Potpourri 2015 LipidSpin Articles | National Lipid Association Online

TERRY A. JACOBSON, MD, FACP, FAHA, FNLA	From the NLA President: Passing the Torch “Skate to where the puck is going to be, not to where it has been.” Wayne Gretzky As I write this last president’s letter for the annual Potpourri edition of the LipidSpin, I’m reminded of how fortunate I’ve been to serve as the President of the National Lipid Association (NLA) during the past year. The year has been a very exciting one, and I’m so privileged to have served with such distinguished company. The eternal flame of our organization has always been the combined... more
ROBERT A. WILD, MD, MPH, PhD, FNLA	Letter From the LipidSpin Editor: Moving Forward with Recommendations The National Lipid Association (NLA) is proud to move forward with its Recommendations for Patient-Centered Management of Dyslipidemia for those practicing clinical lipidology in an environment where many clinical queries remain unanswered for clinicians. To that end, the NLA has developed Part II of these Recommendations. The ACC/AHA Guidelines and many other guidelines throughout the world are very broad and generic in the sense that they do not address many unique specific... more
JAMES A. UNDERBERG, MD, MS, FACPM, FACP, FNLA	Letter From the LipidSpin Editor: Cholesterol Limbo — How Low Can You Go? The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark.” Michelangelo Buonarroti Along with the NLA Scientific Sessions, the summer also brings the anticipation of the Prescription Drug User Fee Act (PDUFA) dates for two new monoclonal antibody inhibitors for proprotein convertase subtilisin/ kexin type 9 (PCSK9). Data to date with this new class of medication for LDL lowering has shown... more
HEIDI T. MAY, PhD, MSPH JOHN R. NELSON, MD, FACC, FASNC, FNLA	Apo A1 Remnant Ratio Although low-density lipoprotein cholesterol (LDL-C) lowering with statin therapy has been part of the National Cholesterol Education Program guidelines for 26 years, significant residual cardiovascular risk remains in both primary- and secondary-prevention patients. This residual risk is particularly prominent in patients following an acute coronary syndrome (ACS). Post ACS patients have two-year cardiovascular event rates of up to 22.4 percent despite high-dose statin therapy.1 In addition... more
LAKSHMI KANNAN, MD, MSc JANANI RANGASWAMI, MD, FACP EDGAR V. LERMA, MD, FNLA	Statins in Chronic Kidney Disease and Dialysis: Clinical Trials, Mechanisms, Dosing, and Treatment Recommendations Patients with chronic kidney disease (CKD) including those undergoing dialysis have an increased risk of premature cardiovascular disease (CVD).1 CKD patients also have a high rate of coronary death and myocardial infarction — rates equivalent to those of diabetics. CKD, per se, has thus been classified as a coronary heart disease risk equivalent.2 Statin therapy has been proven to reduce the incidence of cardiovascular events and mortality in several at-risk patient populations.3 The... more
RAJASREE PAI RAMACHANDRA PAI, MD	Disorders of High-Density Lipoprotein (HDL) A 35-year-old healthy woman is seen at the endocrine clinic for above-normal high-density lipoprotein (HDL). Her triglyceride level is 200mg/dl, and low- density lipoprotein (LDL) is 90mg/dl, with HDL of 129mg/dl. She has no risk factors for coronary artery disease (CAD), except that her father died of premature coronary artery disease at the age of 42. How does one approach a patient with abnormal HDL? When is HDL protective and when is it not? How do we treat low HDL? This editorial... more
KAVITA S. SHARMA, MD MARTHA GULATI, MD, MS, FACC, FAHA	Recent Trials Regarding Exercise and Cardiovascular Outcomes Lifestyle-related risk factors can prevent or promote atherosclerotic cardiovascular disease (ASCVD). Thus, management of lifestyle factors is crucial in addressing the burden of ASCVD. Nonetheless, addressing these factors has often been overshadowed by the administration of medications. Over the past few years, there has been increasing interest in a key lifestyle component — exercise — and its influence on cardiovascular disease (CVD) risk. Several recent studies illustrate the... more
JAMES A. TRIPPI, MD	The Impact of Gilbert’s Syndrome on Atherosclerosis A 51-year-old female with a history of premature coronary heart disease and coronary artery bypass grafting at age 36 was referred for hyperlipidemia. She had untreated low-density lipoprotein cholesterol (LDL-C) >600 mg/dL, a previous cholecystectomy, and non-alcoholic fatty liver. On maximal medical therapy with rosuvastatin 40 mg per day, ezetimibe 10 mg per day, and extended-release niacin 1,000 mg per day, lipid levels remained elevated; LDL apheresis was added. Diagnostic genetic... more
DON P. WILSON, MD, FNLA PIERS R. BLACKETT, MD, FNLA CATHERINE McNEAL, MD, PhD, FNLA	Dyslipidemia, Cardiovascular Disease, and Youth with Diabetes Introduction Individuals with diabetes have an increased risk of morbidity and mortality related to cardiovascular disease,1 accounting for 44 percent of deaths in patients with type 1 diabetes mellitus and 57 percent of deaths in patients with type 2 diabetes mellitus.2 Although youth with diabetes are rarely symptomatic, there is unequivocal evidence that atherosclerosis is well established in some by adolescence.3,4 The increasing prevalence of diabetes, prolonged... more
MERLE MYERSON, MD, EdD, FACC, FNLA	Dyslipidemia in the Patient Living with HIV Introduction The development and use of antiretroviral medications to treat patients infected with HIV have dramatically changed the course of this disease from one that was fatal to a chronic and more manageable condition. However, with antiretroviral therapy (ART) came a new spectrum of diseases brought about by metabolic changes related to the virus, side effects of ART, and the fact that people with HIV were living to ages at which cardiovascular disease (CVD) was... more
TERRANCE J. MORAN, MD, FACC, FAHA	Niacin: The Third or Fourth Option After the clinical studies, Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) and Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE), the National Lipid Association released a statement on the use of niacin: “We believe that niacin remains a valuable adjunct to statin treatment for LDL-C lowering, and a valuable statin alternative in statin intolerant patients.”1... more
EDWIN FERGUSON, MD, FNLA THOMAS D. DAYSPRING, MD, FACP, NCMP, FNLA	Reflections: An Aggressively Managed Lipidologist Can Have an Acute Coronary Syndrome Author Edwin Ferguson, MD, is a 70-year-old practicing preventive cardiologist and certified clinical lipidologist who, despite 20 years of treatment for dyslipidemia, recently had an ST elevation myocardial infarction (STEMI). His cardiovascular journey began in medical school when, despite his normotension and normal weight, testing revealed a triglyceride (TG)/high-density lipoprotein (HDL) axis abnormality.1(Table 1) A decade later, his lipid panel remained abnormal and untreated. At... more
ANNE C. GOLDBERG, MD, FNLA	Foundation Update The Foundation of the National Lipid Association continues to make strides to help educate and promote clinical lipidology — both to clinicians and to the public. In the last Foundation Update, we discussed the launch of “Cholesterol Counts,” an unbranded cholesterol awareness campaign geared toward consumers to assess their knowledge of cholesterol and how their knowledge stacks up against other Americans. The Foundation of the NLA and representatives from Mended Hearts and... more