NLA Finalizes Recommendations Emphasizing Value in Patient-Centered Management of Dyslipidemia

Back in June, I highlighted draft recommendations issued by the National Lipid Association (NLA) that stressed the need for patient-centered management of dyslipidemia. On September 15, the NLA announced that the draft recommendations had been finalized. As a clinician who seeks to provide individualized treatment plans to patients, I’m extremely pleased to see these recommendations come to fruition. The recommendations emphasis on a strong doctor/patient relationship and focus on each patient’s unique medical background may help patients achieve long-term success in preventing cardiovascular disease (CVD).

The NLA developed these recommendations in hopes to add information to the statin therapy recommendations by the American College of Cardiology and American Heart Association in order to acknowledge the various risk of dyslipidemia and show that not one treatment plan fits all patients. While the recommendations go into great detail, there are a few notable points I’d like to highlight from the main conclusion:

  1. An elevated level of cholesterol carried by circulating apolipoprotein (apo) B-containing lipoproteins (non–HDL-C and LDL-C, termed atherogenic cholesterol) is a root cause of atherosclerosis, the key underlying process contributing to most clinical arteriosclerotic cardiovascular disease (ASCVD) events.
  2. Reducing elevated levels of these atherogenic cholesterol particles will lower ASCVD risk in proportion to the extent that atherogenic cholesterol is reduced. This benefit is presumed to be a result from atherogenic cholesterol lowering through multiple modalities, including lifestyle and drug therapies.
  3. The intensity of risk-reduction therapy should generally be adjusted to the patient’s      absolute risk for an ASCVD event.
  4. Atherosclerosis is a process that often begins early in life and progresses for decades before resulting in a clinical ASCVD event. Therefore, both intermediate-term and long-term/lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction therapies.
  5. For patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk.
  6. Non-lipid ASCVD risk factors should also be managed appropriately, particularly high blood pressure, cigarette smoking and diabetes mellitus.

 

The new NLA recommendations highlight how useful comprehensive lipid testing, specifically the VAP + Lipid Panel® (VAP), can be to clinicians. The VAP presents clinicians with a clear depiction of patient’s risk factors for CVD while helping to drill down and evaluate levels of non-high density lipoprotein cholesterol (non-HDL) and (apo) B – two lipoproteins/apolipoproteins associated with arteriosclerotic cardiovascular disease (ASCVD) events. NHDL measures and incorporates ALL atherogenic lipoproteins – VLDL, IDL, LDL and Lpa-c. VAP directly measures all FOUR of these atherogenic lipoproteins to better assess apoB, NHDL contribution to CVD risk. This added information helps predict higher risk and supports the clinician/patient decision for global risk management strategies.

In addition, since the VAP provides concise measurement – there is no need to fast as lipoprotein levels are directly measured and not affected by the non-fasting triglyceride levels used for calculation in basic cholesterol testing. The information obtained from VAP will allow clinicians to help patients better understand their treatment options, reduce their risk for CVD and set actionable goals for treatment – whether that is lifestyle modifications or medication. In an instance where medication is required, clinicians can use the information from VAP to determine which therapy is most appropriate for helping patients reach their lipid goals.

As a clinical lipidologist, I find these recommendations to be a positive step forward in helping patients better manage their high cholesterol and ultimately, their risk for CVD.  According to the Centers for Disease Control and Prevention, 71 million American adults have high cholesterol, with only one in three of them taking the necessary steps to control it. It’s apparent that patients can benefit from being more involved in their treatment plan of action; however, it’s important that we, as clinicians, are taking the necessary steps to examine their full risk to make thoughtful recommendations on an individual basis.

To learn more about the benefits the VAP can provide both you and your patients visit, www.Atherotech.com.


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The Benefits of Comprehensive Lipid Testing

I recently came across an article from Forbes that I feel compelled to address as it questions the value of comprehensive lipid testing. First and foremost, clinicians want to appropriately screen and identify people who are at a higher risk for cardiometabolic disorders. Throughout my twenty years of clinical practice, I have and continue to guide my patients towards achieving optimum heart health, whether it is through testing, lifestyle modifications and/or various other treatments. Comprehensive lipid tests, such as the VAP + Lipid Panel®, have always been a staple in my recommendations to patients seeking to gain full knowledge of their cardiovascular health in an attempt to predict and/or prevent an event, such as heart attack or stroke, from occurring. Such testing should be easy and affordable while also giving information that independently identifies people who are at a higher risk for cardiovascular disease (CVD)/death. Most importantly, such testing, if abnormal, should help motivate the clinician and patient regarding lifestyle changes and appropriate medical care. In short, it must be actionable.

