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Jun 12, 2011 0 comments Uncategorized Uncategorized

A major league thank you to board members and members of the NLA and President (now past) Michael Davidson who at the 2011 Annual Scientific Sessions bestowed on me  the President's Award (the highlight of my professional life). Also a thank you to my friend and colleague John West of Snellville, Georgia who so eloquently introduced me at the ceremony in Manhattan. In my acceptance speech I noted that I have travelled over two million frequent flyer miles in my lecture career which enabled me to influence an army of Lipidaholics and many others to get excited about lipidology. It was quite daunting and in reality ridiculous to be on the same stage as other NLA award winners Tony Gotto, Greg Brown and Rudolfo Paoletti (all of them Lipid Gods).  My journey into lipid education began in the mid 1980s and went nuclear in the early1990s and hit the road in 1998. Although so many contributed to my education I did specifically point out the following mentors:  Dan Rader, Frank Sacks, Sergio Fazio, Bob Rosenson, Virgil Brown, Michael Davidson, Jim Otvos, Bill Cromwell, Peter Jones (of Baylor) and Peter Toth. Time did not permit me to mention Harold Bays, Michael Miller, Pete Kwiterovich, Brian Brewer, Allan Sniderman and others. I extended great admiration to my "lipidaholic rat pack" of Greg Pokrywka, Barry Hull, John West and Tara Dall and because of a brain lock forgot to include my very dear friend Jamie Underberg. Although our relationship is just over a year old, I'd be remiss not to thank Tonya Mallory, Russ Warnick and Joe McConnell of Health Diagnostic labs who have rejuvenated me.  Of course I concluded with thanks to the most important folks in my life: my now departed and beloved Mother (Cora) and Father (Joseph), my so supporting and loving wife Phyllis and my real purpose for being on this planet, my son Bradford (much more famous than his father: just Google him). One other part of my speech deserves repeat: In reality the only reason I became a presence in Lipidology is because of the many thousands of folks who have attended my several thousand lectures in all 50 states. I remind all that none of that would have happened without the support of PhRMA. It is so easy to bash that industry but we would have virtually no understanding of lipid and lipoprotein physiology and pathophysiology CV therapeutics without their support of research and education. I have met with, learned from and worked with thousands of PhRMA people over the last decade. I mentioned two by name in my talk who have endlessly supported my mission to educate: Amrita Chari of Abbott Labs and Craig Sponseller of Kowa (apologies to the many others where time did not permit their mention like Deb Horn, Jason Powel, Ed Lord, Jim Foster, Brad Hardy and so many at BMS, Lilly, Merck & GSK).

As I celebrate my 65th birthday, I am so proud of my NLA membership, my Lipidology Certification and my Fellowship in the NLA.  Thank you all.

