Lipid Luminations

You can't follow your patients to the supermarket or sit down with them at the dinner table. What advice can you give them about healthy dietary oils and fats and the relative risks of unhealthy fats in the short time you have to educate patients in your office? Host Dr. Alan Brown asks these questions and more of Dr. Wahida Karmally, director of nutrition at the Irving Center for Clinical Research at Columbia University Medical Center in New York.

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A series of well-established risk factors define the metabolic syndrome in adults. The situation is less clear for our younger patients, as they typically do not develop cardiovascular disease or experience cardiac events. The key for kids, it seems, is to determine their risk for disease in adulthood and help them with prevention or management. Are we improving our capacity to assess and reduce this risk? Where should we orient future research on pediatric metabolic syndrome? Host Dr. Larry Kaskel tackles these questions and more with Dr. Julia Steinberger, associate professor of pediatrics, the Dwan Endowed chair in pediatric cardiology, and director of the Pediatric Lipid Clinic at the University of Minnesota Medical School.

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Cardiometabolic risk simply includes a series of cardiovascular factors and a series of metabolic risk factors. Less easy to determine, is exactly what we can do that will effectively and efficiently reduce this risk. Dr. Karol Watson, associate professor of medicine at the University of California, Los Angeles (UCLA) David Geffen School of Medicine, and director of the UCLA Cholesterol and Lipid Management Center, takes a look at what is working, as well as the areas where we can make more progress toward suppressing the drivers of cardiovascular and metabolic diseases. Dr. Larry Kaskel hosts.

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Many of us have experienced the frustration of seeing an obese patient who wants to make progress with their weight, but just can't achieve their desired result for any number of reasons. There is a great deal of evidence to suggest that diet and exercise, in the long run, will do more than any combination of medicines; the rub, of course, is how we get them on that magical ‘eat right and exercise' regimen. Dr. Paul Bradley, associate professor of medicine at Mercer University School of Medicine in Georgia, explains why some patients may find that a physician-centered team approach to weight loss could be their answer. Dr. Larry Kaskel hosts.

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Dr. Frank Sacks, professor of medicine at Harvard Medical School and professor of cardiovascular disease prevention in the nutrition department at Harvard's School of Public Health, gives us an update on the long-standing debate about weight loss. New evidence from Dr. Sacks' research tells us that the specifics of macronutrient consumption appear to matter less than general calorie reduction. Yet many folks who did lose weight during this trial gained it back after its conclusion. So what's next? Can we find ways to tailor calorie-reducing diets to the preferences of each patient, or is large-scale gastric surgery the next best option for reversing our obesity epidemic? Dr. Larry Kaskel hosts.

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The answer almost assuredly is patient-specific, but the question of lipid-lowering as the end or the means in measuring cardiovascular risk highlights the ongoing discussion in medicine about targets: whether how we get there is more important than just getting there. Dr. Roger Blumenthal, professor of medicine in the division of cardiology at Johns Hopkins University School of Medicine, goes beyond a focus on lipid numbers in this discussion with host Dr. Larry Kaskel. As Dr. Blumenthal explains, cost-effectiveness is a critical consideration when examining target points in lipid therapy.

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For many years, risk stratification has served as one of the most important tools in our efforts to lower the incidence of cardiovascular disease. Yet our tools are by no means perfect, and thus there is room for improvement. How do we move past the limitations of current biomarkers, imaging and genetic tests, enhancing our capacity to perform more accurate risk assessments? Dr. Vijay Nambi, assistant professor of medicine in the section of atherosclerosis and vascular medicine at Baylor College of Medicine, joins host Dr. Larry Kaskel to talk about a range of issues in risk stratification. How is risk scoring impacted by risk factors versus risk markers? When are 10-year risk measurements preferred over lifetime risk figures?

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Non-alcoholic fatty liver disease (NAFLD) is increasingly common among our young obese patients, a population for which cardiovascular disease and diabetes is a significant concern. Can measured levels of liver fat serve to help us gauge future risk for metabolic consequences in children? Host Dr. Larry Kaskel welcomes pediatric hepatologist, Dr. Miriam Vos, assistant professor in the division of gastroenterology at Emory University School of Medicine, to discuss the challenge of encouraging a young child and their family to develop habits that will promote the decline of the child's NAFLD. Dr. Vos also explores the possibility that body shape may be an important clue in the diagnosis of NAFLD, as well as current efforts to generate more accurate markers to quantify liver fat reduction during treatment.

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Mary Felando, clinical dietician at the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center in Los Angeles, joins host Dr. Larry Kaskel to discuss a heart healthy diet. How can you help your patients to regard meals as medicine? And what is the best 'medicine' for them?

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Results from the recent JUPITER trial demonstrated that high-sensitivity C-reactive protein tests were strikingly effective at identifying patients whose risk of cardiovascular events and mortality could be significantly lowered with statin treatment. But do these results warrant broader screening for C-reactive protein, as some suggest? Join host Dr. Larry Kaskel and Dr. Eliot Brinton as they critically examine the JUPITER trial and the potential limitations of those findings for primary care physicians and the use of statins.

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