Tuesday, September 02, 2008

CME conference day 2

I’m really behind in blogging about the CME conference, having spent much of the last couple of days sightseeing (spent all day today in Yellowstone Park). Day 2 of the conference took place August 31. Every year one special lecture (the Robert Eliot memorial lecture---more on Dr. Eliot in a future post) is devoted to lifestyle issues in the prevention of cardiovascular disease for health care professionals to apply to their patients’ lives and their own lives. This year’s featured speaker was Dr. Arthur Agatston of South Beach diet fame. He had no financial conflicts of interest (he did not mention South Beach and his lecture was funded by a foundation in memory of Dr. Eliot) and discussed the obesity epidemic as well as some initiatives he’s involved in in the public schools to combat childhood obesity.

Every year there are a couple of lectures devoted to cutting edge topics which are in their infancy in clinical application. For the last several years these presentations have covered topics in the genomics of cardiovascular risk assessment and drug therapy. Dr. H. Robert Superko presented some exciting developments on two novel heart disease genetic variants, KIF6 and 9p21. The fields of cardiovascular genomics and pharmacogenomics are a few years away from direct widespread clinical application, but they’ll soon turn EBM upside down. Gone will be the era of “one size fits all” drug therapy and risk assessments based on population studies. Get ready! (Actually, the era of pharmacogenomics is already here for limited applications. The package insert for warfarin, for example, says:

The lower initiation doses should be considered for patients with certain genetic variations in CYP2C9 and VKORC1 enzymes as well as for elderly and/or debilitated patients and patients ….

Dr. Gordon Ewy, chief of cardiology at the University of Arizona and pioneer of CPR, gave an update on his research in favor of the “new CPR.” I have blogged about Ewy’s work many times, starting here. Ewy is years ahead of his time in CPR. The guideline writers have been slow to adopt his work. If you’re going to collapse from a heart attack, do it in Arizona!

None of the presentations on day 2 emphasized pharmaceutical products. The content was relevant, scientifically rigorous and free of commercial bias.

I’m flying home tomorrow, and back to a demanding hospitalist schedule Thursday. I’ll blog about day 3 and post some general observations about the conference (along with a few more images from Grand Teton and Yellowstone) in a few days!

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