of hypertension research, both clinically and experimentally. The contributions made by Ferrario to the hypertension research field are documented in 411 peer-reviewed articles, over 76 book chapters and 3 books. Pioneered research in the renin-angiotensin system includes the discovery of the function of angiotensin-(1-7), a novel hormone that counteracts the vasoconstrictor actions of Ang II, studies demonstrating how inhibitors of angiotensin converting enzyme and angiotensin II receptors act on the body's nervous and endocrine mechanisms to regulate blood pressure, and being among the first to elucidate the a critical role of angiotensin II in the pathogenesis of atherosclerosis, a finding that honed the "hypertension-lipid" hypothesis in the formation of human atherosclerosis. Ferrario's long-time efforts to the discovery of cardiovascular disease mechanisms has been cemented by multiple awards and recognitions from National and International Professional Societies and posts as Officer and Chair of International Organizations dedicated to expanding knowledge of cardiovascular diseases.
	Brian Forrest, MD ASH Hypertension Specialist Adjunct Associate Professor UNC Chapel Hill School of Medicine Chapel Hill, NC Read Biography Dr. Forrest is an Adjunct Associate Professor at UNC Chapel Hill School of Medicine where he attended medical school and completed a Holderness Medical Research Fellowship in Diabetes and an Albert Schweitzer Fellowship in Public Health. He did his internship and residency at Wake Forest University in the Department of Family and Community Medicine and is Board Certified in Family Medicine. He is also an American Society for Hypertension Certified Clinical Specialist in Hypertension and the Founder of the Access Healthcare and Innovadoc Direct Pay practice model. He practices in Apex, N.C. and primarily sees patients in the Access Hypertension and Cardiovascular Disease Prevention Clinic where he cares for a predominantly uninsured population. Currently he serves as President-Elect of the NC Academy of Family Physicians.

TARGET AUDIENCE

This educational activity is designed for primary care family medicine and internal medicine physicians. Allied health care professionals are also invited to participate.

EDUCATIONAL OBJECTIVES

This program is designed to address the following IOM competencies: provide patient-centered care; employ evidence-based practice; apply quality improvement techniques.

The overall educational objective for this activity is to improve the management of patients with the cardiovascular risk factors of hypertension, dyslipidemia, and type 2 diabetes by using evidence based therapies.

After this CME activity, participants will be able to:

Describe the neuro-hormonal pathophysiology of the cardiometabolic syndrome;
Define the pathological interrelationship of the RAS between hypertension, dyslipidemia, and insulin resistance that underlies the cardiometabolic syndrome;
Diagnose the cardiometabolic syndrome;
Demonstrate competency in prescribing evidenced-based treatment with focus on reducing the activity of the RAS to reach the recommended treatment goals (JNC 7, ATP III, and ADA) for hypertension, hyperlipidemic, and type 2 diabetes mellitus (insulin resistance)

ACCREDITATION

COSEHC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

For questions regarding the content of this activity, contact the accredited provider for this CME activity: Contact Debra Simmons; dwirth@wfubmc.edu; Phone: 336-716-1130. For technical assistance, contact Technical assistance: Contact Jeff Atwell; jatwell@wfubmc.edu; Phone: 336-716-5937

DESIGNATION STATEMENT

COSEHC is the designated CME provider for this educational activity. COSEHC designates this educational activity for a maximum of 2.50 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

DISCLOSURE INFORMATION

The Consortium for Southeastern Hypertension Control strives to ensure balance, independence, objectivity, and scientific rigor in all of its educational programs. All faculty members and planning committee members for this activity have been required to disclose any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the session or lecture in which they are participating. This includes relationships in place at the time of the activity or in twelve (12) months preceding the activity, with pharmaceutical companies, biomedical device manufacturers, or other corporations whose products or services are related to the subject matter or presentation topic.

The intent of this policy is to identify openly any conflict of interest so that the learners may form their own judgments about the presentation with the full disclosure of the facts. All Conflicts of Interest Disclosures of faculty and planners are included below.

Michael A. Moore, MD, FACP, FAHA, FASH: Honorarium/Consultant: Daiichi Sankyo, Forest Laboratories, NiCox; Honorarium/Speaker: Daiichi Sankyo, Forest Laboratories

David G. Carmouche, MD: Honorarium/Speaker: Merck Schering-Plough, Abbott Labs, Novartis, AstraZeneca

Carlos M. Ferrario, MD, FACA, FACC, FAHA, FASH: Honorarium/Speaker: Merck, Daiichi Sankyo, Forest, Novartis

Brian Forrest, MD: Honorarium/Speaker: Forest Laboratories, Daiichi Sankyo, Abbott Labs

Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Jan Basile, MD: Research/Grants: Novartis; Honorarium/Consultant: Abbott Labs, Daiichi Sankyo, GlaxoSmithKline, Novartis, Takeda; Honorarium/Speaker: Abbott Labs, AstraZeneca, Daiichi Sankyo, Forest, GlaxoSmithKline, Novartis

Bryan Batson, MD: Research: Novartis; Honorarium/Speaker: Novartis, GlaxoSmithKline, Daiichi Sankyo

Jerry Miller, MD: No financial relationship to disclose

Susie Pollock, BA-COSEHC CME Coordinator: No financial relationship to disclose

James W. Reed, MD: No financial relationship to disclose

Steve Ross, MD: Honorarium/Speaker: Lilly, Daiichi Sankyo, Sanofi Aventis

Debra Simmons, RN, MS-COSEHC Ex. Director: No financial relationship to disclose

Daniel E. Wise, MD: Honorarium/Speaker: Merck, Merck Schering-Plough, Takeda, Novartis, Pfizer, Abbott Labs, Daiichi Sankyo, Forest Laboratories, Bristol-Myers Squibb, AstraZeneca

Commercial Support

All COSEHC Continuing Medical Education activities must be free of any control from a commercial interest. No commercial support has influenced the determination of the educational objectives, selection and presentation of content, selection of persons or organizations in a position to control the content of this activity, selection of educational methods, or the evaluation of this activity

INSTRUCTIONS FOR PARTICIPATION AND CREDIT

This activity is designed to be completed within the time designated; physicians should claim only those credits that reflect the time actually spent in the activity. In order to obtain credit for this activity, participants must complete and submit the activity evaluation and pass the post-test. Participants must earn a score of 75% or higher in order to pass the post-test. Certificates will be available upon completion.

There are no fees for participating in or receiving credit for this educational activity.

FDA Disclosure

The contents of some CME activities may contain discussions of non-approved or off-label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.

SYSTEM REQUIREMENTS

In order to view this presentation, your computer must have audio capabilities (working speakers or headphones) and must have an Adobe Flash Player. The Adobe Flash Player can be downloaded here.