While the fasting basic lipid panel (BLP) is one method for evaluating a person’s risk for CVD, clinical evidence has shown limitations of the BLP and the benefit of using a more comprehensive analysis, such as the VAP. Data published in the Journal of the American College of Cardiology (JACC) in August 2013 reported the VAP showed up to 60 percent of patients were misclassified as having “normal” cholesterol levels by the BLP. The authors concluded the “BLP tends to underestimate true low-density lipoprotein cholesterol (LDLc) – otherwise known as the ‘bad cholesterol’ in the body – when accuracy is most crucial and additional evaluation is warranted in high-risk patients.” Because BLP uses a calculated measurement of very-low density lipoprotein cholesterol (VLDLc) and another calculation of LDLc, levels are consistently underestimated. Unlike the VAP, the BLP is primarily concerned with identification of LDLc in the bloodstream. What many people don’t realize is that LDLc only accounts for 30 percent of the risk of premature CVD, while the remaining 70 percent represents residual risk factors not identified by the BLP. The BLP is primarily concerned with estimating the general level of LDLc in the bloodstream while the VAP will directly measure all LDLc and non high-density lipoprotein cholesterol (NHDLc) and its four atherogenic components.

Comparatively, the VAP provides a direct measurement – so there is no need to fast with VAP as VLDLc and LDLc are directly measured and not affected by the non-fasting triglyceride level used for calculation in BLP estimates – and provides residual risk to give the full picture of a patient’s risk in three key areas: cholesterol defects, triglyceride defects and hereditary lipid defects. By addressing these three areas, clinicians are able to create more personalized and effective treatment programs based on a patient’s individual risk to ultimately improve health outcomes. In addition to the JACC study, there have been more than 14 studies over the last three years examining the importance of directly measuring LDLc with VAP and other residual risk factors associated with CVD. Most recently, two meta-analyses using the VAP were presented earlier this year at the 2014 Annual Meeting of the American College of Cardiology. The analyses examined findings from two major highly cited cardiovascular studies – the Framingham Offspring study and Jackson Heart study – to show the significant impact high-density lipoprotein cholesterol (HDLc) and remnant lipoprotein cholesterol (RLPc) levels have on a patient’s risk. These findings – along with many others – are a critical step forward in helping clinicians develop a better understanding of the relationship between lipoproteins and cardiovascular risk – something that is not possible with the BLP.

The VAP is also the only commercially available panel that reports all lipoprotein parameters considered necessary by national guidelines including the American Diabetes Association, American College of Cardiology, American Association of Clinical Endocrinologists, as well as the National Cholesterol Education Program Adult Treatment Panel III (ATP III).

The prodigious benefits of accurate and affordable comprehensive lipid testing, to me, is noteworthy. Despite access to some of the best medicines and educational information available, it’s quite alarming to see that CVD is on the rise in the United States. As clinicians, we need to encourage our patients to be proactive when it comes to managing their heart health before it’s too late. The first step in doing so is by getting a full understanding of their risk through the use of comprehensive lipid testing. By utilizing the various diagnostic tools at our disposal, we have the ability to aid in lowering the rate at which CVD is growing and work toward developing a more health conscious and heart-healthy world.

For more information about the VAP, visit www.Atherotech.com


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AHA study shows African Americans and women are predominantly impacted by CVD risk factors

A study recently published in the American Heart Association’s (AHA) journal, Circulation, suggested there is an unequal impact of cardiovascular disease (CVD) on race and gender. Researchers from Women’s Hospital in Boston, Massachusetts studied data from 13,541 people in the Atherosclerosis Risk in Communities study. Participants attended examinations during four periods (1987-89, 1990-92, 1993-95 or 1996-98) when they were 52-66 years old and free of CVD. Researchers examined population attributable risk (PAR) changes for five major cardiovascular risk factors — high cholesterol, smoking, high blood pressure, obesity, and diabetes. The PAR measures how common a risk factor is and how much the factor raises the chance of future cardiovascular disease.

These results highlight that African Americans and women are the demographic populations most prominently impacted by CVD risk factors. The study results highlight the ongoing need for targeted as well as population-based approaches to risk factor modifications in order to reduce the overall risk for heart and vascular disease, researchers said.