Tom Dayspring

KeywordsKeywords: president's service award 
May 8, 2011 1 comments Exercise and Nutrition Exercise and Nutrition
I just got an e-mail form a patient who was actually Lipidaholics case #211 (archived at www.lipidcenter.com). It is so nice to get this type of communication from a patient which shows how aggressive care and partnering with a patient can pay off. When he first became involved with me through a mutual friend I was pretty blunt calling him morbidly obese - but it affected him in a right way. I rarely do it with patients not directly under my care but I counseled him from afar. In reality it was not my skills with lipid drugs that helped him but his realization that lifestyle was the way to go. I have full permission to share his name and e-mail to me with my colleagues in the lipid world.  He might be a man to ivite to a future NLA meeting. Even better, because of my assistance he made a nice donation to the NLA Foundation.
Tom: As you rightfully ask us beneficiaries of your communications , it was my pleasure to contribute $ 100 to the foundation  Just before going back to France for the summer tomorrow, I just wanted to give you an update on my case # 211 At that time I was 330 lbs and you rightfully so referred to "morbid obesity" , metabolic syndrome , insulin resistance ....... those for sure got my attention !
I am happy to let you know I am now at 250 lbs on my way to 220 target by year end ,most importantly not through a temporary one time diet, but rather a lifestyle change , going from.... " a bear preparing for the winter ...but never hibernating " to take control of my metabolism , with
1.) controlled and dramatically reduced carbohydrates intake .
2.) frequency of healthy* small meals /snacks, rarely exceeding 4-5 hrs without feeding, attempting to eat what I burn in a day with the appropriate balance of Carbo / protein /fat for healthy muscle tone . (* building on mediteranean diet )
3.) overall reduced food quantities, yet never discontinued my wine societies social activities with great meals and great wines in moderation.
4.) lot of exercise having resumed biking in 2009 after 25 years interruption and since October 28th 2010 going to serious biking with a carbon fiber speed bike .......2338 miles ....average speed of 17.3 mph
......on my 60th birthday February 24th I did bike 100 miles , a symbolic 160 km in just a little over 6 hrs (pictures included )
5.) Medications: on metformin 2 x 500 since April 2009.......reduced Crestor from 40 to 20, 10 and since 4/26th 5 mgr ! , reduced Zetia from 10 to 5 mgr ,Altace 5mgr, Aspirin, Levothyroxin 50 , discontinued Toprol 50 after an episode of very low resting HR in march (43) and near perfect blood pressure of 117/70 after 35 miles biking full speed by 85*F . (In 2008 I tried Niacin , but had to discontinue due to severe hotflush /dizziness after 2 months while traveling to India - jet leg ? )
6) continued supplements from Omega 3, OQ10enzymes ,to multivitamins , D3, B complex, Mg/K for cramps moderation , Glucosamine/Chondroitine for joints health.
The way I feel and medical results speak by themselves ( e.g.small LDL-P from 1247 to 442!....HDL-C exceeding LDL-C , TG at 34, HA1c 5.8% ) Take a look at the enclosed table summarizing the data for the last 6 years ........almost all green, except that at 250 lbs I got to keep loosing more weight and belt size (adipokines control !)......biking in hilly areas should help further !
My doctors, Cardiologist, Internist and Endocrinologist are all delighted and are encouraging me to continue this regiment including training for and realizing my plan to bike this coming September from Malmedy, Belgium (Battle of the Bulge area) where I grew up to my current vacation home in Provence, a 900 miles trip over 2 weeks going through the Alpes (if you are interested /curious.
Needless to say I have myself gained a totally different prospective on life as our common friend Dr X who I met in March in Naples would certainly confirm.
I want to thank you for having been part of this transformation through the publishing of case #211 and your highly didactic monthly case studies, looking forward to continue to learn more overtime
Feel free to use the enclosed medical data for further research/studies/publishing, case update ?, and let me know if I can be of further help .
Jean M. Heuschen
KeywordsKeywords: obesity dyslipoproteinemia metabolic syndrome 
Apr 18, 2011 0 comments Lipoprotein Metabolism Lipoprotein Metabolism

Fantastic new AHA statement on Triglycerides available for free download at AHA Circulation web site. A must read for all NLA members

 

Circulation 2011 [doi:10.1161/ CIR.0b013e3182160726]).

KeywordsKeywords: triglycerides 
Mar 10, 2011 0 comments Lipoprotein Metabolism Lipoprotein Metabolism
Go over to my Lipidaholics Anonymous group to learn abut the expert panel on HDL Nomenclature as it applies to a real world case.
KeywordsKeywords: hdl hdl-p 
Mar 8, 2011 1 comments Lipoprotein Metabolism Lipoprotein Metabolism
Friends: Please go to this web site and download for free a pdf of my latest published article
 

Understanding hypertriglyceridemia in women: clinical impact and management with prescription omega-3-acid ethyl esters

 

International Journal of Women's Health   2011;3:87-97.

