Winter 2015 LipidSpin Articles

CARL E. ORRINGER, MD, FACC, FNLA

From the NLA President: PCSK9 Inhibitors: A New Option for the Highest Risk Patients

On July 24, 2015, the United States Food and Drug Administration approved the clinical use of the PCSK9 inhibitor, alirocumab, as an adjunct to diet and maximally tolerated statin therapy for adults with heterozygous familial hypercholesterolemia (HeFH) or atherosclerotic cardiovascular disease who require additional lowering of LDL-C. On Aug. 27, 2015, evolocumab was approved for the above indications and for treatment of patients with homozygous familial hypercholesterolemia (HoFH).

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P. BARTON DUELL, MD, FNLA

From the PLA President: Specialty Care in Clinical Lipidology

Welcome to the Fall issue of the LipidSpin. It is a great honor and privilege to have the opportunity to serve as the president of the Pacific Lipid Association (PLA) during the coming year. An important goal of the National Lipid Association (NLA) is to be responsive to the diverse needs and interests of individual members and their regional chapters, while maintaining cohesiveness in the organization from the grassroots level all of the way up to the national board and executive... more

DANIEL SOFFER, MD, FNLA
JOSEPH J. SASEEN, PharmD, BCPS, BCACP, FNLA

Letter From the LipidSpin Editors: Full Speed Ahead

Dr. Soffer:
Greetings from Philadelphia. Dr. Saseen and I are very excited to be the new editors of the LipidSpin. Like many of you, I am a long-time reader and occasional contributor, and I consider it a great honor to be entrusted with this responsibility.

As the editors, Joe and I are charged with the task of curating a forum that serves as the member voice of the NLA.

The LipidSpin is an opportunity for the membership to engage... more

NATHAN D. WONG, PhD, FACC, FAHA, FNLA
PAUL D. ROSENBLIT, MD, PhD, FACE, FNLA

Clinical Feature: PCSK9 Monoclonal Antibody Therapy – The Latest Data and Who is Appropriate for Treatment

The most significant advance in clinical lipidology and preventive cardiology in 2015 is the availability of proprotein convertase subtilisin-like kexin type 9 (PCSK9) monoclonal antibody (mAb) therapy. This potent breakthrough therapy has garnered as much excitement as the release of statin therapies more than two decades ago, but important considerations remain regarding patient selection, regulatory limitations of use and unproven ASCVD risk reduction benefits in the absence of long-term... more

ANDREA E. DEBARBER, PhD
P. BARTON DUELL, MD, FNLA

Guest Editorial: Tuberous and Tendon Xanthomas: Don’t Overlook Sitosterolemia or Cerebrotendinous Xanthomatosis

Some inherited lipid disorders can be recognized by the deposition of cholesterol and other lipids in lesions on the body termed xanthomas. Lipid deposition can occur in cutaneous and subcutaneous structures, including tendons, with the pattern of deposition characteristic of the underlying genetic disorder. Tuberous xanthomas are nodules frequently localized to the extensor surfaces of elbows, knees, knuckles, and buttocks. Tendon xanthomas are subcutaneous nodules found in fascia,... more

TERRANCE J. MORAN, MD, FACC, FAHA

EBM Tools for Practice: Guideline Fusion: A Reasonable Approach to Lipid Management

My old professor used to say that one could expand to mediocrity or shrink to excellence. There are now at least eight major organizations with cholesterol management guidelines,1,2,6,8,9,12,16,18 and another four organizations with special- population recommendations.7,13,14,17 A recent review of this glut of guidelines concluded, “The number of published guidelines for management of LDL- related ASCVD risk and the substantive differences in recommendations may... more

ERIC K. GUPTA, PharmD, BCPS, FNLA

Lipid Luminations: CETP Inhibitors: Where Are They Now?

A decade ago, the lipid community was eagerly awaiting the completion of Phase III trials of torcetrapib, the first- in-class of the cholesteryl ester transfer protein (CETP) inhibitors. Given the epidemiological assumptions that every 1.0 mg/dL increase in high-density lipoprotein cholesterol (HDL-C) is associated with a 2 percent reduction in cardiovascular events,1 the prospects of torcetrapib increasing HDL-C 106 percent2 led many of us to believe that the... more

ROB GREENFIELD, MD, FACC, FAHA, FNLA

Specialty Corner: The Clinical Lipid Specialist: The Opportunity of Responsibility

“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” – Sir Winston Churchill

Like many specialties, being a specialist in clinical lipidology is an ongoing process, if not a pathway. Many of us made the decision to enhance our careers and take this pathway for different reasons. Personally, as an interventional cardiologist, it was treating at 4 a.m. a young patient with recurrent unstable angina despite several prior... more

CARLOS A. DUJOVNE, MD, FNLA

Practical Pearls: Evaluating and Managing Myopathies in Dyslipidemics

Statins prevent atherosclerotic cardiovascular diseases (ASCVD). Hepatic injury (my patients most feared effect) occurs in ≤1 percent and is similar on placebo. Elevated hepatic transaminases typically resolve spontaneously and mostly are a result of dyslipidemia causing hepatosteatosis and/or cholelithiasis.1

Myopathies are a potential side effect of statins that may be associated with untreated dyslipidemias.2-5 Myalgias with or without elevated serum creatine... more

P. BARTON DUELL, MD, FNLA

Case Study: Effects of Mipomersen in Combination with Lomitapide in Homozygous Familial Hypercholesterolemia

Mipomersen and lomitapide are specialty medications FDA-approved for the treatment of patients with homozygous familial hypercholesterolemia. Mipomersen is an antisense oligonucleotide that decreases the translation of apolipoprotein B in the liver and reduces concentrations of very-low-density lipoprotein cholesterol (VLDL-C), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B, and lipoprotein(a) in plasma.1,2... more

P. BARTON DUELL, MD, FNLA

Chapter Update: The Latest from the Pacific

The Pacific Chapter of the National Lipid Association continues to be demographically and geographically diverse. We currently have 424 members (about 15 percent of the NLA membership in the U.S.) who are scattered among nine states comprising roughly 1,434,027 square miles of land. This translates into a PLA membership density of one member per 3,382 square miles. Since many PLA members are congregated in larger cities, and there are numerous areas in the West that are sparsely populated,... more

MICHELLE TAYLOR, ACNP, MSN

Member Spotlight: Michelle Taylor, ACNP, MSN

As an acute care nurse practitioner at Orange Coast Memorial Hospital, Michelle Taylor, ACNP, MSN, loves teaching and working with her patients. Being a nurse for 27 years has given her the ability to speak to patients and explain more complex things in a way they can really understand.

Taylor spends her busy days splitting time between supervising stress tests, rounds in the ICU, prepping open heart patients for surgery, evaluating STEMI heart attack patients that come through the... more

ANNE C. GOLDBERG, MD, FNLA

Foundation Update

The Foundation of the National Lipid Association continues to work on increasing its visibility as well as efforts to increase awareness of lipid disorders and management. We are continuing to work in the area of underdiagnosed and undertreated lipid disorders.

We have also continued our popular fundraising events. In September, the Foundation hosted “Cooking with the Foundation” at the Fall Clinical Lipid Update in Pittsburgh. This fun and interactive cooking event took place at... more