Medscape InDiscussion: Dyslipidemia

In this episode, host Dr. Laurence Sperling speaks with Drs Erin Michos and Peter Toth about optimal use of newer dyslipidemia therapies.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958749). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

Cholesterol Treatment Trial: Efficacy and Safety of More Intensive Lowering of LDL Cholesterol: A Meta-analysis Of Data From 170,000 Participants in 26 Randomised Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988224/

IMPROVE-IT: Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes https://www.nejm.org/doi/full/10.1056/nejmoa1410489

ODYSSEY: Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome https://www.nejm.org/doi/full/10.1056/nejmoa1801174

FOURIER: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk -- FOURIER https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2017/03/16/00/46/FOURIER

Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037184

ORION: Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol https://pubmed.ncbi.nlm.nih.gov/32187462/

CLEAR Wisdom: Effect of Bempedoic Acid vs Placebo Added to Maximally Tolerated Statins on Low-Density Lipoprotein Cholesterol in Patients at High Risk for Cardiovascular Disease: The CLEAR Wisdom Randomized Clinical Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865290/

Bempedoic Acid for Heterozygous Familial Hypercholesterolemia: From Bench to Bedside https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8121276/

CLEAR Outcomes: Rationale and Design of the CLEAR-Outcomes Trial: Evaluating the Effect of Bempedoic Acid on Cardiovascular Events in Patients With Statin Intolerance https://pubmed.ncbi.nlm.nih.gov/33470195/

CLEAR Wisdom: Bempedoic Acid Plus Ezetimibe Fixed-Dose Combination in Patients With Hypercholesterolemia and High CVD Risk Treated With Maximally Tolerated Statin Therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865290/

Bempedoic Acid and Ezetimibe -- Better Together https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203625/

REDUCE-IT: Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/nejmoa1812792

STRENGTH: Long-Term Outcomes Study to Assess Statin Residual Risk With Epanova in High Cardiovascular Risk Patients With Hypertriglyceridemia -- STRENGTH https://www.acc.org/latest-in-cardiology/clinical-trials/2020/11/11/21/29/strength

JELIS: Effects of Eicosapentaenoic Acid on Major Coronary Events in Hypercholesterolaemic Patients (JELIS): A Randomised Open-Label, Blinded Endpoint Analysis https://pubmed.ncbi.nlm.nih.gov/17398308/

PROMINENT: Rationale and Design of the Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes (PROMINENT) Study https://pubmed.ncbi.nlm.nih.gov/30342298/

How Low Is Safe? The Frontier of Very Low (< 30 mg/dL) LDL Cholesterol https://pubmed.ncbi.nlm.nih.gov/33463677/

Cholesterol: The Race to the Bottom https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab446/6335767?searchresult=1

SPARCL: High-Dose Atorvastatin After Stroke or Transient Ischemic Attack https://www.nejm.org/doi/full/10.1056/nejmoa061894

EBBINGHAUS: Cognitive Function in a Randomized Trial of Evolocumab https://www.nejm.org/doi/full/10.1056/nejmoa1701131

PROSPER: Pravastatin in Elderly Individuals at Risk of Vascular Disease (PROSPER): A Randomized Controlled Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)11600-X/fulltext

Achievement of Very Low Low-Density Lipoprotein Cholesterol Levels https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044275

In this episode, Dr Laurence Sperling talks with Dr Kim Williams about preventive cardiology nutrition intervention as a key co-therapy for tackling dyslipidemia.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958748). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

Exercise and CVD Mortality

Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80,306 British adults https://bjsm.bmj.com/content/51/10/812#T3

Diet and Dietary Patterns

The reasons for geographic and racial differences in stroke study: objectives and design https://pubmed.ncbi.nlm.nih.gov/15990444/

Heart disease and stroke https://www.cdc.gov/chronicdisease/resources/publications/factsheets/heart-disease-stroke.htm

Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452247/

Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study https://www.thelancet.com/article/S0140-6736(17)32252-3/fulltext

Intensive lifestyle changes for reversal of coronary heart disease https://pubmed.ncbi.nlm.nih.gov/9863851/

Dietary adherence and acceptability of five different diets, including vegan and vegetarian diets, for weight loss: the New DIETs study https://www.sciencedirect.com/science/article/abs/pii/S147101531500080X

