Cardiovascular Symposium In The Heart Of Brooklyn
Saturday March 1st, 2014
8:30 am – 1:00 pm
Interfaith Medical Center
1545 Atlantic Avenue Brooklyn NY 11213.
Over the last three decades, we have witnessed major advancements in the management of cardiovascular (CV) diseases. Despite these achievements, the prevalence of CV diseases has remained disproportionately high in the African American community. Many life-saving procedures-including renal transplant, percutaneous revascularization, implantable defibrillators-are not widely performed in our community.
This conference is intended for actively practicing physicians of all specialties as well as nurse practitioners, physician assistants and nurses
As a result of attending this symposium, the audience will be able to:
- Assess the prevalence of risk factors for CV diseases in the African American population
- Recognize the latest treatment protocols in Diabetes Mellitus
- Be familiar with the new guidelines as formulated by the JNC8
- Review evidence-based management of Heart Failure, including the indications for implantable defibrillators
- Evaluate the current developments in the treatment of Acute Coronary Syndromes
- Identify the spectrum of clinical presentations of CV diseases in women
This symposium has received an unrestricted educational grant from Boston Scientific Company.
The State University of New York (SUNY) Downstate Medical Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
SUNY Downstate Medical Center designates this live activity for a maximum of 3.45 AMA PRA Category 1 Credit (s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
SUNY Downstate Medical Center Office of CME (OCME) and its affiliates are committed to providing educational activities that are objective, balanced and as free of bias as possible. The OCME has established policies that will identify and resolve all conflicts of interest prior to this educational activity. All participating faculty are expected to disclose to the audience, verbally or in writing, any commercial relationship that might be perceived as real or apparent conflict of interest related to the content of their presentations, and unlabeled/unapproved uses of drugs and devices. Detailed disclosures will be made verbally and/or in writing during the program.
In accordance with the American with Disabilities Act, Interfaith Medical Center seeks to make this conference accessible to all. If you have disability which might reqire special accommodations, please contact 718-613-4063 or email your needs to firstname.lastname@example.org
8:15 am -8:45 am Registration and Breakfast
8:45 am -8:50 am Welcoming Address:
Alix Dufresne, MD, F.A.C.P., F.A.C.C., F.E.S.,
Interfaith Medical Center
Pradeep Chandar, MD, Chief Medical Officer,
Interfaith Medical Center
Micheline Dole, MD, M.P.H., FAAP,
Nassau University Medical Center
8:50 am-9:20 am Francois Dufresne, MD, Lutheran Medical Center
Topic: Prevalence of Risk Factors for Cardiovascular diseases in the African-American populations
9:25 am-9:55 am Saka Kazeem, MD, Kingsbrook Jewish Medical Center
Topic: The Burden of Diabetic Complications
10:00 am- 10:30am Eric L. Jerome, MD, FACP, SUNY
Topic: Lessons Learned from the JNC8 Guidelines
10:30am -10:45 am Q&A
10:45am -11:00 am Break
11:00am -11:30 am Herve Thelusmond, MD, FACC, Coney Island Hospital
Topic: Update in the management of Heart Failure
11:30am -12:00 pm Thierry Momplaisir, MD, South Jersey Heart Group
Interventional Cardiologist/Peripheral Vascular Specialist
Topic: Evolution in the Treatment of Acute Coronary Syndromes
12:00pm -12:30 pm Margaret Donat, MD, SUNY Downstate
Topic: Cardiovascular diseases in Women: How Meaningful is the Gender Gap
12:30 pm- 12:45 pm Q&A
12:45 pm Closing Remarks
Maxime J-M Coles, MD, FICS., FRCS., FAANOS.,
Francois Dufresne, MD, Lutheran Medical Center
Abstract Title: Prevalence of Risk Factors for Cardiovascular Disease in the African American Population
Heart disease (CVD), the No. 1 cause of death in America, is responsible for 1 in every 4 death in the U.S. Despite Heart Disease affecting all ethnicities and races in America, disproportionate rates exist in racial and ethnic minority populations. In particular, nearly 50% of African-American adults above 20 years of age have CVD and African-Americans lead all others in age-adjusted death rates for Heart Disease. As alarmingly, established risk factors for CVD such as hypertension, obesity, and diabetes mellitus remain more prevalent and undiagnosed in African-American patients.
Reducing the burden of CVD in African Americans will begin with improved identification and understanding of these risk factors.
