Special Lecture
	Chairperson	:	Prof. Masunori Matsuzaki (Division of Cardiovascular Medicine Department of Medical Bioregulation Yamaguchi University School of Medicine)
	Speaker	:	Prof. Valentin Fuster (Professor, Medicine, Cardiology , Mount Sinai School of Medicine, New York)
Invited Lecture 1
	Chairperson	:	Prof. Toru Kita (President, Kobe City Medical Center General Hospital)
	Speaker	:	Prof. Peter Libby (Chief, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard University, Boston)
Invited Lecture 2
	Chairperson	:	Prof. Yasushi Saito (President, Chiba University)
	Speaker	:	Prof. M. John Chapman (Director, Dyslipidemia and Atherosclerosis Research Unit National Institute for Health and Medical Research (INSERM), Paris / President, European Atherosclerosis Society)
Featured Session  (Cosponsorsip: DAIICHI SANKYO COMPANY, LIMITED)
	Speaker	:	Prof. Akira Endo (Biopharm of JAPAN, Corporation)

Symposium

Symposium 1
"Chronic kidney disease (CKD) as a risk factor for development of cardiovascular diseases"
Moderator:
Prof. Atsunori Kashiwagi  (Shiga University of Medical Science Hospital) Prof. Naoki Kashihara  (Internal Medicine (Nephrology), Kawasaki Medical University)
Symposium 2
"Recent advances in pathobiology and treatment of aortic aneurysms"
Moderator:
Prof. Hiroshi Shigematsu  (Department of Second Surgery, Tokyo Medical University) Prof. Kensuke Egashira  (Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences)
[ Message from the Moderators ]
As the population grows older, the morbidity of aortic aneurysm in Japan continues to rise, as in Western countries. Conventionally, a watch-and-wait approach is taken for small aneurysms, while larger aneurysms are surgically repaired by synthetic graft replacement, which requires thoracostomy or laparotomy. There were basically no other treatment options until recently, when endovascular stent grafting became available. Since then, endovascular surgery has grown rapidly as a minimally invasive technique, and the increased flexibility in treatment strategy is stimulating the demand for accuracy in diagnosis of pathologic conditions. In addition, patients with aortic aneurysm are typically advanced in age and have compromised physiological reserve, further raising the need for less invasive but secure treatment options. The importance of understanding the pathologic state of aneurysm thus cannot be overemphasized. Although linked to arteriosclerosis, tissue degeneration, and genetic predisposition, the etiology of the disease has long remained unclear. Only recently have genetic and molecular biological approaches begun to unravel how the vascular wall integrity is progressively damaged by cytokine-mediated dynamic signaling between infiltrating, chronic inflammatory cells and vascular smooth muscle cells, the major component of the vascular wall. In this symposium, the audience will gain an in-depth understanding of the pathology of aortic aneurysm and information on the latest diagnostic and therapeutic achievements that have stemmed from the better etiological understanding. Future challenges in scientific and clinical researches will also be discussed.
Symposium 3
"Non-invasive diagnosis of Arteriosclerotic disease (US, MRI, MDCT, Vascular function, etc.)"
Moderator:
Prof. Fumitaka Ohsuzu  (Department of Internal Medicine (1), National Defense Medical College) Prof. Akira Yamashina  (Department of Cardiology Tokyo Medical University Hospital)
[ Message from the Moderators ]
In Japan, the incidence of arteriosclerotic diseases is rapidly rising due to changes in lifestyle habits, posing severe challenges in many ways, from mortality, decreased QOL, healthcare cost to reduction of the labor force. Although arteriosclerosis develops slowly, it is most likely, once advanced, to take a rapid turn and become symptomatic. Early, accurate diagnosis and appropriate intervention, therefore, are crucial for prevention of the disease development before onset of the symptom. There are two aspects to the arteriosclerosis process, atherogenesis and arterial sitffness, both of which play key roles in the development of cardiovascular diseases. Thus, both anatomical and functional evaluations of vascular wall structure, i.e., atheroma formation, thickening of the intima and media, and the degree of sclerosis, are essential. Currently, anatomical details are examined by carotid artery echogram, coronary CT, and MRI, while functional examination includes evaluation of endothelial function, pulse wave velocity (PWV), augmentation index (AI), and ankle-brachial pressure index (ABI). With a focus on these noninvasive diagnostic modalities of arteriosclerosis, the symposium will discuss the following five key points: 1) the accuracy in determining the stage of arteriosclerosis; 2) the potential to predict the risk for cardiovascular events; 3) the prospects for assessment of treatment outcome; 4) non-invasiveness in patients; and 5) cost-effectiveness.