Guidelines and Population Studies

2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk https://academic.oup.com/eurheartj/article/41/1/111/5556353

TMAO

Trimethylamine-N-oxide (TMAO) predicts cardiovascular mortality in peripheral artery disease https://www.nature.com/articles/s41598-019-52082-z

Gut microbes impact stroke severity via the trimethylamine N-oxide pathway https://pubmed.ncbi.nlm.nih.gov/34139173/

Statin Adverse Effects

Effects of coenzyme Q10 on statin‐induced myopathy: an updated meta‐analysis of randomized controlled trials https://www.ahajournals.org/doi/10.1161/JAHA.118.009835

N-of-1 trial of a statin, placebo, or no treatment to assess side effects https://www.nejm.org/doi/full/10.1056/NEJMc2031173

Drs Laurence Sperling and Neil Stone put key messages from the 2018 cholesterol guidelines into a clear clinical context.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958747). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625

ASCVD Risk Estimator Plus https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/

2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia https://www.jacc.org/doi/10.1016/j.jacc.2021.06.011

What Do US Physicians and Patients Think About Lipid‐Lowering Therapy and Goals of Treatment? Results From the GOULD Registry https://www.ahajournals.org/doi/10.1161/JAHA.120.020893

Statin Treatment and Muscle Symptoms: Series of Randomised, Placebo Controlled n-of-1 Trials https://www.bmj.com/content/372/bmj.n135

Drs Larry Sperling and Karol Watson discuss health equity and social determinants of health for populations with dyslipidemia.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958746). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals.

Resources

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625

Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease https://www.ahajournals.org/doi/10.1161/CIR.0000000000000638

New AMA Policies Recognize Race as a Social, Not Biological, Construct https://www.ama-assn.org/press-center/press-releases/new-ama-policies-recognize-race-social-not-biological-construct

Race/Ethnicity, Neighborhood Socioeconomic Status and Cardio-metabolic Risk https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397689/

Disparities in Hypertension and Cardiovascular Disease in Blacks: The Critical Role of Medication Adherence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638710/

Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191372/

In this episode, host Dr Laurence Sperling and guests talk about how COVID affected patient-partnered dyslipidemia care, causing clinical teams to innovate.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958311). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

Patel P, Dhindsa D, Eapen DJ, et al. Optimizing the potential for telehealth in cardiovascular care (in the era of COVID-19): time will tell. Am J Med. 2021;134:945-951. doi:10.1016/j.amjmed.2021.03.007

American Medical Association. Telemedicine and team-based care: improve patient care and team engagement by using team-based care in telemedicine. https://edhub.ama-assn.org/steps-forward/module/2781279

Bhaskar S, Bradley S, Chattu VK, et al. Telemedicine as the new outpatient clinic gone digital: position paper from the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (part 2). Front Public Health. 2020;8:410. doi:10.3389/fpubh.2020.00410

Arevian AC, Springgate B, Jones F, et al. The Community and Patient Partnered Research Network (CPPRN): application of patient-centered outcomes research to promote behavioral health equity. Ethn Dis. 2018;28(Suppl 2):295-302. doi: 10.18865/ed.28.S2.295.

Stewart MP, Fink R, Kosirog E, Saseen JJ. Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas. Pharm Pract (Granada). 2021;19:2359. doi:10.18549/PharmPract.2021.2.2359

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Jun 18;139(25):e1182-e1186]. Circulation. 2019;139(25):e1082-e1143.

Golden RL. William Osler at 150: An Overview of a Life. JAMA. 1999;282:2252–2258. doi:10.1001/jama.282.23.2252

In this episode, host Dr Laurence Sperling speaks with Katherine Wilemon, founder of the FH Foundation.

Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958283). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals.

Resources

The Agenda for Familial Hypercholesterolemia: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/10.1161/CIR.0000000000000297?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Familial Hypercholesterolemia Foundation https://thefhfoundation.org/

Cascade Registry https://thefhfoundation.org/fh-research/registry

Finding missed cases of familial hypercholesterolemia in health systems using machine learning https://www.nature.com/articles/s41746-019-0101-5

Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2020/08/27/13/28/genetic-testing-in-dyslipidemia

Genetic Testing for Managing Dyslipidemia https://www.acc.org/Latest-in-Cardiology/Articles/2020/11/13/20/26/Genetic-Testing-for-Managing-Dyslipidemia