Practical Pearls: Impact and Inclusivity - How the NLA Does It

History

We recently celebrated the twentieth anniversary of the NLA in 2022. It seems appropriate, when considering the impact of the NLA on the healthcare community, to reflect upon the environment in which the NLA was conceived, fostered, and evolved.   

In 1987 we started a lipid clinic in our cardiology practice, to call awareness to, and teach the nuances of lipid science relevant to cardiovascular disease prevention. By 1996, almost 10 years after the development and publication of the first set of NCEP Adult Treatment Panel guidelines, it was apparent that the established parameters were not being consistently implemented or impacting health care trends. The information needed to be disseminated by individuals with appropriate knowledge and training.

Physicians who are pioneers in the field of lipidology, including Michael Davidson, Peter Jones, Helmut Schrott, Bob Rosenson, Christie Ballantyne, Neil Stone, Paul Ziajka, and certainly the efforts of Lynn Cofer, our nursing director, all were instrumental in this effort to develop a national lipid training program. To consolidate the work, as well as fund such a program, the idea of combining forces to create one ‘umbrella’ organization emerged. This concept came to include advocacy for reimbursement of preventive services, championed by Paul Zjaika. 

From the expansion of the Florida Lipid Association to the Southeast Lipid Association under the guidance of Virgil Brown, it was apparent there was a great opportunity to gather, learn together, and combine our teaching efforts. 

Unequivocally, the pivotal event became the critically innovative step by Michael Davidson to develop a “Lipid Board Exam” which would address the broad curriculum of lipid science. Despite some initial resistance, he single-handedly wrote the first Lipid Self Assessment Program (SAP), and the Board Exam. Even those of us who thought we were very “knowledgeable” quickly realized we had much to learn!  Ever since, the NLA has had the reputation of providing deep science in the area of lipids, being a gathering place for all of us to learn together and becoming the proper forum to provide high quality education to all those with interest. 

Following this atypical start, after 20 years of growth and maturation, the NLA has developed into an extremely well respected, inclusive scientific organization, founded upon bylaws, a Board of Directors and executive management team, assuring the dissemination of the mission to “reduce cardiovascular disease through sound, evidence based preventive measures.” Our scientific statements have provided guidance to large numbers of clinicians and our input is requested by other professional organizations as they write expert consensus documents and guidelines. Our diverse membership is a great source of pride, and we have intentionally developed strategies which promote diversity, equity, and inclusion, while advocating and promoting the science of dyslipidemia and impact on cardiovascular disease risk.  

Influence and Impact

In its short 20-year existence, the NLA has made enormous strides in education and scientific recommendations, and inspires clinicians to implement greater modalities of care, particularly around inclusivity. There is still much work to do in the pursuit of cardiovascular risk reduction, but the NLA is working to close these gaps through innovative science and practice methods.

The NLA’s inclusive nature allows for many educational and training perspectives to be iterated in the development of scientific recommendations. The NLA scientific statements committee is composed of nutritionists, exercise physiologists, nurses, advanced practice clinicians, pharmacists, and physicians in multiple specialties. They collaborate on practical applications of data, challenges in management, treatment plans, identification of special populations, and then compile their expert knowledge into manuscripts. Each scientific statement is not only a manuscript available in the Journal of Clinical Lipidology, but also has supporting content noted on the NLA website, including a slide set, an infographic for patients, a podcast, and other educational resources. The NLA has created disease-specific scientific statements addressing important lipid-related health problems such as: 

• Familial Hypercholesterolemia (FH)¹, 
• Lp(a) in clinical practice², 
• Statin intolerance³,
• Analysis of clinical trials⁴,
• Coronary Artery Calcium Score⁵,  
• Non-HDL cholesterol⁶, 
• Inflammatory markers⁷, 
• Advanced genetic testing.⁸ 

The unique perspective of the NLA has fostered a patient-centered approach, addressing the needs of special groups with considerations such as ageing, higher risk ethnic groups, and specific disease states like diabetes, which are associated with high residual risk despite statin and lifestyle therapies.  Strategies which focus on improving adherence and maximizing team-based collaborative care are pivotal. The inclusive nature of the resources produced, free to clinicians by way of open-access articles, has distinguished the NLA within the healthcare community. The NLA welcomes cross-organizational collaboration, and because of this, we are reciprocally invited to participate in multi-society guidelines and projects.

