Lipid Luminations

Host Dr. Alan Brown discusses fat, exercise and cholesterol with Dr. Harold Bays, medical director and president of Louisville Metabolic and Atherosclerosis Research Center, an independent research center. They look at the properties of adipose tissue — what Dr. Bays calls adiposopathy, or "sick fat." Dr. Bays says that fat cells are very active in terms of helping determine the metabolic rate and subject to dysfunction. They discuss how the location of fat cells and gender of the patient may cause differential problems and may contribute to arteriosclerosis, the effect of exercise on fat and cholesterol, and what kind of exercise is best for overweight patients.

Host Dr. Alan Brown talks with Dr. George Bakris, director of the Hypertensive Disease Unit at the University of Chicago Pritzker School of Medicine, about lipid management in the hypertensive patient and its particular relevance to patients with chronic kidney disease. How do cardiovascular events differ in chronic kidney disease patients compared to the general population? And do statins work in dialysis patients? They discuss these questions and the conclusions of the Study of Heart and Renal Protection (SHARP).

This program reviews the guidelines for determining which patients should receive coronary CT angiography (CCTA), highlights the differences between CCTA and coronary calcium testing, and explores the overall radiation risk of serial CCTA. Dr. Alan Brown talks to guest Dr. Seth Baum, expert on electrophysiology, interventional cardiology, coronary CT angiography, and clinical lipidology, and a founding member of the Society for Cardiovascular CT.

Dr. Christie Ballantyne discusses with host Dr. Alan Brown the use of genetic testing in various phases of disease onset in patients facing heart disease. They talk about how clinicians can utilize the current technologies, what the costs are and the benefits. How does learning more about the genetic mutation behind familial hypercholesterolemia affect treatment? Dr. Ballantyne and Dr. Brown also discuss what new genetic testing techniques are on the horizon.

Host Dr. Alan Brown discusses management issues and practical advice with certified registered nurse practitioner and clinical lipid specialist Joyce Ross, who says that familial hypercholesterolemia (FH) is the most common genetic disorder, and many who have it are totally unaware of their condition until a cardiovascular event occurs. Find out why early identification, in addition to fostering good lifestyle choices, can mean patients with FH can enjoy a normal lifespan when the disorder is treated throughout the lifespan.

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Who should be tested for genetically elevated cholesterol, or familial hypercholesterolemia? And how do we decide when and how to treat? Host Dr. Alan Brown talks with Dr. Jennifer G. Robinson, director of the Lipid Research Clinic and co-director of the Prevention Intervention Center at the University of Iowa. They discuss who is at risk in families, what age to start testing children, as well as treatment guidelines for children, adolescents, adult men, and women before and after childbearing age. For example, how do we treat children who test positive for familial hypercholesterolemia as young as two years of age?

What are the components of useful, evidence-based data? Dr. Robert Wild discusses with host Dr. Alan Brown the spectrum of data — from expert opinion, to observational studies, to different types of analytic studies, including cross-sectional, case-controlled studies, cohort studies, and clinical trials — and the shortcomings and biases of each. Dr. Wild explores cardiovascular epidemiology, clinical interpretation of biostatistical principles and how to critically evaluate research, in order to better integrate evidence, experience and patient values in clinical decisions.

The Society of Atherosclerosis Imaging and Prevention recently developed appropriate use criteria for carotid IMT. What is the procedure? Why is it used? Why is it controversial? Which patients are candidates? Dr. Edward Gill, professor of medicine in the division of cardiology in the department of medicine at the University of Washington and clinical professor of diagnostic ultrasound at Seattle University, talks with host Dr. Alan Brown about the details of the procedure and how to locate a center for the test.

Patients are bombarded with dietary advice for cardiovascular health. Dr. Penny Kris-Etherton, distinguished professor of nutrition in the department of nutritional sciences at Pennsylvania State University and president of the National Lipid Association, discusses with host Dr. Alan Brown how to evaluate and prescribe a variety of dietary approaches, including lipid-lowering diets, for a variety of outcomes. They look at risk factors to be evaluated in each patient, along with patient preferences and how the diet is to be implemented.

About 1 in 500 people have familial hypercholesterolemia (FH), the genetic disorder characterised by very high levels of low-density lipoprotein in the blood. Host Dr. Alan Brown talks to Dr. James Falko, professor of medicine in the division of endocrinology, metabolism and diabetes at the University of Colorado, Denver, about technology behind LDL apheresis to remove LDL cholesterol from blood. They cover the frequency of the procedure, possible complications, and what the data shows about the benefits of LDL apheresis in FH patients with refractory hypercholesterolemia. Dr. Falko also directs physicians to resources for locating LDL apheresis sites in the United States and Canada.

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