Vol. 14 Issue 2 LipidSpin Articles | National Lipid Association Online

CARL E. ORRINGER, MD, FACC, FNLA	From the NLA President: Non-Statin Therapy for Atherogenic Cholesterol Reduction As clinical lipidogists, the major objective of care for most of our patients is to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). All major guideline documents, including the NLA Recommendations for Patient-Centered Management of Dyslipidemia and the 2013 American College of Cardiology/ American Heart Association (ACC/AHA) Blood Cholesterol Guideline, advocate lifestyle therapy as the first step in patient care, regardless of whether drug therapy is concomitantly... more
HAROLD E. BAYS, MD, FTOS, FACC, FACE, FNLA	From the SELA President: Horses, Zebras, and Unicorns — Oh My! The theme of this issue of LipidSpin is “Unusual Causes of Dyslipidemia/Less Common Dyslipidemias.” Topics range from sitosterolemia, to lysosomal acid lipase deficiency, to myositis due to red yeast rice. Although not necessarily rare for many lipidologists, other topics include potential worsening of lipoproteins with a low-carb diet, issues regarding dyslipidemia and antipsychotic medications, and use of niacin-statin combination in lipid management. Finally, this issue includes a well-... more
JOSEPH J. SASEEN, PharmD, BCPS, BCACP, FNLA	Letter From the LipidSpin Editor: There is Never a Dull Moment In the World of Clinical Lipidology This edition of the LipidSpin is an outstanding representation of how there is never a dull moment in the world of clinical lipidology. This SELA edition of LipidSpin has many outstanding lessons and insights nested within the various articles. As I read through this edition, two things stand out to me as highly noteworthy: collaboration and quality. A collaborative multidisciplinary approach is commonplace among the National Lipid Association (NLA). Seeing two... more
DEBORAH S. CROY, DNP, ANP-BC, AGPCNP-BC, AACC DAVE L. DIXON, PharmD, AACC, CDE, BCPS-AQ Cardiology, FNLA LINDSEY KENNEDY, RN, BSN	Clinical Feature: Dyslipidemia & Antipsychotic Medications: Who is Monitoring the Lipids? Introduction Patients diagnosed with serious mental illness prescribed antipsychotic medications present unique challenges to healthcare providers. The use of second- generation, or atypical, antipsychotics is associated with significant adverse metabolic effects. These include weight gain, glucose intolerance, and dyslipidemia. Furthermore, cardiovascular disease (CVD) is the leading cause of death among patients on antipsychotic therapy.^1-5 Patients are 1... more
GREGORY S. POKRYWKA, MD, FACP, NCMP, FNLA	Guest Editorial: Worsening Lipoproteins on a Low-Carb Diet An exciting new approach to treating obesity and insulin resistance involves significant carbohydrate restriction with the goal of achieving a ketogenic state that results in weight loss and improved insulin sensitivity. Many lipidologists, however, have seen frequent cases of worsening lipid and lipoprotein parameters with such carbohydrate-restricted diets. What’s going on here, what are the associated risks of this increased atherogenic lipoprotein burden for cardiovascular disease (CVD... more
CASEY ELKINS, DNP, NP-C	EBM Tools for Practice: An Evidence-Based Approach to Sitosterolemia Sitosterolemia is a rare, autosomal, recessively inherited sterol storage disease caused by homozygous or compound heterozygous gene mutations of adenosine triphosphate-binding cassette (ABC) genes G5 or G8, in which markedly increased tissue and plasma plant sterol concentrations. The condition can lead to premature atherosclerosis and has also been described as phytosterolemia and Beta-Sitosterolemia.^1-4 It was first described in 1974 by Bhatacharyya.⁵... more