Saka Kazeem, MD, Kingsbrook Jewish Medical Center
Abstract Title: The Burden of Diabetic Complications
Clinical studies have revealed that hyperglycemia is the initiating cause of the diabetic tissue damage, although this process can be modified by both genetic determinants of individual susceptibility and by independent accelerating factors such as high blood pressure. The damage seems to preferentially affect the capillary and endothelial cells in the retina, the mesangial cells in the renal glomerulus, and the neurons and Schwann cells in peripheral nerves. We know that these cells can not reduce the transport of glucose when they are exposed to hyperglycemia. Diabetes can be responsible for both micro vascular diseases-with a ten-fold increase in risk as hemoglobin A1C increases from 5.5-9.5%-and macro vascular disease-the latest seems to have a different mechanism since it appears to be related to insulin resistance and the metabolic syndrome.
Diabetic renopathy is a major vision-threatening diabetic vascular complication and a leading cause of visual disability and blindness. It is almost universal in Type I Diabetes after 30 years of duration. Diabetic nephropathy is the leading cause of end-stage renal disease. In the UKPDS, the reported annual death rate was from 1.4% in patient at the “no diabetic nephropathy stage” to the 19.2% in patient with an “elevated plasma creatinine or renal replacement therapy”. Diabetic peripheral neuropathy is very common, difficult to manage, caused by alteration in nerve blood flow.
Above all, most diabetic patients will die from cardiovascular diseases, namely coronary disease and it is well known that diabetes is considered a “coronary equivalent”. It is expected that the burden of diabetic complications will continue to increase, so the importance of early identification and the need for tight control of these factors.
Eric L. Jerome, MD, FACP, SUNY
Abstract Title: Lessons Learned from the JNC Guidelines
It has been over 10 years since the last publication of the Joint National Committee on Hypertension and the medical community has been starving for new recommendations in the treatment of hypertension
The basic principle of the newest guidelines was intended to be evidence-based; three questions were raised: when to start treatment, how low should we go, and is there any benefit by using specific drugs or classes of drugs. Nine recommendations were formulated and the strength of evidence ranged from grade A- that is a strong recommendation based on “well designed and executed randomized controlled trials- to grade E- based on expert opinions.
Some striking differences with JNC7 included the recommendation to ease the BP threshold for patients older than 65, to treat most patients including the ones with diabetes and kidney diseases to a goal of 140/90. Four classes of drugs were selected as part of the initial therapy: thiazide-type diuretics, calcium channel blockers, angiotensin converting enzyme inhibitor and angiotensin receptor blocker. For the African-American patients-including those with Diabetes, initial treatment should include a diuretic or a CCB.
Herve Thelusmond, MD, FACC, Coney Island Hospital
Abstract Title: Update in the management of Heart Failure
Heart failure remains a major public health problem in the US; over half million of new patients are diagnosed every year. Heart failure is the primary reason for 12-15 millions office visits and 6.5 millions hospitalizations every year. The 0ne-year survival rate is worse than for breast, uterus or prostate cancer. In the US, HF affects 3% of the African-American population and the mortality is 2-5 times greater when compared to Caucasians < 65 years of age. Heart failure has a more aggressive natural history in AA, occurs at an earlier age and is associated with more advanced left ventricular dysfunction at diagnosis
It is important to recognize the disease at an earlier stage so that appropriate therapy-including the combination of nitrate and Hydralazine can be applied. Prevention of arrhythmic death with the use of implantable defibrillator should be aggressively pursued
Thierry Momplaisir, MD, South Jersey Heart Group
Abstract Title: Overview of Acute Coronary Syndromes
Acute Coronary Syndromes(ACS) are responsible for about 1.60 millions hospital admissions and can be divided into Unstable angina’ NSTEMI and STEMI. The majority of acute events are related to thrombus or thromboembolism, usually arising on disrupted or eroded plaques. It is important to identify patients at risk based on the different available scoring systems. Patients should be triaged without delay and initial decision made about medical reperfusion or primary angioplasty/ stent placement. Newest antiplatet agents have been developed that significantly reduced the rate of reocclusion or thrombosis in patients receiving drug-eluting stents.
After the initial acute phase, emphasis should be placed on secondary prevention with aggressive risk factor modification
Margaret Donat, MD, SUNY Downstate
Abstract Title: Cardiovascular Diseases in Women: How Meaningful is the Gender Gap
For reasons difficult to understand, most people do not associate women with the risk of cardiovascular diseases. The reality is that, every year, more women will die from cardiovascular diseases (CVD) than from all types of cancers. Awareness for pathologies like breast cancer has been more widespread, but for each woman who dies from breast cancer, 6 will die from CVD.
Significant number of women lives with heart diseases. Unfortunately, under treatment and under diagnosis of CVD have deleterious consequences. In 1990, the US congress instructed the National Institute of Health to include appropriate number of women in clinical trials.
It has been known that some of the diagnosis tools yield false results and women do at times present with atypical symptoms, hence the delay in seeking medical advice. The important thing to remember is that women will respond to evidence-based therapies and we must have a low threshold for disease detection.