Symposium 4
"Current status of therapeutic angiogenesis by cell transplantation and gene transfer"
Moderator:
Prof. Toyoaki Murohara  (Department of Cardiology, Nagoya University Graduate School of Medicine) Prof. Ryuichi Morishita  (Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine)
[ Message from the Moderators ]
Clinical application of cell transplantation and gene therapy is rapidly becoming a reality for vascular regeneration. For example, autologous bone marrow mononuclear cell transplantation has revealed successful results, although at the same time it has raised several issues to be solved—invasiveness, unsustained effect, ineffectiveness in some patient populations, and so forth. This symposium will summarize the current results and issues of clinical trials for cellular transplantation, and promote debate among participants. We encourage researchers to present their scientific achievements in cellular transplantation and gene therapy and their potential as next generation therapy for cardiovascular diseases.
Symposium 5
"Vascular Imaging and Biomarkers for Vulnerable Plaques"
Moderator:
Prof. Masakazu Yamagishi  (Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science) Prof. Noriaki Kume  (Cardiovascular Medicine, Graduate School of Medicine Kyoto University)
Symposium 6
"Current Status and Future Direction of Coronary Revascylarization : Focusing on Lipid-lowering" Therapy
Moderator:
Prof. Takeshi Kimura  (Cardiovascular Medicine, Graduate School of Medicine Kyoto University) Prof. Tsutomu Yamasaki  (Department of Clinical Epidemiology & Systems, the University of Tokyo)
Symposium 7
"Change in atherosclerotic diseases in Japan and its perspective"
Moderator:
Prof. Hirotsugu Ueshima  (Department of Health Science, Shiga University of Medical Science) Prof. Yutaka Kiyohara  (Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University)
[ Message from the Moderators ]
According to vital statistics, stroke mortality in Japan was highest in the world in the 1950s and 1960s, and it started to decline rapidly in the early 1970s and reached similar levels for Western countries in the 1990s. The age-adjusted mortality from myocardial infarction, which had been far lower than those in Western countries, also turned to a decline in the 1970s followed by a gradual decrease thereafter. Without doubt, the popularization of antihypertensive therapy greatly contributed to these welcome trends. On the other hand, the remarkable postwar economic growth led to a dramatic improvement in the living standards and to westernization of lifestyle including dietary habits in Japan. As a result, metabolic disorders such as obesity have emerged as new health problems, and the elderly population, which is characterized by a high risk of atherosclerotic diseases, has been rapidly expanding due to the reduction in elderly mortality. It is presumed that such changes in the social and living environment have been changing the structure of cardiovascular disease, giving impact their pathophysiology. This symposium aims to clarify secular trends in cardiovascular disease and its current status based on evidence from major cohort studies in Japan and to discuss the future perspectives of the disease.
