Letter From the Lipid Spin Editors: Holiday Gifts

I write this with the holiday season having just passed us. As I sit back and reflect on the past year, it occurs to me that we have much to be thankful for! This past year we embraced the extensive statin safety report from the National Lipid Association. This was followed in September by the release of our Recommendations for the Patient-Centered Management of Dyslipidemia.

Finally, just this past November in Chicago at the American Heart Association meeting, the long-awaited results of the IMPROVE-IT study were released. While purists might argue this was not a titrate-to-goal study, the results only strengthen the concept that atherogenic lipoproteins play a central causal role in the development of atherosclerosis and by extension targeting Non-HDL cholesterol, apolipoprotein B, and/or LDL particle number to lower goals is key to the prevention of atherosclerotic cardiovascular disease.

Just recently, data published in the American Journal of Managed Care suggests that “increasing medication adherence was associated with improved LDL-C levels.”1 While IMPROVE-IT focused on a population of high risk patients at the very low end of the LDL cholesterol spectrum, when placed next to the accumulated data preceding IMPROVE-IT, it would be hard not to extrapolate the inference to high risk patients not at goal, who by definition potentially can gain even greater benefit from larger absolute reductions in LDL-C, Non-HDL-C, ApoB, and LDLp.

For those of us who care for patients with inherited disorders of LDL metabolism such as Familial Hypercholesterolemia (FH), this further reinforces NLA’s Recommendations to reduce LDL-C to <100 mg/dL in high risk patients with FH, and it also suggests that using non-statin medications, such as ezetimibe, is an important part of this management.

Recent data from new medications in development, particularly PCSK9 inhibitors, also suggests that even at low attained LDL-C levels in high risk patients additional cardiovascular risk reduction may be achieved. This is an exciting time to practice clinical lipidology! The future is bright with hope and for even greater expectations for our patients. New and improved interventions are right around the corner; and our approach fits perfectly with the aggressive utilization of current and future pharmacologic interventions. Combining these options with our continued focus on lifestyle interventions and aggressive patient and physician education programs is our gift that keeps on giving — right now and in years to come.

Happy New Year to you and yours!  

References are listed on page 35 of the PDF.