Accreditation
Release and Expiration Dates: December 15, 2009, to December 15, 2010.

Statement of Need
The prevalence of cardiometabolic risk continues to rise in the United States. American physicians should expect to treat unprecedented numbers of patients at high risk for morbidity and mortality from cardiovascular disease in the years ahead. In 2000, approximately 32% of U.S. adults had the metabolic syndrome, a constellation of cardiometabolic risk factors including excessive abdominal fat, insulin resistance, dyslipidemia, and hypertension. Today, that figure has climbed to nearly 40%.

Patients with multiple cardiometabolic risk factors have twice the likelihood of developing and dying from cardiovascular disease, and they have more than seven times the risk of developing diabetes. As the number of these patients increases, the burden of cardiovascular disease can be expected to increase in the United States as well. Unfortunately, cardiovascular disease already affects 80.7 million U.S. adults and is the leading cause of U.S. deaths. As a killer, it surpasses cancer and accidents, causing approximately 869,000 deaths annually—an average of 2,400 deaths per day, or one death every 37 seconds, according to the American Heart Association. The total economic cost of cardiovascular disease is $488.5 billion annually.

Cardiometabolic Risk Factors Are Undertreated and Difficult to Manage
Despite the well-documented risks of unchecked diabetes, obesity, hypertension, and dyslipidemia, these conditions are commonly under-treated. Even when treated, they remain stubbornly difficult to manage:

• The majority of treated diabetic patients fail to meet the minimum A1c goal of 7% or less. Recent data from the Behavioral Risk Factor Surveillance System found that only 42% of treated diabetic patients had an A1c of 7% or less.
• When it comes to first-line therapy for obesity—diet and exercise—few patients succeed, and any improvements are usually modest. Current pharmacotherapy options are limited. Available obesity drugs have produced only modest weight loss to date and have been linked to adverse gastrointestinal effects and mood disorders.
• Only 61% of patients with hypertension are receiving any form of treatment. Of these, only 35% have their blood pressure under control, while it remains uncontrolled in 65% of treated patients.
• Less than half of persons who qualify for any kind of lipid-modifying treatment to reduce the risk of coronary heart disease are receiving it. In fact, less than half of even the highest-risk persons, those with symptomatic coronary heart disease, are receiving lipid-lowering treatment. Of those being treated, only about one-third are achieving target goals.

Cardiometabolic Risk in Children & Adolescents
Cardiometabolic risk is becoming so common in the United States that it is even affecting our children, suggesting that future generations will bear an even greater burden of cardiovascular disease if adequate treatments cannot be found. Estimates of the prevalence of the metabolic syndrome in U.S. children and adolescents range from 4.5% to more than 9%. Among overweight and obese adolescents, the prevalence rate rises to one-third. Two-thirds of adolescents have at least one metabolic abnormality.

Conclusion
Healthcare professionals play a major role in stemming these health consequences and associated costs by employing aggressive strategies for early identification and comprehensive management of patients presenting with multiple cardiometabolic risk factors. The 2009 Cardiometabolic Health Congress will translate the latest cutting-edge medical research into practical clinical approaches for preventing, delaying, and
managing cardiovascular and metabolic risk. The goal is to provide the medical community with evidence-based interventions to improve health outcomes and quality of life for the growing numbers of patients at increased cardiometabolic risk.

Learning Objectives
At the end of the congress participants will be able to:

• explain the interrelationships among the various cardiometabolic risk factors, their impact on cardiovascular health, and their common comorbidities;
• translate evidence-based strategies for prevention, screening, and treatment of cardiometabolic risk factors and their comorbidities to their clinical practice;
• identify which interventions, including lifestyle changes and various drugs in combination, are most appropriate for particular patients based on their risk profiles; and
• discuss how novel and emerging therapies can best be integrated into clinical practice to reduce morbidity and mortality from cardiovascular disease

Target Audience
Advanced-level clinicians responsible for the prevention, diagnosis, and management of cardiometabolic risk.