RALPH VICARI, MD, FACC, FNLA MAYA N. ROA-SEGURA, PharmD, BCPS	Lipid Luminations: A Case of Covert Use of Red Yeast Rice Resulting in Severe Myositis This is the case of a 68-year-old white female who was being seen in her home in August 2014 as part of a health evaluation for her insurance company. She had a history of hyperlipidemia, hypertension, and diabetes mellitus. She had been placed on atorvastatin five years prior to this visit and developed significant myalgia with an elevation in her creatine phosphokinase (CPK) level to 250 mg/dL per patient. In addition to having myalgia at that time, she also complained of severe muscle... more
DEBRA A. FRIEDRICH, DNP, FNP-BC, BC-ADM, FAANP, FNLA	Specialty Corner: Lysosomal Acid Lipase Deficiency (LAL-D) When treating our lipid patients it is important to always consider unusual causes of dyslipidemia in our differential diagnosis. Although rare, lysosomal acid lipase deficiency (LAL-D) is often misdiagnosed as an autosomal dominant lipid disorder and/or fatty liver disease.¹ LAL-D is caused by genetic mutations that result in a marked decrease or loss in LAL enzyme activity in the lysosomes across multiple body tissues resulting in multi- organ damage and premature death.^{2,3... more}
PAVANI KOLAKALAPUDI, MD BASSAM OMAR, MD, PhD, FACC, FAHA	Case Study: Specialized Use of a Niacin-Statin Combination in Lipid Management Case: We report on a 77-year-old Caucasian male with coronary disease and hereditary dyslipidemia requiring intervention. He was treated with rosuvastatin 10 mg daily. This resulted in remarkable improvement of his low-density lipoprotein (LDL-C) to < 70 mg/dL and triglycerides (TG) to < 150 mg/dL, however, he continued to have elevated lipoprotein(a) [Lp(a)] with small, dense LDL — pattern B. A few years later, he required a carotid endarterectomy (CEA) for... more
HAROLD E. BAYS, MD, FTOS, FACC, FACE, FNLA	Chapter Update: A Transitional Year “What a day that was” – David Byrne, Talking Heads, Stop Making Sense Last year (2015) was a transition year that expanded upon the challenges and changes the National Lipid Association (NLA) had undergone for the prior couple of years. From a national perspective, at the demand of NLA members, the NLA released its NLA Recommendations for Patient- Centered Management of Dyslipidemia Part 1 and 2. These documents laid out NLA principles regarding lipid evaluation and... more
PAMELA B. MORRIS, MD, FACC, FACP, FACPM, FAHA, FNLA	Member Spotlight: Pamela B. Morris, MD, FNLA Pamela Morris, MD, is currently an associate professor at the Medical University of South Carolina where she serves as director of the Seinsheimer Cardiovascular Health Program and co- director of Women’s Heart Care. She is also the chair of the American College of Cardiology’s Prevention of Cardiovascular Disease Leadership Council and Section. When asked about the best part of her occupation, Dr. Morris said that she is very fortunate to have a career that is ever-changing and... more
FOUNDATION OF NLA ANNUAL REPORT	Foundation of the NLA 2015 Annual Report The Foundation of the National Lipid Association (FNLA) supports patient and clinician educational, research, and community outreach activities that enhance and support the initiatives of the NLA in its efforts to reduce cardiovascular events and deaths related to abnormalities of cholesterol metabolism. To read the Foundation's 2015 Annual Report in PDF format, click here. ... more
LAURENCE S. SPERLING, MD, FACC, FACP, FAHA, FASPC ANURAG MEHTA, MD DEVINDER S. DHINDSA, MD PRATIK B. SANDESARA, MD JEFFERSON T. BAER, MD, MPH	EBM Tools for Practice: Keep Things Flowing Smoothly: The Evolving Role of Aspirin in Primary ASCVD Prevention Acetylsalicylic acid, or aspirin, has played a central role in the secondary prevention of cardiovascular disease (CVD) for decades, but the data for primary prevention is less clear. The current recommendations are conflicting. The U.S. Preventive Services Task Force (USPSTF) and the American Heart Association (AHA) recommend consideration of aspirin use in patients who have a >10% risk of CVD in 10 years, while the U.S. Food... more