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Practical Pearls

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Kaye-Eileen Willard, MD, FNLA

Practical Pearls: Navigating a Patient’s Roadmap through Effective Care

The focus of this article is to provide a guide for clinicians and patients to effectively navigate the healthcare system in general, as well as in terms of specific lipid-related health concerns. Lennert Griese et al. in their 2020 article, “Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy”1, discuss a patient's need for ‘navigational health literacy’ to orient themselves within healthcare systems. In this... more

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Pamela L. Alebna, MD, MPH
Leonid Khokhlov, MD
Anurag Mehta, MD, FACC

Practical Pearls: Dyslipidemia Management in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Key points

  • MASLD is a risk factor for atherosclerotic cardiovascular disease and is associated with cardiometabolic risk factors, such as obesity (adiposopathy), hypertension, insulin resistance, diabetes and dyslipidemia.
  • The cornerstone of MASLD management is aggressive treatment of risk factors, lifestyle interventions, and reducing excess adiposity.
  • Dyslipidemia occurs in approximately 60-70% of individuals with MASLD.
  • ... more

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Alan Brown, MD, FACC, MNLA
Kathleen Wyne, MD, PhD, FACE, FNLA
Daniel Duprez, MD, PhD, FAHA, FACC, FESC, FASH, FNLA, FASPC

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... more

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Priyanka Satish, MD
Sherwin D’Souza, MD, FACE*
Anandita Agarwala, MD

Practical Pearls: When Is It Reasonable to Consider Withholding Lipid Lowering Therapy?

Lipid lowering therapy is a cornerstone of cardiovascular risk reduction. However, withholding or stopping lipid lowering therapy may be worth consideration in some individuals. These include elderly patients with comorbidities limiting life expectancy, individuals with a coronary artery calcium score of 0 (CAC =0), patients with end stage renal disease (ESRD), and pregnant and lactating women. This review will discuss these scenarios.

Primary Prevention in Elderly Patients... more

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Sarah Miller, MS, RDN, CDN, CDCES

Practical Pearls: Polyphenols Protective Effects

Cardiometabolic Disease and Polyphenols

Cardiometabolic disease is the concurrence of several disease states, including impaired glucose tolerance, hypertension, dyslipidemia, and visceral adiposity. These risk factors predispose patients to chronic diseases such as type 2 diabetes mellitus, stroke and heart disease. Lifestyle modification has been used effectively to reduce several of these risk factors and even delay or prevent the onset of cardiometabolic disease... more

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KATHERINE MANOU, PharmD, BCACP
ROBERT BLOCK, MD, MPH, FACP, FNLA*

Practical Pearls: Tools for Alleviating Drug Disparities in Lipidology

The armamentarium for lipid-lowering pharmacotherapy is evolving. Though statins remain the cornerstone of treatment, and nearly all statins and ezetimibe are generic, recent and emerging therapies such as PCSK9 inhibitors, bempedoic acid, evinacumab, and inclisiran will pose significant challenges in patient access and affordability. When a prescription is sent to a patient’s pharmacy, there is a lot left to chance:

●    Will it need prior authorization?
●... more

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ANN LIEBESKIND, MD, FAAP, FNLA

Practical Pearls: Telemedicine and the Patient Experience

Telemedicine is Here to Stay
Telemedicine is a valuable tool for patient care, but one that has been underused and underdeveloped for many years. When COVID-19 interrupted daily life as we knew it, telemedicine abruptly entered the mainstream of healthcare. It is estimated that provider networks are performing between 50 to 175 times the level of telemedicine that they were pre-COVID. The telehealth industry is here to stay, so understanding how to best incorporate... more

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EUGENIA GIANOS, MD, FACC, FASE, FNLA
RACHEL NAHRWOLD, AGNP-BC

Practical Pearls: How I’m Utilizing Telehealth and EHR-Based Tools to Change my Practice