Physician Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medical Education Resources and HealthScience Media, Inc. Medical Education Resources is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Medical Education Resources designates this educational activity for a maximum of 24 AMA PRA Category 1 credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Registered Dietitian Accreditation
This program has been approved by the Commission on Dietetic Registration for 24 CPEUs.

Nursing Accreditation
Medical Education Resources is a provider of continuing nursing education by the Colorado Nurses Association, an approved accreditor by the American Nurses Credentialing Center’s Commission on Accreditation. This CE activity provides 24 contact hours. Provider approval expires
July 31, 2011. Provider approved by the California Board of Registered Nursing, Provider #CEP 12299, for 24 contact hours.

Instructions for Receiving Credit
Viewers are expected to view all presentations that are part of a symposium before attempting to take the post-test and activity evaluation for that symposium. Successful completion will lead to the issuance of a certificate for 2 AMA PRA Category 1 Credit(s) ™ per symposium - there are 12 in all. To receive credit, the course must be completed before December 15, 2010. If you attended the live presentation on  October 7-10, 2009, and have received CME credit for this program, you are not eligible for additional credit.

Participation in each activity should be completed in approximately two hours. Please follow these steps in order to receive CME credit:

• View the complete symposium program.
• Click on the link to take the post-test.
• Complete the online test and evaluation. Participants must receive a test score of at least 70% and answer all evaluation questions to receive a certificate.
• After successfully completing the online test and evaluation, your application will automatically be processed by the CME provider and your certificate will be sent to you. Please allow 4-6 weeks for this process.
  
  

Policy on Privacy and Confidentiality
Medical Education Resources, Inc. (MER), protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors.  MER and our joint sponsors will not release personally identifiable information to a third party without the individual’s consent, except such information as is required for reporting to the appropriate accrediting agency.

MER and HealthScience Media maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your non-public personal information.

MER can be contacted by e-mail at data@mer.org or by telephone at 303-798-9682.

Hardware and Software Requirements
This online activity must be viewed with Firefox or Internet Explorer 6.0 or later. If you do not have these browsers, you can download Firefox here and Internet Explorer here. Viewing also requires Adobe Flash Player version 8 or 9, which can be downloaded here. Optimal viewing requires a broadband connection of at least 1 Mbps and a 1 GHz processor with 1 GB RAM.

Faculty Disclosures

Jeffrey Anderson, MD
Research Support: AstraZeneca
Consultant: Daiichi Sankyo/Lilly, Bristol-Myers Squibb, sanofi-aventis
Will discuss non-FDA-approved products or off-label usage of fondaparinux and bivalirudin.

Caroline Apovian, MD
Research Support: Gates, Pfizer, sanofi-aventis, Orexigen, Amylin
Consultant: Merck, Arena, sanofi-aventis

Louis Aronne, MD
Research Support: Amylin Pharmaceuticals, Arena Pharmaceuticals, Merck & Co., Novo Nordisk, Orexigen Therapeutics,  Pfizer, Schering-Plough, Trans Tech Pharma, Inc.
Scientific Advisor: Amylin Pharmaceuticals, Genaera Corp., GI Dynamics, GlaxoSmithKline, Johnson & Johnson,
Merck & Co., NeuroSearch, Novo Nordisk, Orexigen Therapeutics, Pfizer Inc., sanofi-aventis, Vivus, Inc.
Will discuss non-FDA-approved products or off-label usage of Tesofensine, Leptin, Lorcaserin, Qnexa, Contrave,
Empatic, and Victorza. 
Will discuss non-FDA-approved products or off-label usage for weight loss: topiramate, pramlintide, exenatide, and liraglutide.

