Spring 2019 LipidSpin Articles | National Lipid Association Online

ALAN S. BROWN, MD, FNLA DANIEL E. SOFFER, MD, FNLA KAYE-EILEEN WILLARD, MD, FNLA	From the NLA President and Editors of LipidSpin: New Clinical Guidelines: Paving the Road Ahead “Knowing is not enough; we must apply. Willing is not enough; we must do.” This remark by Goethe introduces readers to the rationale for the Institute of Medicine of the National Academies Committee on Standards for Developing Trustworthy Clinical Practice Guidelines: Guidelines We Can Trust 2011. If you were asked to compose a set of guidelines to advise clinicians on the best approach to cholesterol management, how would you write them? What if that same set of guidelines... more
NATHAN D. WONG, PhD, FNLA	From the PLA President: President’s Views I am honored to have the opportunity to work with you all in promoting education, service and quality improvement efforts in clinical lipidology and preventive cardiology as this year’s President of the Pacific Lipid Association. Having great passion in this field over the 30-year span of my career, I enthusiastically hope to further promote involvement of our membership in local, regional and national efforts focused on better management of lipids and related risk factors to help combat... more
DANIEL E. SOFFER MD, FNLA	From the LipidSpin Editor: Sparking the Conversation on Inflammatory Disease Management The “response to retention” model of atherosclerosis holds up as the present and best narrative explanation for the initiation and propagation of atherosclerotic cardiovascular disease (ASCVD).(1) As you know, this model posits that the passage of apolipoprotein B (apoB)-containing lipoproteins (LP) triggers the initiation of the atheroma. Low density lipoproteins (LDL) and triglyceride rich lipoprotein remnants (TRLr) are retained by proteoglycans in the subendothelial space where they... more
BRUCE A. WARDEN, PharmD, BCPS-AQ CEZARY WOJCIK, MD, PhD, DsC, FNLA MICHAEL D. SHAPIRO, DO, FNLA	Clinical Feature: Clinical Trial Evidence for the Role of Reducing Inflammation for Cardiovascular Disease Prevention Introduction Despite significant advances in detection and treatment, cardiovascular disease (CVD) is the leading cause of death and disability worldwide.(1,2) The 3-hydroxymethylglutaryl coenzyme A (HMGCoA) reductase inhibitors (aka statins) ushered in a new era for prevention of cardiovascular disease. The first statin, lovastatin, became commercially available in 1987. This was followed in 1994 by the landmark Scandinavian Simvastatin Survival Study (4S), which... more
ANURAG MEHTA, MD AMIT KHERA, MD, MSc	Guest Editorial: High-sensitivity C-reactive Protein Versus Coronary Artery Calcium Scoring: Dissecting a Biological Target from a Cardiovascular Risk Assessment Tool Differentiating Biological Targets for Cardiovascular Risk Reduction from Risk Assessment Tools Cardiovascular disease (CVD) remains the leading cause of mortality across the globe. The cornerstones of CVD prevention and treatment are accurate risk assessment — such that the intensity of preventive treatment matches the magnitude of absolute risk — and targeting biological markers that are known to mediate CV risk, respectively. Biological markers are... more
TERRANCE J. MORAN, MD, FNLA	EBM Tools for Practice: Best Biomarkers for Inflammation Atherosclerosis is widely recognized as a chronic inflammatory disorder. Therapies with anti-inflammatory effects in patients with an increased inflammatory status can reduce cardiovascular events, as the CANTOS study showed.(1) Inflammatory markers are an essential tool for evaluating a patient’s inflammatory state. The question is: which biomarker is best? A significant body of evidence involves the interleukin-Iβ/interleukin-6 (IL-Iβ/IL-6) axis, with epidemiologic studies mainly... more
ERIC K. GUPTA, PharmD, CLS, FNLA	Lipid Luminations: Medications that Reduce Inflammation Also May Reduce Cardiovascular Disease Along with lipid accumulation, inflammation plays a key role in the development of atherosclerosis.(1) Perhaps 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG CoA reductase) inhibitors (statins) are effective in the prevention of atherosclerotic cardiovascular disease (ASCVD) because they significantly decrease low-density lipoprotein (LDL) particles and inflammation. In the cholesterol synthetic pathway, statins block the formation of mevalonate through the inhibition of HMG CoA... more
CEZARY WÓJCIK, MD, PhD, DSc, FNLA	Practical Pearls: Top 10 Ways to Reduce Inflammation Inflammation is a dynamic process with many interconnected signaling pathways involving multiple classes of cells by which the human body responds to pathogen exposure and/or tissue damage, playing a central role in all stages of atherosclerosis. (1) Cholesterol crystals directly activate nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and interleukin 1 beta (IL-1β) production. Therefore, cholesterol lowering, per se, has an anti-inflammatory effect.(2... more
ROB GREENFIELD, MD, FNLA MICHELLE TAYLOR, CCRN, CLS, ANP	Case Study: Identifying and Managing the Patient with High Inflammatory Burden CASE STUDY This case has unanswered questions but shows how a cardiologist and nurse practitioner who became certified lipid specialists create a team approach for their patient. MS. TAYLOR AND DR. GREENFIELD: Ms. C is a 59-year-old woman relocating from another state and seeking a cardiology follow-up evaluation two years after suffering an ST-segment elevation myocardial infarction (STEMI) that was successfully stented. Aside from... more
ERIC K. GUPTA, PHARMD, CLS, FNLA MICHAEL D. SHAPIRO, DO, FACC, FNLA NATHAN D. WONG, PhD, FNLA CAROL KIRKPATRICK, PhD, MPH, RDN, CLS, FNLA Yehuda Handelsman, MD, FACP, FACE, FNLA	Chapter Update: Focus on Member Engagement This year promises to be an important turning point for the Pacific Lipid Association (PLA). Our goal is to reinvigorate our membership through greater opportunities to serve the PLA and National Lipid Association (NLA). This can only be done by improving member communication and engaging our membership in activities that are both personally rewarding and promote the mission and goals of the PLA/NLA. First, it is worthwhile to applaud some accomplishments of a few of our PLA members... more
ALYSSA LYNOTT, RDN, LD CAROL KIRKPATRICK, PHD, MPH, RDN, CLS, FNLA GEETA SIKAND, MA, RDN, CDE,CLS, FNLA	Specialty Corner: Dietary Patterns and Systemic Inflammation: Examining the Connection Introduction Chronic systemic inflammation is associated with the development of many chronic diseases, including metabolic syndrome, obesity, type 2 diabetes mellitus, and atherosclerotic cardiovascular disease (ASCVD). Because of this, an increasing number of clinicians are measuring inflammatory biomarkers in patients. The inflammatory biomarkers most commonly measured in clinical practice are C-reactive protein (CRP), which is an acute-phase protein, and... more
WENJUN FAN, MS	Member Spotlight Q: Could you tell us about what drew you to preventive cardiology? A: I was very interested in cardiology during medical school. However, after witnessing my two grandpas pass away from a serious heart attack and ischemic stroke, I realized the importance of cardiovascular disease prevention before limited treatments could be applied for its irreversible consequences. I believe there are millions of individuals and families living with regret for not... more
ANNE C. GOLDBERG, MD, FNLA	Foundation Update I would like to thank everyone who supported the Foundation of the National Lipid Association in 2018 by volunteering to work on our patient resource initiatives or awareness campaigns, attending a fundraiser, purchasing a Lipids Are My Life shirt at an NLA conference, speaking with your colleagues and patients about the Foundation or making a donation. As you consider your charitable giving throughout the year, please keep the Foundation in mind. You can donate online at... more