TD

KeywordsKeywords: triglycerides women 
Mar 6, 2011 0 comments Guidelines and Policy Guidelines and Policy
Recently I came across the following quote while reading a discussion in the North American Menopause Society's "First to Know" newsletter. (www.menopause.org)
With respect to a discussion on Vitamin D measurement and treatment recommendations the following quote puts potential cutting edge therapy into perspective.  Dr. Robert Heaney of Creighton University, was quoted as stating, there are three decision levels that can be invoked here: the personal, the professional, and the policy decision level.
     1) At the personal decision level, the physician decides what he or she will personally do.
     2) At the professional decision level, the physician decides what to recommend to his or her individual patient.
     3) At the policy decision level (guidelines), recommendations are made for an entire population. As one moves from the personal to the professional to the policy decision level, the recommendations become appropriately more conservative.
In the real world (especially Lipidology), caring for high and very high risk patients, thank goodness the art of practicing medicine (#2 above), not guidelines still prevails.
Tom D
KeywordsKeywords:  
Feb 20, 2011 0 comments Special Populations Special Populations
Big news this week has been the release of: "Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update. A Guideline From the American Heart Association." It is now available as a pre-publication and soon will appear ion Circulation and no doubt JACC. However the pdf is available free for downloading http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820faaf8v2
I'd be very disappointed if every Lipidaholic did not immediately go and get this. The last 2007 update was called evidence-based and the 2011 document is called effectiveness-based. Get the paper and read the gobbledygook explanation about the differences.
As with most guidelines a lot is repetitive from the 2007 update and original 2004 paper. As always guidelines are way behind what cutting edge clinicians are doing but the honest truth is that the standard of CV care for women in the US is semi-pathetic and the vast  MAJORITY of clinicians counseling women do not even follow basic guidelines. How  to explain 50% of women with hypertension get no treatment? Here are a few key points (positive and negative)
    1) Continued emphasis on lifelong risk of CVD
    2) A newer updated Framingham Risk Score (to determine ten year rsik) with the new caveat that if a woman's score puts her into the 10-20% ten year risk zone, she is now to be considered high risk (coronary heart disease risk equivalent). That is a gigantic shift in work up because previously she would have had to score > 20% which almost no woman except one who was quite elderly ever reached.
    3) No routine use of aspirin unless the risk is high
    4) Only recommended supplement is omega-3 FA
    5) Reminder that the # 1 risk factor for premenopausal MI is smoking: surverys show very few clinicians are aware of that.
    6) Reminder that > age 60 women are far more likely to die of strokes than CHD manifestations (just the opposite with men)
    7) No change in LDL-C goals
    8) Require non-HDL-C calculations which enter into therapeutic decisions
    9) Somewhat of a move against super aggressive glycemic control
    10) Reminder that black women are have horrendous risk and it is equivalent to that of a caucasian male. Also there is a "Hispanic Paradox" where even though their incidence of diabetes is high, they have the lowest CVD mortality
    11) Downplaying of the role of coronary calcium and CIMT testing
    12) Downplaying of CRP testing: no mention of other types of inflammation assessment
    13) recognizing that making the diagnosis of metabolic syndrome matters (it is one of the criteria that puts a woman into the at-risk category
    14) Alerted all that preeclamsia, eclampsia, and gestational diabetes are major risk factors for CVD later in life and a detailed pregnancy history now should be part of the medical record
    15) Inflammatory collagen diseases (Lupus, RA, etc) are all major CVD risk factors and a thorough CV workup needs to be done and if positive treated in all such women.
Shortcomings:
    1) Reliance on lipid goals with no serious mention of measuring atherogenic lipoproteins. There is a vague sentence that novel biomarkers (with no mention of what they consider a novel biomarker) should be reserved for better risk assessment in those with a ten year calculated risk of 10-20%.  Wait a minute: as noted above any woman with a calculated risk > 10% is a high risk woman, but here they state you could use with their blessing novel biomarkers to better ascertain risk. Why do them if she is already declared high risk because of a > 10% ten year risk? This looks like the committee's right hand did not know what the left hand was doing.
In fact let me get something off my chest. There are some very prestigious people on this expert panel. They state the following: Optimal Lipid/lipoprotein concentrations: LDL-C < 100 mg/dL, HDL-C > 50 mg/dL, TG < 150 mg/dL, non-HDL-C < 130 mg/dL.  CLEARLY THEY HAVE NO KNOWLEDGE that those are lipid, not lipoprotein measurements. The best any lipid measurement can be is a surrogate or proxy or estimate of what the actual lipoprotein concentration actually is. As long as experts keep disingenuously perpetuating the myth that lipid concentrations are the same as lipoprotein concentrations or worse have the same meaning the public is doomed to inferior cardiovascular care. My bet is the vast majority of those signing their names to this guideline DO HAVE THE KNOWLEDGE and have personally (and for their families) had actual lipoprotein measurements but for some reason do not like to educate providers about this crucial distinction.
Would not you think based on AMORIS, INTERHEART, Women's Health Study, Women's Health Initiative, Cardiovascular Health Study, MONET, Framingham, MESA, etc, etc, this is a topic perhaps worthy of a paragraph???
    2) No lowering of desirable TG levels or even a discussion of TG issues in women.
    3) A mind boggling error in which they do advocate an LDL-C goal of 70 mg/dL in very high risk women but keep the non-HDL-C goal of 130 mg/dL instead of as one would expect  100 mg/dL (as per NCEP  ATP-III).
    4) No serious discussion of hormonal therapies: either OC in younger women or MHT (menopausal hormone therapy) in symptomatic women with quality of life issues. A PATHETIC shortcoming. Most clinicians seeking such information have little clue the only place to obtain it is position statements from the North American Menopause society http://www.menopause.org/PSht10.pdf or ACE or the Endocrine Society J Clin Endocrinol Metab 2010 Jul;95(7 Suppl 1):s1-s66. Epub 2010 Jun 21.
    5) Virtually no discussion of lipid/lipoprotein physiology and pathophysiology in women
    6) Very shallow discussion of the lipid-modulating therapies that women may require.
TD
KeywordsKeywords: women guidelines 
Feb 20, 2011 0 comments Lipoprotein Metabolism Lipoprotein Metabolism
The AHA has posted a 2011 update to the AHA Women's Guideline series (last update was 2007 and original set was 2004). Go over to the Lipidaholics Anonymous Group and see how well the new recommendations apply to a real world case.
KeywordsKeywords: women guidelines 
Feb 7, 2011 3 comments Exercise and Nutrition Exercise and Nutrition