Richard Bergman, PhD
Research Support: Amylin, sanofi-aventis
Consultant: Tethys Bioscience
Stock/Shareholder: Tethys Bioscience
Speaker’s Bureau: Merck
Has received $10,000 or more in the last 12 months from Merck, whose products or services may be mentioned in this activity.
Will discuss non-FDA-approved products or off-label usage of rimonabant (a CB-1 inhibitor), CVT-3619 (adenosine agonist), and guanethidine for sympathectomy.

Christopher Cannon, MD
Research Support: Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, GlaxoSmithKline, Merck, Merck Schering-Plough Partnership
Clinical Advisor: Equity in Automedics Medical Systems
Will discuss non-FDA-approved products or off-label usage of prasugrel and ticagrelor for ACS.

Anthony Cincotta, PhD
A.H. Cincotta is the president and CSO of VeroScience and has a conflict of interest respecting presentation of Cycloset clinical data within the context of Continuing Medical Education symposia and the promotional marketing and commercialization of Cycloset.

Robert Cooper, MD
Nothing to disclose.

Ralph DeFronzo, MD
Grant Support: Bristol-Myers Squibb, Amylin, Eli Lilly, Novartis, Pfizer, Takeda, Roche, Merck
Speaker’s Bureau: Amylin, Eli Lilly, Takeda
Advisory Board: Bristol-Myers Squibb, Amylin, Eli Lilly, Novartis, Pfizer, Takeda, Roche, Johnson & Johnson

Michael Farkouh, MD
Research Support: Merck, Bristol-Myers Squibb, GlaxoSmithKline, VIA
Consultant: sanofi-aventis, Novartis

Kenneth Fujioka, MD
Research Support: Orexigen, EnteroMedics, Amylin, Roche, Nastech, Pfizer, Arena, Merck, Sanofi, Obecure
Consultant: Novo Nordisk, Amylin, Merck, Sanofi
Will discuss non-FDA-approved products or off-label usage of Contrave, Qnexa, and lorcaserin.

Om Ganda, MD
Speaker’s Bureau: Daiichi Sankyo

J. Michael Gaziano, MD
Financial Support: Investigator initiated research funding for the trial to be discussed.

Thomas Giles, MD
Research Support: Forest, Novartis
Consultant: Forest, Boehringer Ingelheim

Ronald Goldberg, MD
Nothing to disclose.

Alan Gradman, MD
Consultant: NicOx

Joseph Izzo, MD
Research Support: Novartis, GlaxoSmithKline, Daiichi Sankyo
Consultant: Merck, Medical Education Consultants, Novartis, GlaxoSmithKline, SCS Healthcare, Daiichi Sankyo, Medplan
Speaker’s Bureau: Merck, Medical Education Consultants, Novartis, SCS Healthcare, Daiichi Sankyo, Medplan

David Kendall, MD
Research Support: Abbott Diabetes Care, Amylin Pharmaceuticals, Bayer Diabetes Care, DexCom, Eli Lilly & Co., MannKind, Merck, NIH-NHLBI, Novo Nordisk, Roche, sanofi-aventis
Consultant, Scientific & Clinical Advisory Board Activity, and Educational Funding: Amylin Pharmaceuticals, Bayer Diabetes Care, Daiichi Sankyo, Eli Lilly & Co., HealthPartners, Intarcia, Merck, Roche, Takeda, UnitedHealth Group
Employment: Wife is current employee of Roche.
All industry-sponsored research activity, advisory/consultancy work, and educational services are performed under contract to the nonprofit Park Nicollet Institute and the International Diabetes Center. Dr. Kendall receives no personal compensation for these activities.

Michael Landzberg, MD
Research Support: Actelion, Myogen, Gilead, NMT Medical
Other Financial Support: Implant medical devices as therapy in the cath lab.

Wendy Lane, MD
Research Support: Eli Lilly, Insulet Corp.
Consultant: Eli Lilly & Co.
Speaker’s Bureau: Eli Lilly & Co.
Has received $10,000 or more in the last 12 months from Eli Lilly & Co., whose products or services may be mentioned in this activity.
Will discuss non-FDA-approved products or off-label usage.

