Editor's Corner: "The Only Constant in Life is Change"

"Charles Darwin didn’t say that only the strong survive, he said those who survive are the ones who most accurately perceive their environment and successfully adapt to it." - Leon Megginson

In many ways, we are at a crossroads. Emphasis on the focal point of Darwin’s fundamental theory as quoted above: Survival depends on the ability to assess one’s environment and change accordingly. 

Firstly, this edition of the LipidSpin has been a daunting task to complete, with a topic that is inherently “slippery” and has many hidden aspects. The result, however, is one we truly hope provides some additional insights to our membership about the very challenging topic of Exploring the Costs of Cardiovascular Disease Management. We all recognize the intrinsic benefit of risk screening, risk stratification, appropriate diagnostic testing and pharmacological interventions for the right patient, at the right time. And yet, in spite of the importance, the cost to the patient who adheres to the lifestyle and medication regimens we define for them may be prohibitive. We have many times recognized and reviewed the social determinants of health as they impact our patients and influence their decision making, of what to prioritize in their health care. Sometimes it is as basic as buying groceries, or buying medicines. 

So, one of our crossroads to face is the very intangible specter of addressing whether we can continue with our current approach to “reactive healthcare”. By that, we must recognize that we as a healthcare system, in the US and globally, are adept at providing care for disease management, cardiovascular and otherwise. And it is prohibitively and unsustainably expensive! However, as we have shifted our mission statement of the NLA to focus on optimizing cardiovascular and metabolic health, rather than a disease management focus, we also must recognize this entails a paradigm shift from reactive medical interventions to a primary focus on prevention. This too is costly, from an infrastructure standpoint, and a philosophical one in terms of the energy expenditure needed to redirect the spotlight to primordial and primary prevention.

Additionally, however, the other crossroad which we face is the future of the LipidSpin. In the last year or two, it has become increasingly challenging to create a consistently meaningful product, which fills the fundamental goals of the journal:

• A reliable, practical educational source of relevant information regarding best practice in lipid management,
• AND an opportunity for chapter engagement to determine themes, as well as provide opportunity for authorship (and serious mentorship) to individuals without significant writing experience.

We have analyzed the challenges thoughtfully and together, leaders in the NLA have recognized the need to evolve into a different and ideally more compelling, contemporary format. How exactly that will look is not entirely clear but does involve the development of a more digital and social media directed educational tool which will allow us to put our energy in the right places. It is with mixed emotions that I have endorsed this concept, but wholeheartedly do so now after much reflection. Analysis of the environment in which we live, and adaptation to our changing circumstances is mandatory for survival.

I want to profusely thank the Communications Committee functioning as associate editors of the journal and all of the prior editors of the LipidSpin who have forged the way to create editions which fulfill the need to provide evidence-based knowledge and guidance to our readers. And, most importantly, I want to thank the authors who have contributed over the years to make this a well-respected journal within our membership. Finally, I want to thank D’Ayn Sayre on our NLA staff, who has tirelessly kept all of us on track to bring this work to fruition each time. And in addition, her contributions of wonderful and creative graphics have been amazing!

In closing, I will share two more quotes which describe the ethos of what we have done and are about to do with the LipidSpin, and what we hope to do in healthcare today: 

“All changes, even the most longed for, have their melancholy; for what we leave behind is a part of ourselves; we must die to one life before we can enter another.” - Anatole France

“Change is the law of life. And those who look only to the past or present are certain to miss the future.” - John F. Kennedy