Symposium 8
"New Approach to Antiatherogenic Drugs"
Moderator:
Prof. Shinji Yokoyama  (Department of Biochemistry 1, Nagoya City University Medical School) Prof. Shizuya Yamashita  (Department of Cardiovascular Medicine ,Osaka University Graduate School of Medicine)
[ Message from the Moderators ]
The last two decades of the 20th century were marked with successful medical control of arteriosclerotic diseases, especially in preventing ischemic heart disease, by bile acid sequestrants and statins, which exert antiatherogenic effects via lowering plasma LDL and activating the LDL receptor. At the same time, fibrates showed promising results in lowering plasma triglycerides. More recently, selective inhibitors of dietary cholesterol absorption have been developed and also show antiatherogenic actions. However, these agents have shown limited preventive effect, from only 30 to 40%, against arteriosclerotic diseases. Therefore, new approaches to pharmaceutical development have been sought in order to achieve more effective prevention and treatment of the disease. The newer classes of lipid-relating medication include the drugs that raise "the negative risk factor" HDL, the lipid antioxidants, and the acyl-CoA: cholesterol acyltransferase (ACAT) inhibitor to directly interfere with intracellular cholesterol accumulation. Another new, independent approach is the use of anti-inflammatory drugs and platelet aggregation inhibitors. These attempts, however, have not been fully successful yet. Against this background, this symposium will explore the prospect of pharmacologic control of arteriosclerotic diseases, covering the latest research findings in Japan. Symposium presentations include: researches on HDL from the increase in its biogenesis, the catabolic down-regulation to the remodeling in the blood; reevaluation of the long-standing lipid antioxidant, probucol; and the results of a recent, Japanese large-scale clinical trial of anti-inflammatory and anti-platelet aggregation drugs. The potential of direct, pharmacological modulation of the intranuclear receptor that is involved in gene regulation for energy and sterol metabolism will also be discussed.
Symposium 9
"Metabolic derangement in postprandial state and atherosclerosis"
Moderator:
Prof. Kazuaki Shimamoto  (Department of Internal Medicine(2), Sapporo Medical University School of Medicine) Prof. Shinichi Oikawa  (Department of Medicine (Hematology, Gastroenterology, and Endocrinology and Metabolism), Nippon Medical School)
Symposium 10
"The management of metabolic syndrome in children and adolescence"
Moderator:
Prof. Tadashi Nakamura  (Department of metabolic , Osaka University Graduate School of Medicine) Prof. Ohta Takao  (Division of Child Health and Welfare(pediatrics), Department of Investigative Medicine , Faculty of Medicine , University of the Ryukyus)
[ Message from the Moderators ]
In Japan, the new national health screening and intervention program started last year with a focus on metabolic syndrome. In this system, metabolic syndrome screening targets adults aged 40 years or older aiming at the primary prevention of arteriosclerotic diseases. It is, however, desirable to initiate the prevention and the management of lifestyle-related diseases in younger populations. In 2007, a research group of the Ministry of Health, Labour, and Welfare issued a diagnostic guideline for pediatric metabolic syndrome, shifting attention to the importance of prevention and management of obesity and metabolic syndrome not only in young adults in their 20s and 30s but also in children and adolescents. To encourage discussion on appropriate management in children, this symposium aims to characterize the pediatric form of metabolic syndrome, which is distinct from the adult form, by summarizing its diagnostic criteria, associated risk factors such as hypertension, insulin resistance and dyslipidemia, nutritional management for prevention and treatment, and the relationship with childhood obesity.
Symposium 11
"NonHDL cholesterol as a risk factor of coronary heart disease"
Moderator:
Prof. Hiroyuki Daida  (Department of Cardiology, Juntendo University School of Medicine) Dr. Mitsuhiro Yokoyama  (Hyogo Prefectural AWAJI Hospital)
[ Message from the Moderators ]
Since establishing the benefit of low density lipoprotein cholesterol (LDL-C) lowering by statins, lipid-lowering therapy has been practiced in clinical setting, with a target level recommended in the guideline. On the other hand, guidelines for target levels in the treatment of hypertriglyceridemia or low HDL cholesterolemia have not been clearly established. In this regard, the triglyceride level is not suitable for setting a target level, as it is significantly affected by diet. Alternatively, the non-high density lipoprotein cholesterol (non-HDL-C) level (total cholesterol – HDL-C) has been proposed as a therapeutic indicator. Non-HDL-C appears to be a useful barometer, because it reflects not only LDL-C, but also remnant lipoproteins and small dense LDL, the risk factors for atherosclerosis . As the influence of diet on total and HDL cholesterol levels is minimal, the non-HDL level is also stable with or without fasting. In addition, the Japanese Guideline (National Research Group for Primary Hyperlipidemia) and the U.S. National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Guideline both recommend the non-HDL-C level as a secondary cholesterol-lowering target in patients with hypertriglyceridemia and the HDL-C level as a third target in patients with low HDL. This symposium aims at discussing the positioning of non-HDL-C in Japan from different angles.