Harold Lebovitz, MD
Advisory Board: Amylin, ATCC, Biocon Pharma, Indigene, Intarca Pharmaceuticals, MetaCure, Poxel Pharma
Consultant: Amylin, AstraZeneca, Biocon Pharma, Enzymotec, GlaxoSmithKline (International), GI Dynamics, MetaCure, Novo Nordisk,
sanofi-aventis, VeraLight
Stock/Shareholder: Amylin, Merck
Speaker’s Bureau: GlaxoSmithKline (International), Lilly (International)
Has received $10,000 or more in the last 12 months from GlaxoSmithKline, Biocon Pharmaceuticals, Amylin Pharmaceuticals, and Intarcia, whose products or services may be mentioned in this activity.
Will discuss non-FDA-approved products or off-label usage of pramlintide-leptin (phase 3 studies) in reducing body weight and the published studies comparing the addition of pramlintide to prandial insulin in type 2 patients inadequately controlled on oral agents and basal insulin.  Will mention new long-acting incretin mimetics that have concluded phase 3 trials and are currently being reviewed by the FDA.

Preston Mason, PhD
Research Support: Forest Laboratories; Pfizer, Inc.
Consultant: NicOx
Speaker’s Bureau: Forest Laboratories
Has received $10,000 or more in the last 12 months from Forest Laboratories and Pfizer, Inc., whose products or services may be mentioned in
this activity.

Darren McGuire, MD, MHSc
Research Support: GlaxoSmithKline, Biosite, Inc.
Consultant: Tethys Bioscience, AstraZeneca, Novo Nordisk
Will discuss non-FDA-approved products or off-label usage of drugs demonstrated to improve glycometabolic parameters and/or prevent diabetes: alpha-glucosidase inhibitors, metformin, thiazolidinediones, ranolazine, ACE inhibitors, ARBs, and rimonabant.

Suzanne Oparil, MD
Research Support: Abbott Laboratories, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Forest Laboratories, GlaxoSmithKline, Novartis, Merck & Co., Pfizer, Daiichi Sankyo
Consultant: Bristol-Myers Squibb, Daiichi Sankyo, Novartis, sanofi-aventis, The Salt Institute

Anne Peters, MD
Consultant: Amylin, Abbott Diabetes Care, Lilly, Medtronic Minimed, Novo Nordisk, Takeda
Speaker’s Bureau: Amylin, Abbott Diabetes Care, Lilly, Medtronic Minimed, Novo Nordisk, Takeda
Has received $10,000 or more in the last 12 months from Amylin, Abbott Diabetes Care, Lilly, Medtronic Minimed, Novo Nordisk, and Takeda, whose products or services may be mentioned in this activity.

Richard Pratley, MD
Research Support: Novartis, Takeda, Merck, Roche, Lilly, Novo Nordisk, MannKind, sanofi-aventis
Consultant: Novartis, Takeda, Merck, Roche, Novo Nordisk
Stock/Shareholder: Novartis
Speaker’s Bureau: Novartis, Takeda, Merck, Novo Nordisk
Other Financial Support: Honorarium: Novartis, Takeda, Merck, Roche, Novo Nordisk

Ioana Preston, MD
Research Support: Actelion, Gilead, United Therapeutics
Consultant: Actelion, Gilead, United Therapeutics, Bayer
Speaker’s Bureau: Actelion, Gilead
Will present data from recent clinical trials regarding the safety and efficacy of different treatments in patients with early (mild) pulmonary hypertension; some of these treatments are not currently approved by the FDA for this specific indication.

