Spring 2013 LipidSpin Articles | National Lipid Association Online

PETER P. TOTH, MD, PhD, FNLA	From the NLA President: Our Pursuit Continues The NLA has consistently held a determined focus on promoting the highest levels of education and professional development. We are defined by the quality of our outstanding leadership, members, partners and staff. As a result, we are continuously challenged to assess and refine our work in an attempt to produce the best and most innovative programming in Clinical Lipidology, leading to a direct and measurable impact in our medical community and across the globe. With our core mission... more
J. ANTONIO G. LÓPEZ, MD, FACC, FAHA, FACP, FCCP, FNLA	From the PLA President: Apolipoproteins in Clinical Practice I am pleased to present to the National Lipid Association the Spring 2013 issue of the Lipid Spin. The Pacific Lipid Association serves the states of Washington, Oregon, California, Idaho, Montana, Nevada, Utah, Alaska, and Hawaii. The theme of this Spring issue is "Roles of Common Apolipoproteins in Cardiovascular Disease (CVD) and How They Affect Our Clinical Practice." The authors discuss apolipoproteins, their relevance, a review of the literature and the implications... more
ROBERT A. WILD, MD, PhD, MPH, FNLA	Letter From the Lipid Spin Editors: The Times They Are A-changin' ...the times they are a-changin' ~Bob Dylan These are exciting times for Lipidologists! We can always count on change as the one sure thing in life. Our field is changing. As health care evolves, the NLA is doing its part to position our field to take advantage of the changes that our system demands. Our leaders are providing new ways to navigate systems to the benefit of our patients. As a multidisciplinary organization, we now have even more ways... more
Paul D. Rosenblit, MD, PhD, FACE, FNLA Edward A. Gill, MD, FAHA, FASE, FACP, FACC, FNLA Robert G. Thompson, MD, FACC	Clinical Feature: Is it Time to Abandon the Cholesterol Content of Atherogenic Lipoproteins? The year 2013 marks the "Silver Anniversary" of three key announcements that identified relationships among various lipid fractions, lipoproteins, apolipoproteins, non-lipid disorders and cardiovascular disease (CVD) risk. In 1988, NCEP ATP I¹ recognized evidence that high levels of low density lipoprotein cholesterol (LDL-C) contributed to increased CVD risk and subsequently this has become the primary lipoprotein lipid target to reduce CVD.^2-4 They... more
John R. Nelson, MD, FACC, FASNC, FNLA Paul N. Hopkins, MD, MSPH	Guest Editorial: The Role of Remnant Lipoproteins in Atherogenesis Remnant Lipoproteins Promote Foam Cell Formation Atherosclerosis is characterized by accumulation of inflammatory foam cells whose formation is promoted by the subendothelial retention of ApoBcontaining lipoproteins. Plaques develop in predisposed areas of the arterial tree where blood flow is either slow or has a back and forth pattern (thus coronary arteries are particularly prone).¹ In these predisposed areas endothelium displays increased susceptibility... more
Michael D. Shapiro, DO, FACC, FSCCT Eliot A. Brinton, MD, FNLA	EBM Tools for Practice: "HDL-P vs. ApoA1 vs. HDL-C" in Context of the HDL-Hypothesis Controversy Recent high-profile interventional studies and a large genetic association analysis have failed to show a benefit of raising high density lipoprotein cholesterol (HDL-C) levels on cardiovascular disease (CVD) outcomes, calling into question the validity of the HDL hypothesis. Among several plausible explanations for these findings, one is that assaying the cholesterol content of HDL (HDL-C) may fail to adequately measure its protective effects. Two potentially better ways to assess the... more