We can all agree that life has now been forever divided into eras of ‘before and after the coronavirus of 2019 (COVID19)’ with a tidal shift impacting our personal lives and every aspect of medical care, including the traditional healthcare appointment. COVID-19 has highlighted the suboptimal risk factor control of our patients that predisposes them to worse outcomes, disparities in access to clinical care, and the multiple inefficiencies of our current healthcare system. With these factors... more

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THOMAS R. WHITE, MD, FNLA
DHARMESH PATEL, MD, FACC, MBBS (London), FACP, FASPC, FNLA

Practical Pearls: The Young Active Asymptomatic Patient With Very High LDL-C

We present a clinical case and offer Practical Pearls from primary care/Lipid Specialist and cardiology for management of a common scenario, reinforcing the importance of a clinician-patient discussion.

Key points:

  • Severe hypercholesterolemia (LDL-C ≥ 190 mg/dL)​
    • is a high-risk condition
    • warrants high-intensity statin
    • warrants outreach to family members (cascade screening) to test their lipid profile (+/- FH genotyping) and Lp(a)... more

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NICOLE CIFFONE, MSN, ANP-C, AACC, CLS, FNLA
SUSAN HALLI-DEMETER, DNP, FNP-BC, CLS, FNLA

Practical Pearls: Motivation from Failure

Imagine the following scenario:
   
Your patient presents for a routine follow-up appointment. As you review the chart you realize the labs, blood pressure, and/or weight deteriorated since the last visit.  You recall sharing valuable clinical pearls with the patient and providing ample counseling, but now you are questioning if you did enough. As you enter the room the patient appears hopeful to hear good news, excited to tell you how they tried to follow the plan of care you... more

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MRINALI SHETTY, MD
DAVID DAVIDSON, MD, FACC, FNLA

Practical Pearls: Recognition and Treatment For Fabry’s Disease and Morquio A Syndrome

Fabry’s Disease and Morquio A syndrome are two rare genetic diseases that lead to a diverse series of problems including cardiovascular.(1,30) Until recently, treatment options have been limited to treat these conditions. Now that there are available therapies to help improve quality and quantity of life, (20,46) it is important to be able to recognize these conditions in clinical practice to help initiate treatment earlier. The goal of this “Practical Pearl” is to help identify these... more

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EDWARD GOLDENBERG, MD, FACC, FACP, FNLA
STEPHEN MENG, MD
HEATHER MILEA, MSN, FNP-BC, PCCN, CHFN
RAVEEN CHAWLA, MD

Practical Pearls: A Personalized Approach to Risk Stratification

Discuss this article at www.lipid.org/lipidspin 

Clinical practice guidelines are integral to daily management of cardiovascular diseases, including hyperlipidemia. The most recent 2018 Multisociety Cholesterol Guidelines advocate for a more personalized approach to risk assessment. Consider the following vignette: A 50-year-old man of South Asian descent with... more

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CEZARY WÓJCIK, MD, PhD, DSc, FNLA

Practical Pearls: Top 10 Ways to Reduce Inflammation

Inflammation is a dynamic process with many interconnected signaling pathways involving multiple classes of cells by which the human body responds to pathogen exposure and/or tissue damage, playing a central role in all stages of atherosclerosis. (1) Cholesterol crystals directly activate nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and interleukin 1 beta (IL-1β) production. Therefore, cholesterol lowering, per se, has an anti-inflammatory effect.(2... more

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ADINA S. GUTSTEIN, MSN, CRNP, CLS, FPCNP

Practical Pearls: Severe Hypertriglyceridemia in a 40-Year-Old Woman: Using the ApoB App to Confirm a Diagnosis and Target Future Cardiovascular Risk

Case History

Mary is a 40-year-old school teacher who was referred for severe elevation of triglycerides (TGs). She has a past medical history of hypertension, gestational diabetes, pregnancy-induced hypertension, former tobacco use and idiopathic gastroparesis. She was not pregnant at the initial consultation, and reported regular menses. She denied knowledge of hypertriglyceridemia during pregnancy. Family history was notable for premature coronary heart disease (... more

