From the NLA President: Times They Are A-Changin’

There are many new influences on how dyslipidemia is managed today. While this is exciting, as is common with change, there are cogs in the wheel of progress. Healthcare providers and patients are aware of barriers for implementing therapies that appear to be efficacious for optimal care. Multiple factors are involved with this issue. While our newest class of approved anti-dyslipidemia medication, PCSK9 inhibitors, appear to be safe and efficacious, evidence demonstrating that they significantly lower cardiovascular risk is imminent.

Another factor is the high cost of therapy and failure of the insurance industry to provide approval for access. The National Lipid Association (NLA) is aware of these issues, and has embarked on several avenues to identify barriers and solutions surrounding them. The NLA’s “Challenges in Prescribing PCSK9 Inhibitors” survey results will be reported at the American College of Cardiology’s Scientific Session highlighting the specific issues facing providers. We also collaborated with likeminded organizations such as the American Society for Preventive Cardiology (ASPC) and the Association of Black Cardiologists (ABC) to identify barriers and embrace the diversity of patients representative of the NLA membership. These forums included town hall meetings and a national forum, which was convened to discuss value and access for heart disease and stroke prevention. These activities have resulted in publications to assist the provider in optimal care.

In November 2016, Pfizer announced the discontinuation of work with their PCSK9 inhibitor bococizumab. On a more positive note, two other PCSK9 inhibitors remain as investigational: one from Alnylam and the Medicines Company, and one from Eli Lilly. We look forward to further data from these trials, which if approved will be helpful in providing competition for this class and may help reduce cost.The work of Endo, Brown and Goldstein represented seminal work with the LDL receptor that lead to the development of statin therapies and later the introduction of PCSK9 inhibitors. This same work has now highlighted another potential arena for LDL lowering. Esperion is currently engaged in investigation of their adenosine triphosphate citrate lyase inhibitor (bempedoic acid). This is a novel, nonstatin therapy that works solely in the liver and blocks cholesterol biosynthesis. This mechanism is distinctly different from that of PCSK9 inhibitors and statin therapy. Once in the liver, bempedoic acid is converted to a coenzyme A (CoA) derivative, or ETC-1002-CoA, which directly inhibits ATP citrate lyase (ACL). This is a key enzyme that supplies substrate for cholesterol and fatty acid synthesis in the liver. Inhibition of ACL by ETC-1002-CoA results in reduced cholesterol synthesis and upregulation of LDL receptor activity in the liver. This promotes the removal of LDL-C from the blood. Bempedoic acid is an oral medication that is now in phase 3 trials, which is currently in enrollment. The purpose of the trial is to determine if bempedoic acid (ETC-1002) is effective and safe versus placebo in patients with elevated LDL cholesterol and who are statin-intolerant. Multiple other therapies continue to emerge and be investigated for the treatment of dyslipidemia, including those for treatment of elevated triglyceride and Lp(a) levels. This indeed is an exciting and promising time for lipid management and optimal treatment of our patients.

The NLA continues to move forward as the go-to organization for all things lipid and we are excited about upcoming events and efforts to keep our membership up to date. Here are a few noteworthy items:

15th Anniversary — Philadelphia

The 2017 NLA Scientific Sessions are scheduled for May 18–21 in Philadelphia, and we are celebrating the NLA’s 15th Anniversary. The program is outstanding, featuring nationally and internationally recognized faculty, including Daniel Rader, MD, FNLA; G. Kees Hovingh, MD, PhD, MBA; and Gerald Watts, MD, DSc, PhD. In addition to the Lipid Academy and Masters in Lipidology courses, the NLA is bringing back the Translation of the LDL Receptor: an NLA Core Curriculum Intensive Program. The LDL Receptor program provides a comprehensive 1.5-day course lead by leaders in the lipidology community. For more information on the preconference courses and the Scientific Sessions, visit lipid.org/sessions. Last year, the NLA awarded the inaugural W. Virgil Brown Distinguished Achievement Award. This year, come see Robert Eckel, MD, FNLA, receive the W. Virgil Brown Distinguished Achievement Award & Lectureship during the Scientific Sessions. You don’t want to miss the NLA 15th Anniversary Casino Night hosted by the Foundation of the NLA. Come support the NLA and the Foundation with a night of luck, charm, and dancing. Rumor has it, that a special guest will join the festivities. He has stated: “Wealth is not his that has it, but his that enjoys it.” Plan to come out to support the Foundation and share the wealth.

Strategic Planning

 The Executive Committee and distinguished guests met January 21–22 in Orlando for our annual strategic planning meeting. The focus of the meeting was to advance the organization’s educational offerings and develop new programming for the organization. We focused on discussion to expand the continuing education opportunities for the multidisciplinary membership. The membership will see improvements on our already successful meetings and courses in addition to new programmatic offerings and activity styles.

Junior Faculty Research Award

The NLA collected applications for the first-ever Junior Faculty Research Award. The initial window closed January 31. The selection committee is hard at work reviewing the applications for both the Basic Science Award and Clinical Research Award. While the window is now closed for this round of awards, the window will open again at the end of the year for the 2018–2019-award window. For more information, visit lipid.org/researchaward.

Spring CLU

Thank you to everyone for attending the Spring CLU in Phoenix. We had a wonderful meeting with internationally recognized faculty, including Antonio M. Gotto, MD, FNLA; Jennifer Robinson, MD, MPH, FNLA; and Sergio Fazio, MD, PhD, FNLA. We had a great time at the Foundation event, Food of Foot Tasting Tour, visiting various restaurants and sampling the local fare.

I hope to see you at the rest of the 2017 meetings.