Swiss Re Ag · SIX:SREN
Swiss Re — Investor Presentation (2017)
33 slides from Swiss Re's investor presentation, 2017
Slide 1: The Lipid Debate: What's New?
THE LIPID DEBATE: WHAT’S NEW? Dr Detloff Rump
Slide 2: Agenda
Agenda • The Statin debate • The TChol/LDL/HDL/Trig debate • The ratio debate • Conclusions 2
Slide 3: Statins
Statins 3
Slide 4: There is an academic debate…and it is not concluded
There is an academic debate…and it is not concluded 4
Slide 5: ..and the debate is about….
..and the debate is about…. https://theconversation.com/bmj-vs-the-lancet-there-are-no-winners-in-the-statins-war-65593 5
Slide 6: ..and the debate is about….
..and the debate is about…. https://theconversation.com/bmj-vs-the-lancet-there-are-no-winners-in-the-statins-war-65593 6
Slide 7: Firstly: How effective are statins?
Firstly: How effective are statins? 7
Slide 8: How does this stack up?
How does this stack up? THE NUMBER NEEDED TO TREAT How well do drugs work? Ads and news stories usually say that amedicine slashes the riskof, say, heart attacks by a big number, like 50%. But that often overstates the benefit, because it fails to provide the absoluterisk. If only 2 people inagroup
Slide 9: So there are benefits, but they seem limited
So there are benefits, but they seem limited http://www.bendbulletin.com/health/4954532- 151/weighing-risks-and-rewards-of-statins 9
Slide 10: Secondly: Are statins safe? There are doubts…
Secondly: Are statins safe? There are doubts… https://therenegadepharmacist.com/should-you-take-statins- what-happens-to-your-body-when-you-take-statins/ 10
Slide 11: Firstly: Are statins safe? There are doubts…
Firstly: Are statins safe? There are doubts… 11
Slide 12: …but there appear to be non-doubters
…but there appear to be non-doubters https://drmalcolmkendrick.org/2017/05/08/its-official-statins-do-not-have-any-side-effects/ 12
Slide 13: …and he is referring to….
…and he is referring to…. Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT- LLA): a randomised double-blind placebo-controlled trial 13
Slide 14: …but there appear to be non-doubters
…but there appear to be non-doubters https://drmalcolmkendrick.org/2017/05/08/its-official-statins-do-not-have-any-side-effects/ 14
Slide 15: JAMA recommendations for 2017
JAMA recommendations for 2017 ASCVD=Atherosclerotic Cardiovascular Disease 15
Slide 16: JAMA recommendations for 2017
JAMA recommendations for 2017 ASCVD=Atherosclerotic Cardiovascular Disease 16
Slide 17: TChol / LDL / HDL / Trig…ratios
TChol / LDL / HDL / Trig…ratios 17
Slide 18: Cholesterol elevation and heart disease are not very well correlated
Cholesterol elevation and heart disease are not very well correlated 18
Slide 19: Could high cholesterol (incl LDL) have positive effects?
Could high cholesterol (incl LDL) have positive effects? It would seem so 19
Slide 20: Many heart attack patients have normal LDL cholesterol
Many heart attack patients have normal LDL cholesterol 20
Slide 21: The discussion shifts towards small dense LDL
The discussion shifts towards small dense LDL https://www.docmuscles.com/category/cholesterol/ 21
Slide 22: What is it about small dense LDL?
What is it about small dense LDL? 22
Slide 23: Trigs seem to cause increase in small dense LDL particles
Trigs seem to cause increase in small dense LDL particles 23
Slide 24: And Trigs also have an effect on HDL
And Trigs also have an effect on HDL 24
Slide 25: HDL the higher the better? Not true…
HDL the higher the better? Not true… 25
Slide 26: Triglycerides fluctuate
Triglycerides fluctuate http://www.clinlabnavigator.com/lipid-variability.html 26
Slide 27: Lipid ratios
Lipid ratios 27
Slide 28: There are a few lipid ratios (atherogenic indices) commonly used
There are a few lipid ratios (atherogenic indices) that are commonly used to optimise the predictive capacity of the lipid profile 28
Slide 29: What is a good option?
What is a good option? • If small dense LDL is the culprit • ..then we want to know how many small dense LDL particles there are • (it is understood that testing for small dense LDL is expensive) • TChol tells us, how many LDL particles are there (appr. 2/3 of all cholesterol) • Triglycerides correl
Slide 30: Conclusions
Conclusions • The Statin debate is a heated one…..let’s keep an eye on it! • Our attention is being drawn to small dense LDL particles • The TChol/HDL ratio may – at this stage – be the most reasonable tool to gauge CVD risk 30
Slide 31: @ Swiss Re
@ Swiss Re 31
Slide 32: @ Swiss Re
@ Swiss Re 32
Slide 33: Legal notice
Legal notice ©2017 Swiss Re. All rights reserved. You are not permitted to create any modifications or derivative works of this presentation or to use it for commercial or other public purposes without the prior written permission of Swiss Re. The information and opinions contained in the presentati