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This activity is provided by the Discovery Institute of Medical Education.
This activity is supported by an educational grant from Sanofi-Synthelabo Inc., a member of the sanofi-aventis Group.
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The Fairmont Dallas, Dallas, Texas – November 15, 2005 This online CME activity is based on presentations given at an American Heart Association satellite symposium in Dallas, Texas, on November 15, 2005. The Discovery Institute of Medical Education designates this educational activity for a maximum of 2.75 AMA PRA Category 1 Credits™. Persons who attended the symposium are NOT eligible to receive credit for completing this enduring material. Please note that the course is accredited only for physicians (MD, DO, or equivalent). All other participants receive a certificate of completion. In accordance with the Discovery Institute of Medical Education policies regarding financial and off-label disclosures, participants are advised that 1 or more presentations in this CME activity may contain references to off-label or unapproved uses of drugs or devices. Participants should note that the use of these agents outside current approved labeling is considered experimental and are advised to consult prescribing information for these products. This CME activity was planned and produced in accordance with the Accreditation Council for Continuing Medical Education (ACCME) Essential Areas and Policies. © 2006-2007 Discovery Institute of Medical Education
Activity Purpose This activity was developed to increase awareness among cardiologists and other health care professionals about (1) the endocannabinoid (EC) system and its role in metabolic homeostasis; (2) its impact on key constituents of cardiovascular and metabolic risk status, including high-density lipoprotein cholesterol (HDL-C) and insulin, in the presence of excess abdominal adiposity; and (3) its neuromodulation through the administration of CB1 blockade as a risk reduction measure. Statement of Need Already a major health issue in the United States, the impact of obesity has also become an issue worthy of worldwide concern. Intra-abdominal adiposity plays a central role in a constellation of morbidities, including CVD, diabetes, and related metabolic and vascular disorders (eg, dyslipidemia, hypertension). Recent studies implicate the EC system as a significant contributor to metabolic homeostasis. EC receptors have been detected centrally, peripherally, and in endocrine and related tissues. EC blockade is thought to mitigate the effects of an overstimulated EC system characterized by excess visceral fat and the ensuing morbidities of CVD, diabetes, and metabolic disorders. This course explains the EC system and discusses the potential for multirisk management through its regulation. Learning Objectives Upon completion of this activity, participants should be able to
Accreditation Statement The Discovery Institute of Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Designation Statement The Discovery Institute of Medical Education designates this educational activity for a maximum of 2.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Faculty Disclosures and Biographies The Discovery Institute of Medical Education requires that those involved with content development and/or presentation disclose to participants any significant financial interest or other relationship (1) with the manufacturers of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. This CME activity may include discussions regarding the use of medications that may be outside of the approved labeling for these products. Physicians should consult the current prescribing information for these products. The Discovery Institute of Medical Education requires faculty members to disclose that a product is not labeled for the use under discussion. Compliance is documentation that demonstrates the provider has a practice in place to make this requirement known to the faculty. Christie M. Ballantyne, MD Dr Ballantyne is director of the Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center; associate chief and clinical director of the Section of Atherosclerosis, Department of Medicine; director of the Maria and Alando J. Ballantyne, MD, Atherosclerosis Laboratory; professor of medicine and pediatrics, Baylor College of Medicine; and codirector of the Lipid Metabolism and Atherosclerosis Clinic, The Methodist Hospital, Houston, Texas. He received his doctor of medicine degree from Baylor College of Medicine. His postgraduate training included an internal medicine residency at the University of Texas Southwestern Medical School, Dallas, Texas; a cardiology fellowship at Baylor College of Medicine; and an American Heart Association/Bugher Foundation Fellowship at the Howard Hughes Medical Institute and Institute for Molecular Genetics at Baylor. Dr Ballantyne has been the recipient of numerous study grants, including an American Heart Association Established Investigator Award, and has several National Institutes of Health (NIH) grants to study leukocyte-endothelial adhesion molecules and novel markers for atherosclerosis. He is also editorial director for