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International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease. Prof. Mohamed Sobhy, MD, FACC Professor of Cardiology, Alex. University Fellow of American College of Cardiology. International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease. - PowerPoint PPT Presentation
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International Guidelines for Prevention of Atherosclerotic
Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic
Cardiovascular Disease
Prof. Mohamed Sobhy, MD, FACCProfessor of Cardiology, Alex. UniversityFellow of American College of Cardiology
Prof. Mohamed Sobhy, MD, FACCProfessor of Cardiology, Alex. UniversityFellow of American College of Cardiology
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Guidelines:Aim to present all the relevant evidence on a
particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or
therapeutic procedure.They should be helpful in everyday clinical decision-
making.
Guidelines:Aim to present all the relevant evidence on a
particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or
therapeutic procedure.They should be helpful in everyday clinical decision-
making.
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Prevention programs.
Public health Challenges and Community programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Prevention programs.
Public health Challenges and Community programs.
The Rationale for an active approach to the prevention of cardiovascular diseases (CVD) is firmly based on five observations:
The Rationale for an active approach to the prevention of cardiovascular diseases (CVD) is firmly based on five observations:
CVD is the major cause of premature death in most populations; it is an important source of disability and contributes in large part to the escalating
costs of health carethe underlying pathology is usually atherosclerosis, which develops
insidiously over many years and is usually advanced by the time symptoms occur
death, myocardial infarction and stroke nevertheless frequently occur suddenly and before medical care is available, and many therapeutic
interventions are therefore inapplicable or palliative the mass occurrence of CVD relates strongly to lifestyles and modifiable
physiological factors risk factor modifications have been unequivocally shown to reduce mortality and morbidity, especially in people with either unrecognized or recognized
CVD.
CVD is the major cause of premature death in most populations; it is an important source of disability and contributes in large part to the escalating
costs of health carethe underlying pathology is usually atherosclerosis, which develops
insidiously over many years and is usually advanced by the time symptoms occur
death, myocardial infarction and stroke nevertheless frequently occur suddenly and before medical care is available, and many therapeutic
interventions are therefore inapplicable or palliative the mass occurrence of CVD relates strongly to lifestyles and modifiable
physiological factors risk factor modifications have been unequivocally shown to reduce mortality and morbidity, especially in people with either unrecognized or recognized
CVD.
Objectives of Cardiovascular PreventionObjectives of Cardiovascular Prevention
To reduce the incidence of first or recurrent clinical events due to coronary heart disease, ischemic
stroke and peripheral artery disease.The focus is prevention of disability and early
death.Lifestyle changes, management of major CV
factors, use of different prophylactic drug therapies.Intermediate end-points… subclinical organ
damage [LVH, CA plaque, ED, electrical instability]
To reduce the incidence of first or recurrent clinical events due to coronary heart disease, ischemic
stroke and peripheral artery disease.The focus is prevention of disability and early
death.Lifestyle changes, management of major CV
factors, use of different prophylactic drug therapies.Intermediate end-points… subclinical organ
damage [LVH, CA plaque, ED, electrical instability]
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
Canadian Cardiovascular Society 1998 Consensus Conference On The Prevention Of Cardiovascular Diseases:
The Role Of The cardiovascular Specialist
Recommendations for assessment with fasting lipid profile (total cholesterol, high density lipoprotein cholesterol, triglyceride and low
density lipoprotein levels) in various patient groups
Recommendations for assessment with fasting lipid profile (total cholesterol, high density lipoprotein cholesterol, triglyceride and low
density lipoprotein levels) in various patient groups
Patient group Frequency
Patients with coronary artery disease, CAD or peripheral vascular disease
Annually
Patients with xanthomata or a family history of early CAD with genetic dyslipidemia
One measurement during youth, repeated at age 30 years; if no evidence of genetic dyslipidemia, resume testing every five years from age 40 (for men) or 50 (for women)
Adults with diabetes Repeat every one to three years or as clinically indicated
Men aged 40 to 70 years, women aged 50 to 70 years
Every five years
Clinical judgement should be used for patients with multiple risk factors who are approaching these target ages. Note that the translation of number of risk factors into risk
levels is incorrect outside of these age ranges. CAD Coronary artery disease
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
Editorial
New British recommendations for prevention of coronary heart disease in clinical practice
Heart 1999; 81:335 (April)
Priorities for CHD prevention in clinical Practice
Priorities for CHD prevention in clinical Practice
1. A. Patients with established CHD.B. Patients with other major atherosclerotic
disease.2. Patients with HTN, dyslipidemia, DM, FH of
premature CHD or combination.
1. A. Patients with established CHD.B. Patients with other major atherosclerotic
disease.2. Patients with HTN, dyslipidemia, DM, FH of
premature CHD or combination.