Please visit current issue of JCI http://www.jci.org/articles/view/41651/pdf

 

Free for downloading is

Nicotinic acid inhibits progression of atherosclerosis in mice through its receptor GPR109A expressed by immune cells

 

Always suspected what niacin does to lipids is only a part (likely modest) part of its MOA

 

TD

KeywordsKeywords: niacin 
Feb 4, 2011 1 comments Exercise and Nutrition Exercise and Nutrition

Head over to the Lancet and check out the just published HPS data in Lancet: C-reactive protein concentration and the vascular benefi ts of statin therapy: an analysis of 20 536 patients in the Heart Protection Study: 

Interpretation Evidence from this large-scale randomised trial does not lend support to the hypothesis that baseline CRP concentration modifi es the vascular benefi ts of statin therapy materially.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62174-5/abstract

Also see editorial by JP Despres

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62316-1/fulltext#article_upsell

Sooner or later they will all figure out that it is apoB and LDL-P that predicts what statins will or will not do. Why does no one, other than Alan Sniderman and his many followers (including me) ever mention the pretty ugly apoB data in JUPITER in all those folks with normal LDL-C. We need to see the NMR data from HPS that Dr Virgil Brown tlaked about in the IAS meeting in Boston two years ago. One day we will hopefully also have the JUPITER NMR data. Then we can all move on.

KeywordsKeywords: crp heart protection study 
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Thomas Dayspring
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Job Title: Clinical Assistant Professor of Medicine; Director: North Jersey Institute of Menopausal Lipidology
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