www.lipidsonline.org. Dr Ballantyne has published extensively and spoken nationally and internationally on lipids, atherosclerosis, and inflammation. His research interests include the pathophysiology of atherosclerosis, with an emphasis on monocyte activation and adhesion. H. Bryan Brewer, Jr, MD Dr Brewer is director of lipoprotein and atherosclerosis research at the Cardiovascular Research Institute at Washington Hospital Center in Washington, DC. He was formerly chief of the Molecular Disease Branch at the National Heart, Lung, and Blood Institute (NHLBI) of the NIH in Bethesda, Maryland—a position he held from 1976 to 2005. Dr Brewer’s research led to the elucidation of the first published sequences for the human plasma apolipoproteins, the initial determination of the metabolism of the plasma apolipoproteins in normal and hyperlipidemic individuals, and the identification of multiple gene defects leading to the genetic dyslipoproteinemias. More recently, he has pioneered the use of transgenic mice and rabbits as well as recombinant adenovirus vectors to identify genes that modulate lipoprotein metabolism and the development of atherosclerosis. Dr Brewer received his medical degree from Stanford University School of Medicine in California. After completing his internship and residency in internal medicine at Massachusetts General Hospital in Boston, he joined the NHLBI. Additionally, he served as a member of the Board of the National Cholesterol Education Program, which established treatment guidelines for patients with hyperlipidemia in the United States. A recipient of the J. D. Lane Investigator Award from the US Public Health Service, Dr Brewer has also received the Heinrich Wieland Prize from the Federal Republic of Germany and the Public Health Service Commendation Award, Meritorious Service Medal, and Distinguished Service Medal from the NIH. Dr Brewer has published more than 400 original manuscripts and 75 reviews and book chapters on the subjects of genetic dyslipoproteinemias, lipoprotein metabolism, and atherosclerosis. He has served on the editorial boards of several prestigious journals and is currently on the editorial board of the Journal of Biological Chemistry. Vincenzo Di Marzo, PhD Dr Di Marzo was born in Naples, Italy, in 1960. He received his degree in chemistry in 1983 from the University of Naples “Federico II” and his PhD in biochemistry from the Imperial College of Science, Technology and Medicine in London in 1988. He is presently first researcher at the Institute of Biomolecular Chemistry of CNR, Pozzuoli, Naples, Italy, where he has resided since 1988. He is also adjunct associate professor at the Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia.
From 1994 to 1997, Dr Di Marzo was the primary investigator of a Human Frontier Science Program research grant to study the biosynthesis and metabolism of the endocannabinoid anandamide. He was also the primary investigator of a 3-year European-funded INTAS research grant awarded to study the immunomodulatory role of endocannabinoids. In 1995, he founded the Endocannabinoid Research Group, a multidisciplinary and multisite research group in the Naples area devoted to studies of all aspects of endocannabinoid research, of which he is currently the coordinator. He is currently also responsible for a unit funded by the VolkswagenStiftung to work on the role of endocannabinoids in memory. He was president of the International Cannabinoid Research Society in 2004-2005 and is coauthor of more than 230 articles on eicosanoids and endocannabinoids in peer-reviewed journals. Henry N. Ginsberg, MD Dr Ginsberg is principal investigator on three R01 research grants from the NHLBI. He is also the coprincipal investigator at Columbia University on the ACCORD Trial. His research interests have focused on the regulation of plasma cholesterol and triglyceride blood levels, particularly the metabolism of apolipoprotein B–containing lipoproteins in cells, mice, and humans. Much of his present work focuses on the interaction between insulin resistance and increased secretion of very low-density lipoproteins by the liver. Very active in clinical research training and education, Dr Ginsberg is program director of Columbia University’s NIH-funded General Clinical Research Center, a T32 Training Grant in Arteriosclerosis, and a K12 Clinical Research Scholars Program. He is codirector of a K30 Clinical Research Curriculum Award program. Antonio M. Gotto, Jr, MD, DPhil Dr Gotto is Stephen and Suzanne Weiss Dean of the Joan and Sanford I. Weill Medical College of Cornell University, New York, New York, where he is also professor of medicine and provost for medical affairs for Cornell University. Previously, he spent more than 2 decades at Baylor College of Medicine in Houston, Texas, where he was Bob and Vivian Smith Professor, chairman of the Albert B. and Margaret M. Alkek Department of Medicine, and chief of the Internal Medicine Service at The Methodist Hospital in Houston, Texas. During that time, he also held the J. S. Abercrombie Professor Chair for Atherosclerosis and Lipoprotein Research and was the scientific director of the Methodist DeBakey Heart Center at Baylor. Dr Gotto and his associates were