Marc Sabatine, MD
Research Support: (for Timi Study Group) Accumetrics, Amgen, AstraZeneca, Bayer Healthcare, Beckman Coulter, Biosite, Bristol-Myers Squibb, CV Therapeutics, Eli Lilly & Co., GlaxoSmithKline, Inotek Pharmaceuticals, Integrated Therapeutics, Merck & Co., Millennium Pharmaceuticals, Novartis Pharmaceuticals, Nuvelo, Ortho-Clinical Diagnostics, Pfizer, Roche Diagnostics, sanofi-aventis, Schering-Plough Research Institute
Research Support: diaDexus, Ortho Clinical Diagnostics, sanofi-aventis, Schering-Plough
Advisory Board: AstraZeneca, sanofi-aventis, Singulex
Speaker’s Bureau: Bristol-Myers Squibb, sanofi-aventis
Other Financial Support: Honorarium: Bristol-Myers Squibb, Eli Lilly, sanofi-aventis, Novartis
Has received $10,000 or more in the last 12 months from AstraZeneca, Bristol-Myers Squibb, diaDexus, Eli Lilly, Ortho Clinical Diagnostics,
sanofi-aventis, Schering-Plough, and Singulex, whose products or services may be mentioned in this activity.
Will discuss non-FDA-approved doses of clopidogrel and will discuss prasugrel.

Jeffrey  Sager, MD
Research Support: Actelion, Gilead
Consultant: Actelion, UT, Gilead, Lung Rx, Pfizer
Speaker’s Bureau: Actelion, UT, Gilead, Pfizer
Has received $10,000 or more in the last 12 months from Actelion, whose products or services may be mentioned in this activity.

Jay Skyler, MD
Research Support: Bayhill Therapeutics; Halozyme, Inc; Osiris Therapeutics, Inc.
Stock/Shareholder: Amylin Pharmaceuticals; DexCom Corporation; Ideal Life; MannKind Corporation; Medingo, Ltd.; Patton Medical Devices; Tandem Diabetes Care; Tethys Bioscience
Speaker’s Bureau: Novo Nordisk
Board of Directors Member: Amylin Pharmaceuticals; DexCom Corporation; Moerae Matrix, Inc.
Advisory Board: Patton Medical Devices; Valeritas, LLC
Advisor: BD Technologies; Ideal Life; Johnson & Johnson; MannKind Corporation; Medingo, Ltd.; Merck; Novo Nordisk; Salutria (Atherogenics); sanofi-aventis; Tethys Bioscience; Teva; Valeritas, LLC
Has received $10,000 or more in the last 12 months from Amylin Pharmaceuticals, DexCom Corporation, Novo Nordisk, and sanofi-aventis, whose products or services may be mentioned in this activity.
Will discuss non-FDA-approved products or off-label usage.

Raymond Townsend, MD
Research Support: NIH, Novartis, NicOx
Consultant: Roche, Spacelabs, GlaxoSmithKline, Protherics

William White, MD
Research Support: NIH; Novartis Consultant: NicOx, Inc.; Savient; Takeda
Speaker’s Bureau: Forest
Has received $10,000 or more in the last 12 months from NicOx, Inc. whose products or services may be mentioned in this activity.
Will discuss non-FDA approved products or off-label usage of naproxicinod.

Carol Wysham, MD
Consultant: Amylin Pharmaceuticals
Speaker’s Bureau: Amylin, Eli Lilly & Co, Merck, Novo Nordisk, sanofi-aventis
Has received $10,000 or more in the last 12 months from Amylin and Eli Lilly & Co., whose products or services may be mentioned in this activity.

Bernard Zinman, MD
Research Support: GlaxoSmithKline, Novo Nordisk, Merck
Consultant: GlaxoSmithKline, Amylin, Eli Lilly, Merck, Novartis

Educational Supporters

Actelion Pharmaceuticals US, Inc.	Amylin	Amylin/Lilly
Daiichi Sankyo, Inc.	Daiichi Sankyo and Eli Lilly and Company	Eli Lilly and Company
Forest Laboratories	NicOx, Inc.	Novo Nordisk
Orexigen Therapeutics	Tethys Bioscience	VeroScience, LLC