Using the coronary risk prediction chart for primary prevention
Using the coronary risk prediction chart for primary prevention
Charts are not appropriate for:Coronary Heart Disease or other major atherosclerotic
disease.Familial hypercholeserolemia or other inherited
dyslipidemiaEstablished hypertension (Systolic >160mmHg or
diastolic > 100mmHg or associated TOD)DM with associated TOD
Renal dysfunction
Charts are not appropriate for:Coronary Heart Disease or other major atherosclerotic
disease.Familial hypercholeserolemia or other inherited
dyslipidemiaEstablished hypertension (Systolic >160mmHg or
diastolic > 100mmHg or associated TOD)DM with associated TOD
Renal dysfunction
People at high risk without clinically overt CHD or other major atherosclerotic disease People at high risk without clinically overt
CHD or other major atherosclerotic disease Patients with HTN, dyslipidemia, diabetes mellitus,
FH of premature CHD or combination are at high risk of developing CHD
Patients with DM are at particularly high risk Individuals at high multifactorial risk of developing
CHD or other atherosclerotic disease As absolute risk of coronary heart disease
increases, so lifestyle intervention should be intensified
Patients with HTN, dyslipidemia, diabetes mellitus, FH of premature CHD or combination are at high
risk of developing CHDPatients with DM are at particularly high risk
Individuals at high multifactorial risk of developing CHD or other atherosclerotic disease
As absolute risk of coronary heart disease increases, so lifestyle intervention should be
intensified
New British recommendations for prevention of coronary heart disease in clinical practiceNew British recommendations for prevention of coronary heart disease in clinical practice
The joint British recommendations on prevention of coronary heart disease in clinical practice closely
mirror the European guidelines.The difference reflect intelligent adaptations to
national conditions and concerns The recommendations concerning primary
prevention are based on the assessment of risk, in absolute terms of developing clinical coronary
disease within the next year
The joint British recommendations on prevention of coronary heart disease in clinical practice closely
mirror the European guidelines.The difference reflect intelligent adaptations to
national conditions and concerns The recommendations concerning primary
prevention are based on the assessment of risk, in absolute terms of developing clinical coronary
disease within the next year
The assessment is based onThe assessment is based on
Framingham risk function (age, sex, smoking status, SBP, lipids measurements)
British recommend ratio of total HDLLevel of risk at which to intervene in primary
preventionEuropean recommends 10 year risk of CHD 20%
British a staged approachHigh risk >30%
Low risk 15%
Framingham risk function (age, sex, smoking status, SBP, lipids measurements)
British recommend ratio of total HDLLevel of risk at which to intervene in primary
preventionEuropean recommends 10 year risk of CHD 20%
British a staged approachHigh risk >30%
Low risk 15%
BP …. Based on BP alone rather than BP in the context of absolute CV risk.
British recommendations:BP>160/110 mmHg should be lowered irrespective of
other factors because of established benefit in reducing the cerebrovascular component of CV risk
15% risk of CHD corresponds to 20% overall CV risk.
In persons of BP 140-160/90-100 mmHg. British Society starts treatment when risk of CAD >15%
BP …. Based on BP alone rather than BP in the context of absolute CV risk.
British recommendations:BP>160/110 mmHg should be lowered irrespective of
other factors because of established benefit in reducing the cerebrovascular component of CV risk
15% risk of CHD corresponds to 20% overall CV risk.
In persons of BP 140-160/90-100 mmHg. British Society starts treatment when risk of CAD >15%
Introducing drug treatment for raised BP or lipid concentration should be strongly determined by the
absolute risk of developing disease.An absolute risk of coronary heart disease >15% (equivalent to a CV risk of 20%) over 10 years is
sufficiently high to justify drug treatment.
Introducing drug treatment for raised BP or lipid concentration should be strongly determined by the
absolute risk of developing disease.An absolute risk of coronary heart disease >15% (equivalent to a CV risk of 20%) over 10 years is
sufficiently high to justify drug treatment.
Exceptions to treatment based on absolute risk are:Exceptions to treatment based on absolute risk are:
Hypertension (SBP>160mmHg or diastolic BP>100mmHg) or HTN with associated target
organ damage.Familial hypercholestrolemia or other inherited
dyslipidemia.Diabetes Mellitus with associated target organ
damage.Drug treatment is required for all these patients to
reduce the risk of CHD (and CV risk).
Hypertension (SBP>160mmHg or diastolic BP>100mmHg) or HTN with associated target
organ damage.Familial hypercholestrolemia or other inherited
dyslipidemia.Diabetes Mellitus with associated target organ
damage.Drug treatment is required for all these patients to
reduce the risk of CHD (and CV risk).
A staged approach to managing patients at high risk is advised.
As a minimum, those with absolute CHD risk >30% should be targeted and treated now.
As resources allow individuals with a risk >15% should be progressively targeted
For all high risk patients every effort should be made to achieve the lifestyle, risk factor and
therapeutic targets.
A staged approach to managing patients at high risk is advised.
As a minimum, those with absolute CHD risk >30% should be targeted and treated now.
As resources allow individuals with a risk >15% should be progressively targeted
For all high risk patients every effort should be made to achieve the lifestyle, risk factor and
therapeutic targets.
