Clinical Lipid Update Highlights

 
 

Joshua W. Knowles, MD, PhD, FAHA, FACC
Instructor, Cardiovascular Medicine
Stanford University
Attending Physician, Stanford Center for Inherited Cardiovascular Disease
Familial Hypercholesterolemia (FH) Clinic
Cardiovascular Medicine
Chief Medical Officer, The FH Foundation
Diplomate, American Board of Clinical Lipidology
Stanford, CA

"Nuts and Bolts" of Genetic Testing for Familial Hypercholesterolemia

Genetic testing for Familial Hypercholesterolemia (FH) has been shown to be both efficacious and highly cost-effective when incorporated into national screening algorithms in several European countries. In addition, genetic testing for FH is recommended as part of the NLA guidelines for cases where clinical lab and presentation are uncertain. In this talk we will discuss the indications for FH genetic testing and the "nuts and bolts" of genetic testing including: Practical information on how to order the tests; which labs are routinely doing FH genetic testing; the cost and turnaround time that can be expected; the basics of interpreting the genetic test report and special considerations for genetic testing such as requirement for patient consent. The hope is that clinicians will no longer view FH genetic testing as a "black box" but will be able to incorporate genetic testing into their diagnostic armamentarium.

 
 
 

Alan T. Remaley, MD, PhD
Section Chief of Lipoprotein Metabolism Section Cardiopulmonary Branch
National Heart, Lung, and Blood Institute
Bethesda, MD

Translating New Findings in HDL Biology into Novel Therapeutics

High Density Lipoproteins (HDL) compose the major anti-atherogenic fraction of lipoproteins, but despite over 50 years of research, we still do not fully understand their biological and chemical properties. This fundamental lack of understanding of HDL has limited the progress in developing therapeutic strategies for modulating HDL for the prevention and treatment of cardiovascular disease. In this lecture, we will review the current state of HDL research and describe one example, namely recombinant Lecithin: Cholesterol Acyltransferase (LCAT), in which new discoveries in the field of HDL metabolism have recently been translated into a potential new therapy. The role of LCAT in HDL metabolism and Reverse Cholesterol Transport will be reviewed, as well as the effect of recombinant LCAT in pre-clinical animal models of cardiovascular disease. Finally, the results of a Phase I clinical trial of recombinant LCAT in patients with stable cardiovascular disease will be presented, along with the effect of recombinant LCAT infusion on HDL metabolism and renal function in patients with Familial LCAT Deficiency.

 
 
 

Marc T. Hamilton, PhD
Professor
Inactivity Physiology Department
Pennington Biomedical Research Center
Baton Rouge, LA

Cardiometabolic Consequences of Sitting Time

Since we first proposed the "inactivity physiology" paradigm a decade ago, there has been a global movement of experts taking notice of the time people sit. Sedentary time (mostly sitting) is independent of moderate to vigorous activity (“exercise”) and is more related to low intensity physical activity. Current studies are probing the association of inactivity with risk factors for metabolic syndrome, coronary artery diseases, type 2 diabetes, obesity, some cancers, deep venous thrombosis, and mortality. Our early work identified the most potent molecular mechanism known to regulate lipoprotein lipase (LPL) activity in skeletal muscle. Non-fatiguing and intermittent light activity throughout each hour of the day has better effects on LPL activity and some other processes than does exercise training. Another example is a novel inactivity-responsive gene that potentially may prevent DVT. Experimental and epidemiological studies have recently provided evidence that the healthy effects of low-intensity physical activity are independent of the type of moderate activity historically recommended (but practiced by <10% of the population). This has generated much enthusiasm among public health experts because of the potential for providing more effective behavioral solutions to the millions of people who cannot (or will not) do moderate intensity exercise.

 
 
 

Michael B. Bottorff, PharmD, FCCP, FNLA, CLS
Professor and Chair
Department of Pharmacy Practice
South College School of Pharmacy
Diplomate, Accreditation Council for Clinical Lipidology
Knoxville, TN

Generics and Manufacturing: What Prescribers Need to Know

In recent years a number of major "blockbuster" drugs have become available in generic form. Many of these generics are indicated for treating dyslipidemias. Generic drugs comprise approximately 8 out of every 10 prescriptions filled in the United States and therefore represent a significant savings to patients compared to the brand name equivalent. Since the passing of the Hatch-Waxman Act in 1984, generic drugs are approved based onbioequivalence to their branded counterpart, without the need for expensive and lengthy safety and efficacy trials. Bioequivalence is usually determined in healthy volunteers based on FDA-set upper and lower boundaries for specific pharmacokinetic parameters such as area under the curve (AUC) and maximum achieved serum concentration (Cmax). Generic drugs deemed bioequivalent are listed as AB rated in the FDA Orange Book, and therefore may be substituted for the brand name drug according to most state laws. The prescriber should be confident that an AB rated drug is not only bioequivalent to its branded counterpart, but that it would share the same efficacy/safety profile and be subjected to the same manufacturing/packaging standards as any approved drug in the United States.

 
Publish Date: 
Friday, January 1, 2016 - 01:15

This page was last updated: Jan 11, 2017