Symposium 12
"Hypoalphalipoproteinemia: causes and treatment"
Moderator:
Prof. Keijiro Saku  (Department of Cardiology,Fukuoka Univ.Medical School) Prof. Katsunori Ikewaki  (Department of Internal Medicine (1), National Defense Medical College)
[ Message from the Moderators ]
High density lipoprotein (HDL) is called a "chameleon" molecule because it switches between pro-inflammatory and anti-inflammatory properties, similar to how a chameleon changes its color. This characteristic transformation of HDL is well reflected in the results of clinical trials. Low HDL-C is clearly a risk factor for coronary heart disease (CHD), and a decrease in HDL-C levels by 1 mg/dL increases the risk of CHD by 2–3%. However, it is not yet clear how to manage a low HDL-C level: should HDL-C be raised, should treatment be initiated in the first place, or should HDL-C-raising therapy be considered as part of CHD prevention or longevity programs? This symposium offers debate from different angles on the etiology and treatment of low HDL-C, from the bench to bedside. This includes strategies that enhance statin-like, multifaceted actions of HDL; the current understanding of the molecular mechanism of HDL functions and drug development; the future of HDL-C-raising drugs; the category of functional and dysfunctional HDL; the importance of non-HDL-C vs. LDL-C/HDL-C; and case studies of cardiovascular patients complicated with obesity, metabolic syndrome, and diabetes.
Symposium 13
"How to manage dyslipidemia in very elderly? "
Moderator:
Prof. Yasuyoshi Ouchi  (Department of Geridtric Medicine Graduate School of Medicine The University of Tokyo) Prof. Hidenori Arai  (Geriatric Medicine, Graduate School of Medicine Kyoto University)
[ Message from the Moderators ]
Japan is expected to have a population of more than 30 million elderly aged 65 years or older in 5 years, with the number of old olds (75 years and over) exceeding the number of young olds (65-74 years) in 10 years, which is unprecedented worldwide. The healthcare and longevity of the old olds are thus becoming a major domestic issue. Although prevention is the best medicine in coronary artery diseases and cerebral stroke, which are potential threats to the activities of daily living (ADL) and the quality of life (QOL) for the elderly, there is little evidence and no clear guideline for lipid-lowering therapy to prevent cardiovascular events in the old-old population. The 2007 Guideline for Diagnosis and Prevention of Atherosclerotic Cardiovascular Diseases by the Japan Atherosclerosis Society recommends the same lipid management strategy for young olds as in average adults based on Japanese clinical trial results. For old olds, on the other hand, lipid management is left up to each attending physician, because there is insufficient little evidence. This symposium invites medical experts in various fields to discuss current lipid management in old olds as part of the primary and secondary prevention of cardiovascular events. EWTOPIA75, the ongoing clinical trial of ezetimibe initiated by the Japan Geriatrics Society, will be also be presented.

Special Symposium 1
Message from Committee on Lifestyle : "Changes in Lifestyle and Cardiovascular Disease in Japan: Message to the Future"
Moderator :	Prof. Jun Sasaki  (International University of Health and Welfare Graduate School) Prof. Norio Tada  (Division of General Medicine ,Department of Internal Medicine, Kashiwa Hospital,The Jikei University School of Medicine)
[ Message from the Moderators ]
The development of arteriosclerotic diseases involves a combination of environmental factors, such as excessive nutrition and lack of exercise, in addition to a genetic predisposition. Currently, Japanese women have the world's longest life expectancy, in which their lifestyle habits and constitution seem to play a central role. In Japan, however, the disease structure has changed greatly as a result of adopting a western lifestyle, with excessive food intake, decreased daily physical activity and lack of exercise. In Okinawa, where the adoption of western lifestyle began comparatively early in Japan, the life expectancy was Japan's longest in 1980, but it dropped to 26th in 2000. This is called the "Okinawa 26 shock." Compared to other prefectures, Okinawan men have a higher mortality rate due to arteriosclerotic disease, including myocardial and cerebral infarction. Furthermore, the westernized lifestyle is a leading contributor to metabolic syndrome; it increases arteriosclerotic risk factors such as visceral obesity, sugar metabolism abnormality, hypertension, hypertriglyceridemia and low HDL cholesterol. Should such a situation continue, the incidence of arteriosclerosis might increase and consequently shorten the life expectancy of the rest of the Japanese population. In this symposium, we will summarize the evidence for a correlation between cardiovascular disease and Japanese lifestyle habits, with a focus on the changes in nutrition and daily physical activity, to promote a discussion on lifestyle guidance for the prevention of arteriosclerotic diseases.