Recent international guidelinesRecent international guidelines
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
American College of Cardiology (ACC)2001 update
American Heart Association (AHA)2002 update
CANADIAN Cardiovascular Society 1998 Consensus.
International Task Force for prevention of Coronary heart disease
Joint British recommendation for prevention of CHD2002
European guidelines on CVD prevention in clinical practice2003
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of high total risk for developing fatal cardiovascular event.
Definition of high total risk for developing fatal cardiovascular event.
Patients with established cardiovascular disease.Asymptomatic subjects who have
2-1 Multiple risk factors resulting in a 10 year risk ≥ 5% now or if extrapolated to age 60.
2-2 Markedly raised levels of single risk factors: total cholesterol(320 mg/dl), LDL (240 mg/dl), BP ≥
180/140 mmHg 2-3 Diabetes type 2 and diabetes type 1 with
microalbuminuria.
Patients with established cardiovascular disease.Asymptomatic subjects who have
2-1 Multiple risk factors resulting in a 10 year risk ≥ 5% now or if extrapolated to age 60.
2-2 Markedly raised levels of single risk factors: total cholesterol(320 mg/dl), LDL (240 mg/dl), BP ≥
180/140 mmHg 2-3 Diabetes type 2 and diabetes type 1 with
microalbuminuria.
New imaging methods to detect asymptomatic individuals at high risk for cardiovascular eventsNew imaging methods to detect asymptomatic
individuals at high risk for cardiovascular events
Coronary Calcification (EC-CT or MS-CT)Carotid-intimal median thickness
LVH (ECG, echo)
Coronary Calcification (EC-CT or MS-CT)Carotid-intimal median thickness
LVH (ECG, echo)
Management of CVD risk in clinical practice:Management of CVD risk in clinical practice:
Behavioral risk factorsStop smoking tobacco
Make healthy food choices Increase physical activity
Management of other risk factors:Overweight and obesity
Blood pressurePlasma lipids
DiabetesScreening close relatives
Behavioral risk factorsStop smoking tobacco
Make healthy food choices Increase physical activity
Management of other risk factors:Overweight and obesity
Blood pressurePlasma lipids
DiabetesScreening close relatives
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Why Egyptian Guidelines are mandatory?Why Egyptian Guidelines are mandatory?
Religion Habits
Cost-benefit ratioRole of university
Role of physiciansRole of Ministry of Health
Religion Habits
Cost-benefit ratioRole of university
Role of physiciansRole of Ministry of Health
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
When public intervention strategies address the diversity of racial, ethnic, cultural, linguistic,
religions, and social factors in the delivery of their services, the like hood of their acceptance by
community increases.
When public intervention strategies address the diversity of racial, ethnic, cultural, linguistic,
religions, and social factors in the delivery of their services, the like hood of their acceptance by
community increases.
Public health approach can provide an attractive opportunity to interrupt and prevent the continuing
costly of cycle preventing atherosclerotic cardiovascular disease and its complications.
Public health approach can provide an attractive opportunity to interrupt and prevent the continuing
costly of cycle preventing atherosclerotic cardiovascular disease and its complications.
Public health challenge and community programs
Public health challenge and community programs
Public health approaches, such as reducing calories, saturated fat and salt in processed food
Increasing community and school opportunities for physical activity can achieve a downward shift in the
distribution of population’s BP, reduce morbidity, mortality and the lifetime risk of an individual becoming
hypertensive.Food manufactures and restaurants should reduce sodium
in food supply by 50% during the next decade
Public health approaches, such as reducing calories, saturated fat and salt in processed food
Increasing community and school opportunities for physical activity can achieve a downward shift in the
distribution of population’s BP, reduce morbidity, mortality and the lifetime risk of an individual becoming
hypertensive.Food manufactures and restaurants should reduce sodium
in food supply by 50% during the next decade
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
International Guidelines for Prevention of Atherosclerotic Cardiovascular Disease
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Definition of guidelines.Rationale and objectives of guidelines.
What are the international guidelines for prevention of atherosclerotic CVD
Total CV risk as a guide to preventive strategies.Management of CV risk as a guide to preventive strategies
Importance of Egyptian guidelines.Public health Challenges and Community programs.
Prevention programs.
Prevention programsPrevention programs
Current programsBridge the gap (clinical trials application)
E Quit, computers soft ware Strengths
Nationally and internationally recognized physician researchersA medical clinic staffed by registered nurses and certified medical
technicianProject managers and site monitors experienced with managing and
running clinical trials A data coordinating center to collect, input and analyze data generated from
prevention researchAffiliation with some of the major medical research and healthcare
providers.Make a contribution, Foundations and individuals
Current programsBridge the gap (clinical trials application)
E Quit, computers soft ware Strengths
Nationally and internationally recognized physician researchersA medical clinic staffed by registered nurses and certified medical
technicianProject managers and site monitors experienced with managing and
running clinical trials A data coordinating center to collect, input and analyze data generated from
prevention researchAffiliation with some of the major medical research and healthcare
providers.Make a contribution, Foundations and individuals