Remaining Relevant

As the association has grown, matured, and gained recognition and respect within the healthcare community, it has set a course to further pursue greater scope of impact, by incorporating a Diversity, Equity, and Inclusion (DEI) committee. Global conversations about justice, equality, and tolerance inspired the NLA to form this group in 2020. Since then, the NLA has been able to commit to the following actions:

1. Affirming diversity, equity, and inclusion as a core value in all aspects of our mission.
2. Developing a structure to focus efforts on promoting diversity within our organization.
3. Including social determinants of health and bridging gaps in knowledge related to lipid management in scientific literature. 
4. Ensuring this topic is included in our educational offerings, from both a provider and patient perspective. 

These efforts are long overdue within organizations representing healthcare professionals, including the NLA, which must do more than just consider inclusive approaches. In our effort to do more, the DEI committee reviews the agendas for each scientific session for content and composition of speakers. We have begun translating our clinical patient management ‘tear sheets’ into languages other than English. We are including implicit ‘bias training’ for NLA and its leadership. The National Lipid Association and the Foundation of the NLA are participating in collaborative, interdisciplinary projects with special-interest organizations, to develop further plans and projects in this arena. 

The NLA and its membership are working to bridge gaps in knowledge regarding new therapies, novel cures for disease, and management of genetic conditions, with special attention to underserved, vulnerable, diverse communities and populations. Some may find these aspirations lofty, but this organization and its membership has the history, the structure, the collaboration, the drive to do this, and more. 

Conclusion

In summary, the NLA has evolved into the most credible place for all clinicians to gain the knowledge required to become outstanding experts in the field of Clinical Lipidology as well as receive the credentials necessary for career success. The reputation of the NLA has reached a point where its members have been asked to participate in the development of national guidelines by major specialty organizations and NLA contributions have been pivotal in those guidelines. We can take great pride in our diverse membership and leadership across many dimensions such as ethnicity and gender, as well as professional diversity including nutritionists, nurses, advanced practice clinicians, pharmacists, pharmaceutical representatives and physicians in multiple specialties. One of the most important characteristics of the organization, however, remains the warm feeling of “family” that is evident at every meeting. All the leading experts in the field attend and are happy to share their knowledge unselfishly with anyone who asks. I often hear from new members, “What makes lipidologists such a friendly bunch?” My answer, “We are a lonely bunch who rarely can find others who want to talk lipids!” Thanks to the National Lipid Association, we now have a growing number of people who are interested in the field and who will lead the organization and the specialty forward towards a very bright future.

Dr. Brown has received honoraria from Amgen, Regeneron, Merck, Amarin, Esperion, and Ionis. Dr. Wyne has received research funding from Intercept and Amryt Pharmaceuticals. Dr. Duprez has no financial relationships to disclose.

References

1. Goldberg AC, Hopkins PN, Toth PP, et al. Familial Hypercholesterolemia: Screening, diagnosis and management of pediatric and adult patients. Journal of Clinical Lipidology. 2011;5(3). doi:https://doi.org/10.1016/j.jacl.2011.03.001
2. Wilson DP, Jacobson TA, Jones PH, et al. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. Journal of Clinical Lipidology. 2019;13(3). doi:https://doi.org/10.1016/j.jacl.2019.04.010
3. Cheeley MK, Saseen JJ, Agarwala A, et al. NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient. Journal of Clinical Lipidology. 2022;14(4). doi: https://doi.org/10.1016/j.jacl.2022.05.068
4. Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 1 - Full Report.  Journal of Clinical Lipidology. 2015,9(2). ttps://doi.org/10.1016/j.jacl.2015.02.003
5. Orringer CE, Blaha MJ, Blankenstein R, et al. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. Journal of Clinical Lipidology. 2020;15(1). doi: https://doi.org/10.1016/j.jacl.2020.12.005
6. Blaha MJ, Blumenthal RS, Brinton EA, et al. The importance of non-HDL cholesterol in lipid management. Journal of Clinical Lipidology. 2008,2(4). doi: https://doi.org/10.1016/j.jacl.2008.06.013
7. Davidson MH,  Ballantyne CM, Jacobson TA, et al. Clinical utility of inflammatory markers and advanced lipoprotein testing: Advice from an expert panel of lipid specialists. Journal of Clinical Lipidology. 2011,5(5). doi: https://doi.org/10.1016/j.jacl.2011.07.005
8. Brown EE, Sturm AC, Cuchel M, et al. Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association. Journal of Clinical Lipidology. 2020,14(4). doi: https://doi.org/10.1016/j.jacl.2020.04.011