Lipid Luminations

The Women's Health Initiative trial reported that hormone replacement therapy increases the risks of coronary artery disease in postmenopausal women. Dr. Eliot Brinton, director of the metabolism section of the cardiovascular genetics department at the University of Utah School of Medicine in Salt Lake City, and a founding board member of the National Lipid Association and the American Board of Clinical Lipidology, discusses with host Dr. Larry Kaskel a new analysis of the Women's Health Initiative that disputes these findings. Dr. Brinton explores the various risks associated with estrogen, provides guidance on how to evaluate the use of estrogen in postmenopausal women, as well as the practice of stopping estrogen. Tune in to hear Dr. Brinton identify the evidence that supports the cardio-protective effects of estrogen as well the relationship between stroke and estrogen use.

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Dr. Jerome Cohen, emeritus professor of internal medicine at Saint Louis University School of Medicine and director of Preventive Cardiology Programs at the Saint Louis University Health Sciences Center, joins host Dr. Larry Kaskel to discuss the results of the National Health and Nutrition Examination Surveys (NHANES), which show that, while LDL cholesterol levels are falling, triglyceride levels in the United States are skyrocketing. These levels are five times higher than the NHANES data of the 1970s. How can we educate our patients about the serious risks associated with triglycerides, which are often ignored when addressing cardiovascular disease?

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Dr. James Stein, director of the Preventive Cardiology Program and the Vascular Health Screening Program at the University of Wisconsin Hospital and Clinics, discusses with host Dr. Larry Kaskel the usefulness of carotid ultrasound for the detection of cardiovascular disease in individuals that otherwise would be considered not at risk. Tune in to learn about the relationship between intima-media thickness (IMT) and heart disease, and how an IMT image of the carotid arteries can provide specific data on the individual that can be compared to the population to assess risk.

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Cindy Conroy, a registered dietitian at the Iowa Heart Center Lipid Clinic, discusses with host Dr. Larry Kaskel practical approaches to helping patients implement a successful lifestyle change program. Ms. Conroy emphasizes the importance of educating patients about the relationship between sugar intake and triglycerides, but also of thoroughly interviewing patients to determine feasible changes for the individual. Tune in to learn about the ideal staffing and facilities model for improving and supporting lifestyle change programs, and establishing a successful lipid clinic.

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For most Americans, the ratio of omega-6 to omega-3 fatty acids in their diet is about sixteen to one, an unhealthy ratio that promotes chronic diseases from heart disease to macular degeneration to colitis. Worse, omega-6s can counteract the beneficial effects of omega-3s. Dr. Seth Baum, medical director of the Integrative Heart Care Center in Boca Raton, Florida, details for host Dr. Larry Kaskel the chemical distinction between these two fatty acids. How much and what type of fish oil supplement should you recommend for your patients?

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Dr. Peter Tóth, visiting clinical associate professor in the department of family and community medicine at the University of Illinois School of Medicine, discusses with host Dr. Larry Kaskell the key lipid clinical trials of 2008, beginning with the remarkable results of the JUPITER trial. Dr. Tóth examines the ENHANCE trial controversies, as well as the recent phenomena from long-term extension diabetic outcome trials.

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According to a new study published in the New England Journal of Medicine, men and women who have normal cholesterol levels but signs of inflammation in the blood vessels (high levels of C-reactive protein) can cut the risk of heart attack or stroke in half. Dr. Paul Ridker, author of the study, discusses the scope and findings of the study with host Dr. Larry Kaskel as well as the controversial implications of the study. Dr. Ridker explains the remarkable correlations between high-sensitivity C-reactive protein and cardiovascular disease, and reviews the number needed treat as compared with the use of statins for persons with hyperlipidemia. Dr. Ridker identifies those class of persons who would not benefit from statin treatment, and the practical utilization of the CRP tests.

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Predicting the risk of heart attack is a tricky business. Dr. Carl Orringer, visiting associate professor of medicine at Case Western Reserve University School of Medicine and board-certified lipidologist who serves on the National Lipid Board of the National Lipid Association, talks with host Dr. Larry Kaskel about a non-invasive five-minute CT scan known as calcium scoring, an important tool for early detection. Dr. Orringer outlines how calcium scoring is a good predictor of cardiovascular disease and can identify patients at risk for heart attack — patients, such as women and diabetic individuals, who would not be considered candidates under traditional risk scoring models.

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Cigarette smoking is the leading preventable cause of illness and premature death in the United States, claiming over 400,000 lives a year because it directly increases the risk of dying from heart disease, stroke, emphysema, and a variety of cancers. Dr. Douglas Jorenby, director of clinical services at the Center for Tobacco Research and Intervention at the University of Wisconsin, discusses with host Dr. Larry Kaskel smoking cessation strategies for the 21st century. In addition to reviewing the research on the FDA-approved medications and nicotine replacement therapies, Dr. Jorenby talks about the relationship between smoking and cardiovascular disease. Dr. Jorenby also explains the importance of counseling in any form to support those therapies and addresses the limitations of therapies not approved by the FDA, such as hypnosis and laser therapies.

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The ADVANCE Study involved 11,140 high-risk patients with type 2 diabetes. Join host Dr. Larry Kaskel when guest Dr. Eliot Brinton explains the findings from the largest-ever study of treatments for diabetes, which provided no evidence of an increased risk of death among patients receiving aggressive treatment to lower blood glucose. Dr. Brinton highlights how the findings of the ADVANCE trial contrast the findings of the ACCORD trial, and the impact these findings will have on treatment protocols.

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