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:
- 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.
- 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.
- The intensity of risk-reduction therapy should generally be adjusted to the patient’s absolute risk for an ASCVD event.
- 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.
- For patients in whom lipid-lowering drug therapy is indicated, statin treatment is the primary modality for reducing ASCVD risk.
- 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.