P. Barton Duell, MD	Lipid Luminations: Lipoprotein(a)—Clinical Significance, Evaluation, and Management Lipoprotein(a), also referred to as Lp(a), is an unusual plasma lipoprotein that was first described by Berg in 1963.¹ The lipoprotein(a) particle consists of a low density lipoprotein (LDL) particle to which a single molecule of apoprotein(a) is covalently bound via a disulfide linkage to apoprotein B-100. The size of the apoprotein(a) moiety varies substantially between individuals because of differences in the number of kringle-4 repeats, as discussed below. Lipoprotein(a) is... more
Michael J. Bloch, MD Ali Olyaei, PharmD	Specialty Corner: Nephrology Corner-Limitations of Statin Use and Adjuvant Therapies in Stage IV CKD and Dialysis Coronary heart disease (CHD) remains the leading cause of death in Western civilizations. The role of abnormal lipid metabolism as a modifiable risk factor for CHD is well documented. The presence of chronic kidney disease (CKD) is also associated with an increased risk of CHD, but the pathogenesis of this relationship is not completely understood. Specifically, it remains unclear whether and to what degree the management of dyslipidemia can affect the risk of CHD in patients with advanced... more
J. Antonio G. López, MD, FACC, FAHA, FACP, FCCP, FNLA John R. Nelson, MD, FACC, FASNC, FNLA	Practical Pearls: Cardiac Auscultation for the Lipidologist: A Systolic Murmur You Do Not Want to Miss! It is typically silent, but sometimes you can hear it, a soft systolic ejection murmur heard over the aortic area during cardiac auscultation on physical examination. As cardiovascular risk reduction specialists, we do not to want to miss this cardiac murmur. It is not innocent or benign; this is the murmur of aortic valve sclerosis (ASc). In addition, there is a normal split of the second heart sound, a normal carotid upstroke, and a peak transaortic systolic gradient noted on Doppler... more
Rob Greenfield, MD, FACC, FAHA, FNLA Susan Given, cFNP, MN, BSN	Case Study: Digging Deeper-A Case for Apolipoproteins and Lifestyle in Office Practice R.E. is a 58-year-old Asian male who finally quit smoking one month ago, and is now being treated for hypertension to goal with the combination amlodipine/benazepril. He has type 2 diabetes and takes metformin 500 mg bid. His initial lipid panel revealed a TC=230 mg/dL, LDL=140 mg/dL, HDL=35 mg/dL and TG=265mg/dL and his Non HDL- was 195. His BMI was 29, FBS=109mg/dL and his HbA1C=6.8. In general he has led a sedentary lifestyle. He was placed on Simvastatin, 40 mg q HS and three months... more
B. Alan Bottenberg, DO, FACOI, FNLA	Chapter Update: Pacific Lipid Association As President-elect of the Pacific Lipid Association, it gives me a great pleasure to present our chapter update. Our members continue to be very active in their communities as well as throughout the NLA. Our own Matthew Ito, PharmD, will become the NLA President this May. March of last year, our immediate past president, John Nelson, MD, held his annual CME conference in Fresno, California. The conference, entitled "Treatment of the High Risk... more
Daniel Steinberg, MD, PhD	Member Spotlight: Daniel Steinberg, MD, PhD Like many young clinicians starting out, Daniel Steinberg, MD, PhD, did not intend to build a career in Clinical Lipidology. But the Harvard-trained biochemist had motivation to pick a field quickly: it was 1950, the Korean War had just broken out, and he had served less than two years in World War II. His thesis supervisor, Christian B. Anfinsen, MD, had just accepted a position at what was the newly created National Heart Institute-if Dr. Steinberg accepted a job there, he would not need... more
Anne C. Goldberg, MD, FNLA	Foundation Update Following the Foundation of the NLA’s inaugural Familial Hypercholesterolemia Roundtable in New Orleans this past February, I am pleased to report meaningful progress on our important FH initiative. We convened with an outstanding delegation of representatives from the American College of Osteopathic Physicians, American Society for Preventive Cardiology, FH Foundation, International FH Foundation, National Lipid Association, National Society of Genetic Counselors, and the Preventive... more