Special Symposium 2
Message from Subcommittee for Pathology: "Pathophysiology of Human Atherosclerosis: Linking Pathology, Imaging, and Biomarkers"
Moderator :	Prof. Makiko Ueda  (Department of Pathology, Osaka City University Graduate School of Medicine) Prof. Katsuo Sueishi  (Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyusyu University)
[ Message from the Moderators ]
As dyslipidemia, diabetes and metabolic syndromes have become more common in recent years, Japan has seen a remarkable increase in the incidence of generalized atherosclerosis, which occurs not only in the coronary arteries but also in other arteries such as the aorta, carotid, intracerebral and lower extremity arteries. Consequently, the prevalence of atherosclerosis-associated diseases, e.g., cardiac infarction, cerebrovascular diseases, aortic aneurysm and aortic dissection, and arteriosclerosis obliterans of the lower limbs, is on the rise. Owing to recent advances in diagnostic imaging using CT, MRI and ultrasound, it is now feasible to evaluate atherosclerotic lesions systemically. These imaging techniques also provide critical information on plaque characteristics, which should reflect the pathophysiology of atherosclerotic plaques. Previous studies have demonstrated that interactions between vascular wall cells (endothelial cells, smooth muscle cells), and blood-origin cells (monocytes/macrophages, T lymphocytes, neutrophils, platelets) play a key role during the progression and destabilization of human atherosclerosis: Under these circumstances, the production of various substances may be enhanced, and these substances may be released into the blood stream. These substances have been evaluated as biomarkers, and the relevance of biomarker increase and plaque instability is becoming increasingly clear. This symposium aims to shed light on the characteristics of and differences among atherosclerotic lesions in different arteries as well as to understand the relationship between the pathology, imaging, and blood biomarker charcteristics.
JAS guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese "Some issues remained to be discussed"
Moderator :	Prof. Tamio Teramoto  (Department of Internal Medicine, Teikyo University School of Medicine) Prof. Masayuki Yokode  (Department of Clinical Innovation Medicine, Translational Research Center, Kyoto University Hospital)
[ Message from the Moderators ]
Two years ago, the Japan Atherosclerosis Society issued the 2007 Guideline for Diagnosis and Prevention of Atherosclerotic Cardiovascular Diseases. Based on the latest domestic and international evidence, the Guideline is intended to provide the principle of atherosclerotic disease prevention that is most suitable for Japanese people. To reflect the current pathophysiology in the Japanese population, LDL-C, instead of serum total cholesterol, is used as a common parameter in the diagnostic criteria and management goal for dyslipidemia, and metabolic syndrome is now listed as a serious risk. Given such background, this symposium aims to explore and analyze the issues that have arisen from the use of the Guideline in everyday clinical practice. In particular, there is a need for further reviews on LDL-C methods, dyslipidemia and cerebral stroke risk, and an appropriate method of lipid management for elderly and diabetic patients; we will invite the nation's leading experts to discuss these issues. Furthermore, Dr. Alan T. Remaley, who played a pivotal role in the US National Institute of Health's evaluation of the LDL-C direct method, will present the project's assessment and results. We hope to provide the audience with opportunities to share the latest achievements in the relevant field and express their views on the future direction in lipid management.

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