The VAP+ Lipid Panel® provides patients with a comprehensive lipid analysis in order to identify their risk for CVD. Knowing your risk is the first step in preventing hard coronary events. Interestingly, the Jackson Heart Study – the largest investigation to date of causes of cardiovascular disease in an African American population – found increased levels of triglyceride rich remnant lipoprotein cholesterol (VLDL3, IDL) measured with the VAP+ Lipid Panel® were a significant, independent predictor of heart attack events among participants in multivariate analysis.  These findings show the value of comprehensive lipid testing in specific patient populations to provide valuable information not captured by the basic lipid panel.

To learn more about the VAP+®, visit Atherotech.com.  To learn more about this study, visit: http://newsroom.heart.org/news/blacks-women-face-greater-burden-from-cvd-risk-factors?preview=2c70


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Atherotech’s Kenneth French Appears on Eva Herr Radio Show

select1394On June 15, Atherotech’s very own Kenneth French was featured as one of the guest’s on a six-part early detection and prevention series hosted by The Eva Herr Radio Show. Eva Herr is considered one of the world’s top experts in integrative and preventive healthcare issues.   During the segment, Kenneth detailed the increasing prevalence of cardiovascular disease (CVD) in the United States and the benefit of comprehensive lipid testing, such as the VAP® + Lipid Panel, on determining a patient’s CVD risk. Kenneth discussed the importance of patient’s knowing their cholesterol numbers to determine the real risk of CVD without relying on a calculated low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol in the body), which can be misleading in regards to lipid based CVD risks. Kenneth explained the history of cholesterol testing, starting with the basic lipid panel, and its limitations, and stressed that by knowing your risk, patients have the ability to prevent future and recurrent cardiac events.

Kenneth is a Medical Science Consultant at Atherotech and has extensive experience in atherosclerosis and dyslipidemia. For several years now, Kenneth has served as a medical liaison for several companies as well as national laboratories through education regarding topics on atherosclerosis, dyslipidemia, metabolic syndrome, and comprehensive testing.  He is utilized as a resource in lipid management, participating in numerous round-table discussions and consulting with physicians on how to interpret laboratory metrics.

To listen to Kenneth discuss the impact cardiovascular disease has on our nation and the evolution of lipid testing, click here, or to listen to Kenneth’s full segment, visit: http://bit.ly/1jBkWVe.


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Lipoprotein and Vascular Diseases Division and Atherotech Diagnostics to Hold Annual Dinner Meetings on July 28-29 during the American Association for Clinical Chemistry’s Annual Meeting & Clinical Lab Expo

Atherotech Diagnostics is excited to announce two events it will co-sponsor with the AACC Lipoproteins and Vascular Diseases Division (LVDD) during the American Association for Clinical Chemistry’s Annual Meeting & Clinical Lab Expo in ChicDr. Davidsonago, IL.

 

The first event is the annual LVDD Dinner Meeting scheduled for Monday, July 28 at the Hyatt Regency in Chicago from 5:30-9:30 p.m. The event will be led by Dr. Michael Davidson of the University of Chicago. LVDD members are invited to this annual awards celebration and scientific session on current topics in cardiovascular disease. Tickets cost $50 and are limited to the first 100 LVDD members. Registration includes a reception, awards presentation and dinner followed by scientific presentations. Tickets can be picked up at the McCormick Place Convention Center at Conference Registration.

 

Toth

In addition to the annual dinner, the second event will be the International Lipoprotein Standardization Forum and takes place the following night on Tuesday July 29, 2014 from 6:00-9:00 p.m. at the Hyatt Regency in Chicago. Dr. Peter Toth of CGH Medical Center in Sterling, IL will lead the forum entitled, ‘ACC/AHA Guidelines on Blood Cholesterol Management: Controversies and Curious Omissions.’ LVDD members are invited to join the discussion on recent findings related to lipoproteins, with a focus on new technologies and standardization efforts. Tickets cost $40 and are limited to the first 60 LVDD members. Registration includes a reception followed by dinner and scientific presentations. After July 23, registration will take place onsite at the meeting.

 

Atherotech is committed to supporting scientific lipoprotein advances and standardization efforts for research and clinical care.

For more information on both events, visit: http://www.aacc.org/events/2014_annual_meeting/conference/special-events/pages/default.aspx


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