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COLLEEN GROVES, RD, LD, CDE

Practical Pearls: Diet and Disparities

Providing education on healthy eating to the underserved population can be challenging. As a dietitian in a rural federally qualified health center, I often am asked to see patients with abnormal lipids, diabetes, obesity and/or cardiovascular disease who have difficulty affording the foods recommended by their healthcare provider. Many of these patients have to stretch small food budgets or receive from social services small stipends that comprise their entire food budget. These same... more

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JOEL MARRS, PharmD, BCPS, BCACP, CLS, ASH-CHC, FNLA

Practical Pearls: The Potential for Hypoglycemic Agents to Affect Lipid Parameters

Clinical Question: What are the common hypoglycemic agents that can affect lipid parameters and which parameters are effected?

Many patients with diabetes mellitus have indications for statin based lipid-lowering therapy because of their high risk of cardiovascular disease as recommended by the American College of Cardiology/ American Heart Association, American Association of Clinical Endocrinologists, American Diabetes Association and the National Lipid... more

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TERRANCE J. MORAN, MD, FACC, FAHA

Practical Pearls: Statins and Fibrates: A Re-Interpretation of the Data

On April 18, 2016, the FDA announced retraction of prior approvals related to the combination of a statin with fenofibrate.1 This decision was prompted by the results of the ACCORD Lipid Trial, which failed to show reduction in cardiovascular events in diabetics when fenofibrate was routinely added to a statin.2 The question now is whether this failure applies to all patients or might there be a group that does benefit from a fibrate-statin combination?

We will review the fibrate... more

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JOHN P. STEIN, MD

Practical Pearls: My Statin or My Sarcolemma? Could Vitamin D Provide Some Answers for Improved Statin Compliance?

Most coronary heart disease occurs in those over the age of 65.1 Statins reduce cardiovascular morbidity and mortality in both primary and secondary prevention. Data from the Cholesterol and Recurrent Events (CARE),2 Long-term Intervention with Pravastatin in Ischemic Disease (LIPID),3 and Scandinavian Simvastatin Survival Study (4S)4 trials have shown statins to be as effective in the elderly as in younger populations.5 The NLA Recommendations for Patient-Centered Management of Dyslipidemia... more

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SAMUEL S. GIDDING, MD

Practical Pearls: Should Lipid Recommendations for Children be Gender Specific?

It is well known that women are not protected from cardiovascular events but experience event rates at older ages equivalent to men after a 10-year lag time. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study showed similar findings regarding atherosclerosis, with 25- to 34-year-old women having much less atherosclerosis than similarly aged men and only slightly more atherosclerosis than 15- to 24-year-old adolescents/men.1 This naturally raises the question... more

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PAMELA B. MORRIS, MD, FACC, FACP, FACPM, FAHA, FNLA

Practical Pearls: Selection of Dyslipidemia Guidelines in Special Populations

Atherogenic lipoproteins play a critical role in the initiation and progression of vascular atherosclerosis, and decades of research have clearly demonstrated the benefits of lipid-lowering therapy for prevention of atherosclerotic cardiovascular disease (ASCVD) events. However, despite the publication of guidelines for management of dyslipidemia by numerous professional societies, there still are inadequate numbers of patients receiving evidence-based therapy. One factor contributing to... more

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DONALD G. LAMPRECHT, PharmD, BCPS, FNLA, CLS
LISA J. SCHWELLENBACH, PharmD, BCPS

Practical Pearls: Lowering Triglycerides with Omega-3 Fatty Acids

Approximately 27 percent of adult Americans have elevated (≥ 150 mg/ dL) fasting triglycerides (TG).1 This commonly encountered dyslipidemia is an important indicator of the presence of atherogenic lipoprotein particles and may be considered a modifiable risk factor for cardiovascular disease.2 While genetic defects are responsible for familial forms of hypertriglyceridemia, secondary causes of hypertriglyceridemia often can be attributed to dietary factors (e.g. very... more

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