Dear friends and colleagues,
A 40-year old man visits my outpatient clinic with a medical history of Wegener's disease (a necrotic granulomatous small vessel vasculitis) with ocular and renal manifestations for which I had treated him with oral courses of cyclophosphamide/azathioprine, prednisone), atrial fibrillation, amiodarone-induced hyperthyroidism (reversed after amiodarone was stopped), extreme overweight (BMI well over 40), hypertension and coronary artery disease for which he received a coronary stent a few years ago. His drug therapy includes a beta blocker (rate control of atrial fibrillation), RAS inhibitor (hypertension with coronary artery disease), statin (hyperlipidemia with coronary artery disease), acetylsalicylic acid (to prevent atherothrombosis) and co-trimoxazole (to prevent Wegener relapse). With this treatment his Wegener disease has been in remission now for two years. A few months ago, I checked his fasting plasma glucose which appeared too high. Therefore, I added metformin as a first choice glucose lowering therapy. Despite a maximized dose and addition of a sulphonylurea derivative, his glycosylated hemoglobin level was still 8.5% and considered suboptimal. I discussed with him several therapeutic options including starting insulin with a major drawback of increased weight gain, starting a DPP-4 inhibitor with the obvious advantage of reduction in body weight but also uncertainty about long term cardiovascular effects and a new attempt to reduce body weight by adapting his life style. We decided together to add a DPP-4 inhibitor and to send him to a specialized clinic to treat his adiposity which we both considered as his major underlying problem. After intensive psychological and dietary consultation, it was decided to offer him bariatric surgery.
One week after surgery, his general practitioner contacted me because he developed hypotension, hypoglycemia and did not tolerate the co-trimoxazole. We decided to stop the RAS inhibitor as well as the metformin, DPP-4 inhibitor and accepted interruption of co-trimoxazole therapy. Four weeks later (5 weeks after surgery) his body weight was reduced by over 30 kg. He had started a sport program (which was previously physically impossible because of his serious overweight) and experienced a rapid and dramatic improvement in his exercise capacity. His blood pressure was 120/80 mmHg. HbA1c was 6%.
This case demonstrates the dramatic impact of adipositas on physical and psychological well-being. Several questions come up when thinking about this patient's history: what is the impact of his Wegener's disease and treatment on his weight gain and atherosclerosis; how does his pharmacotherapy affect development of atherosclerosis, end-organ damage and organ vulnerability to ischemia-reperfusion injury; why does a caloric restriction combined with bariatric surgery (stomach reduction in this case) affect diabetes and hypertension so rapidly. These and other questions will be discussed extensively during this EACPT-meeting which is entirely devoted to cardiovascular damage and drugs to prevent this. This meeting will not only provide you with state-of-the art scientific knowledge but will also allow you (for early subscribers) to get hands-on experience in ultrasound imaging techniques and vascular function measurements which can help you evaluate interventions aimed at improving cardiovascular health. Finally, this meeting will provide a platform to support consortia formation in order to attract money from EU Horizon 2020 to start-up new research in clinical cardiovascular pharmacology. For this purpose, a workshop will be organized empowered by financial and juridical experts from the department of Valorization of the Radboud University Medical Center as well as successful applicants of EU projects.
Interested? We cordially invite you and will be pleased to welcome you at this high-end state-of-the-art 2014 EACPT phocus meeting 'Drugs to fight cardiovascular damage' from July 3 to July 5, 2014 at the Radboud University Medical Center Nijmegen, the Netherlands.
Prof. Gerard Rongen, Chair of the Organizing Committee
Prof. Gonzalo Calvo-Rojas, President of EACPT