the first to achieve the complete synthesis of a plasma apolipoprotein (apo C-I), and they also determined the complete cDNA and amino acid sequence of apo B-100, one of the largest proteins ever sequenced and a key protein in atherosclerosis and cardiovascular disease. Dr Gotto's research interests include the structure, metabolism, and function of the plasma lipoproteins and apolipoproteins and their relation to atherosclerosis; clinical disorders of lipid transport, including hyperlipoproteinemias and hypolipidemias; and the pathology of atherosclerosis and coronary heart disease. Dr Gotto received his BA magna cum laude (biochemistry) in 1957 from Vanderbilt University, his DPhil (biochemistry) in 1961 from the University of Oxford, where he was a Rhodes Scholar, and his MD in 1965 from Vanderbilt University School of Medicine. His residency training was at Massachusetts General Hospital in Boston. He has served as national president of the AHA and as a member of both the National Heart, Lung, and Blood Advisory Council and the National Diabetes Advisory Board. He is also a member of the Institute of Medicine and of the American Academy of Arts and Sciences. He received the 2000 Distinguished Alumnus Award from Vanderbilt University and the Vanderbilt University School of Medicine. He has received honorary doctoral degrees from the University of Bologna and Abilene Christian University, as well as honorary professorships from the University of Buenos Aires and Francisco Marroquin University (Guatemala). He is past president of the International Atherosclerosis Society and past cochairman of the US Russian and US Italian Cardiovascular Work groups. He has received the Order of the Lion from the Republic of Finland. Dr Gotto is coauthor of The New Living Heart and The New Living Heart Diet, which explain the origin and dietary treatment of cardiovascular disease to the general public; he is also author of The Living Heart Cookbook. His original scholarly articles number well over 400. Luc Van Gaal, MD, PhDSources of Funding for Research: Fonds Voor Wetenschappelijk Onderzoek Vlaanderen (FW), Pfizer Pharmaceuticals. Consulting Agreements: Abbott Laboratories, Roche Pharmaceuticals, sanofi-aventis Group. Speakers Bureau/Honorarium Agreements: Abbott Laboratories, Roche Pharmaceuticals, sanofi-aventis Group. Financial Interests/Stock Ownership: None. Discussion of Off-label, Investigational, or Experimental Drug Use: Rimonabant. Dr Van Gaal studied medicine at the University of Antwerp, graduating in 1978. He obtained a specialist degree in internal medicine and another in endocrinology and metabolism in 1983. He is now responsible for the Metabolic Unit at the University Hospital Antwerp. In 1992, he became professor of medicine at Antwerp University and is currently head of the Department of Diabetology, Metabolism and Clinical Nutrition of the University Hospital. Dr Van Gaal’s main clinical and research interests are related to obesity, type 2 diabetes, and lipid metabolism. He is a member of many scientific, national, and international societies and of the editorial board of a series of scientific journals. He is a board member of the Belgian Association for the Study of Obesity (BASO) and past president of the Belgian Diabetic Society. He was the copresident of the 10th European Congress on Obesity, organized in Antwerp in May 2000. Dr Van Gaal has published more than 160 papers in international medical journals, mainly in the areas of general endocrinology, obesity, diabetes, and lipids, and has contributed to a number of textbooks about obesity. Instructions to Participants Course participants will view audio/slide presentations and then must complete a test and a course evaluation to receive continuing medical education credit. No fees are charged to participate in the program or to receive the certificate. Full instructions are available on the user instructions page. Disclaimer The opinions expressed herein are those of the faculty and do not necessarily represent the views of the sponsors, accrediting body, commercial supporter, or publisher. Please review complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients. Medicine is a constantly changing science, and clearly established therapies are not always available for every condition. New research findings necessitate continual changes in drug and treatment therapies. Reasonable efforts have been made to provide up-to-date, accurate information that is within generally accepted medical standards at the time of publication. However, as medical science is ever evolving, and human error is always possible, the sponsors, accrediting body, commercial supporter, and publisher (or any other involved party) do not guarantee total accuracy or comprehensiveness of the information in this article, and they are not responsible for omissions or errors or the results of using information provided in this course. The participant should confirm the accuracy of the information in this activity from other sources. In particular, all drug doses, indications, and contraindications should be confirmed in package inserts.Click here to view minimum system requirements.
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