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In two thousand and four Doctor Paul Ritker was named by time magazine as one of the one hundred most influential people in the world now how does one get considered for a list of the most influential people in the world well for starters you must do something trans formative change the world in a way that is likely to have long term implications fifteen years ago it was known but often ignored that more than half of the first heart attacks occurred in people with normal cholesterol levels 7 more than ten years ago doctorate chris started the series of studies that demonstrated quite convincingly than me that inflammation was a major factor in miocardial and strokes the data even indicated that the risk student elevated inflammation wasn’t least is great as the risk to the elevated ldl cholesterol as you might imagine this revolutionary finding was not welcomed by everyone the doctorate permit criticism not with the argument but with more and more evidence in the past ten years doctor richter has truly transform medicne as a direct result of his determined efforts elevated inflammation is now recognized as a critical factor in the major chronic diseases of aging doctor richter is very much aware that periodontitis Gum Disease is the most common chronic inflammatory disease in developed countries. He has been in active participant in the dialogue about the role and potential aspects of periodontal disease in cardiovascular disease i am very pleased to welcome doctor Paul Rckter as our keynote speaker to open the ninety-fifth annual meeting
of the american academy of periodontology.

              The key issue i think for this society AAP
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is there evidence individuals identified it increase risk due to inflammation
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benefit from a therapy the otherwise would not have receipt
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and secondly is there evidence that if we reduce inflammation per se
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could we actually a man in the world where that intervention
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might lower vessel urban riots
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dhamma cardiologists are our favorite
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motive attackers tulika reduction
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but we showed years ago it was his data for nineteen ninety eight ninety nine on
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that when we give these very powerful staten drugs
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we not only lower-class 
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we inherit inflammation
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and the left hand side the slightly so that the number of heart attacks or
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strokes we prevent is greater when information is present and we give a
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staten
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than what information is absent
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and the right hand side we showed that you can lower syrupy levels you can
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inhibit inflammation
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with these drugs
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so fast forward what did we do it we said well who should we treat
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and i want you to hold on his ideas that retreat in terms of what we get to
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periodontal disease
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each of these for survival curves is twenty five percent of the saudis
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those of you and the red line the bottom of a high-class rahta hai syrupy well
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as health care providers hopefully you’ve seen your international for the
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screen you for your class trawl and hopefully you’re probably on
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diet exercise will be cessation and probably on a step
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the yellow survival curve in the middle though i’m worried about
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these are people who have low levels of cholesterol but have the inflammation in
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your patients have
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and they’re at higher risk than those in the light blue curve
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who are already treated
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but because they don’t have hyperlipidemia we don’t treat them
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so we designed a big clinical trial
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it happened we called jupiter
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some multinational randomized double blind to the controlled trial
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to address whether or not giving us time to patients with inflammation
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can prevent vascular events
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so we do this study
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we work routes are almost eighteen thousand patients worldwide
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we put six thousand women in to this trial we have a lot of minority patients
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we have a lot of smokers and non-smokers a very cross-sectional survey has
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probably extremely similar to who you see
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in standard practice
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well this trial reported out last year
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and uh… i was stopped early by status safety martin board
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because when we gave us that the people who only had inflammation
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we had a forty four percent reduction ever getting a future heart attack or
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stroke
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very narrow conference animals
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very small p_ dalia and in fact a number needed to treat of twenty five
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that’s actually smaller i’d be more efficient than treating hyperlipidemia
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tourist turns upside down our communities you of
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are we only gonna targeting the pulp lipids where we also got target
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information
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because we’re trying to figure out in health care how to save cost
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the best way to do is to prevent it in the first place
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and so here’s a
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possibility of just under two years cutting our entire angioplasty or bypass
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surgeries in half
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by rethinking
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the role of inflammation and how this information can be modulated
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with which runs out to be a very safe effective therapy
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to now we have to rethink
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who are population of patients has the stomach information
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on target if you missed your entire practice
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probably fits
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this guideline
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but the most exciting thing that a cardiovasc incommunicado had a reduction
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in all cause mortality
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twenty percent reduction in dying for many cause when we gave people with
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inflammation
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of staten drug
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and for us that changes how we think about things
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because we’re trying to figure out public health recommendations and we can
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say to a patient
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yes i can lower your risk of heart attack yes i come over here is the
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stroke and you will live longer
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we now have the kind of therapy our patients are willing to take
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relevant to your thinking and if your patients have
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aural inflammation
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do you want to lower that would benefit so is the benefit in this trial of a
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staten based only a lower in the classroom was also based on lowering
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information in its sole
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kelly imagine other modalities solo information well
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i’ll take you through this quickly
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we power this trial on the idea that information had no impact at all
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a good scientists have to say
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my pet hypothesis is wrong
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so the null hypothesis was the benefit we might see would be from little or no
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alone and had that in the case
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we should have seen about twenty five percent risk reduction
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because that’s what cluster lauren does
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but what we observed was way off the map
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cutting rates in half
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was not what the close for a hypothesis anticipated
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so we do seven now sees
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ride to summarize in here in the bottom of slot
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for the patience in this clinical trial who again would not have gotten this
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anti-inflammatory therapy
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who not only lowered their ldl cholesterol very aggressively but also
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lower their syrupy very aggressively
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they had seventy-nine percent reduction
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and ever getting a heart attack
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a stroke
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a bypass surgery and plaster a dying a card aggressive debt
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this raises the possibility that lowering inflammation per se
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a beyond just the benefits of these drugs for lower in cholesterol
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might well open up a new way of thinking
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about prevention of
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heart disease
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which at the end of the day still kills half of us in the western society
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so now the tension in this field changes
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if we can convince the primary care community in the car divestiture
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community
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that the way to get at
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vascular prevention
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is both rule that the reduction and information that we have to begin asking
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questions
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can’t targeted anti-inflammatory therapy reduce cardiovascular risk
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well are the only giving you a little bit gave up ask for instance
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but as many different ways we can go about inhibiting information
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dr corbin himself is involved in many different studies looking at ways
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inhibit interleukin as an example
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there many interesting drugs even develops a block you could try in
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production
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who are blocking a kind it’s an engine inc issues and we have a lot of ways to
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get there
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is so exciting to me to see the periodontal community thinking about
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this
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to see arthritis clearly thinking about this
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deseo dermatology college thinking about this because we do believe this is the
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way to beat this disease
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sunit and with a pitch for the cardiovasc community and their pitch for
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you the korean fancy community has to move forward
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in nineteen sixty one colleagues just twenty miles west of your really in
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massachusetts to find
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alder age male gender diabetes hypertension smoking
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as major cardiovascular risk factors
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nineteen sixty one
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what we know this disease is more complicated than that and we in the
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cardiovasc reach may have to move forward beyond his major respect is
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understand what’s going on
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so i want to leave you with a real challenge that if this is a difficult
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issue to hold onto this notion that maybe there’s something fundamental
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after that we’ve missed
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than i would argue the reason you’re opening speaker chezza cardiologists
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because i what i really want you to do
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is abuse of the bug going to try to do several years ago the time is right now
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can improve
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repair is not clear
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reduce cardiovascular risk
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we don’t know the answer to that
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but the biologists iseas make sense to me as a cardiologists
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the idea that improve
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truth health
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and again what i mean by that is seething t
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performing the kinds of things that you as a community can do
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to reduce the burden of the information in the world cavity
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there’s enough biology at this time to say
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can a randomized trial be supported by the n_i_h_
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to actually bring it to a forefront is it possible
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that one of the keys to preventing cardiovasc use lies right in the society
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so my real reason for wanting to be you’re trying to say
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i think my
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and this group
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need to think through this process
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because a randomized trial taking high-risk patients with periodontitis is
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improving it and some natural history in the others and if the cardiovasc
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beverage came down
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well two things would happen
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one is we would have a great thing for society
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and the second thing is the controversy
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about whether or not this has value would be over
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and the only way to get there i think mister panama straps
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so doctor cochran doctor carmen
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members of the board no society thank you so much for the opportunity here
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and welcome the boston

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