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Statin Intolerance— Facing Adversity Official Publication of the National Lipid Association LipidSpin Theme: Statin Intolerance— Facing Adversity Also in this issue: Evidence-Based Approach to the Use of CoQ10 to Deal with Statin Intolerance Vitamin D Deficiency and Statin Intolerance This issue sponsored by the Southeast Lipid Association Volume 11 Issue 4 Fall 2013 visit www.lipid.org Elsvier MauiAd.Full Page8.13:Maui Ad 8/30/13 9:08 AM Page 1 MORETHANA MEETING IN MAUI Join us for the opening session of the 2014 Clinical Lipid Update Meeting as world renowned thought leaders discuss Lipid Management and Metabolic Syndrome in various populations from around the world. W.Virgil Brown,MD,FNLA Cesare R. Sirtori,MD,PhD Yuji Matsuzawa,MD,PhD GeraldWatts,DSc,MB,BS,PhD This meeting features evidence-based sessions that include: A debate from John Brunzell,MD and Sekar Kathiresan,MD How Close are we to Personalizing CVD Prevention with Genetics? Other key sessions include: HDL Analytics & Functionality Debate: Is it time to Stop using Benjamin Ansell, MD, FNLA Fibrates Combined with Statins? Jocelyne R. Benatar, MD, MBChB Cardiovascular Risk inAsians Eliot Brinton, MD, FNLA and Pacific Islanders Beatriz Rodriguez, MD, PhD Dietary Issues and Supplements Keawe’aimoku Kaholokula, PhD Kathleen Wyne, MD, PhD, FNLA Nathan Wong, PhD Terry Jacobson, MD, FNLA Latha Palaniappan, MD, MPH Forrest Batz, PharmD Geeta Sikand, RD, FNLA See you in Maui! Visit www.lipid.org/springclu to register now. To book your room, call 800-888-6100 and ask for the National Lipid Association room rate. Get the NLA room rate starting at $235/night plus tax if you book your room by February 11, 2014. Delta Airlines discount code: NMGR6 WALDORF ASTORIA GRANDWAILEA HOTEL WAILEA, MAUI, HAWAII CME Credit provided by the National Lipid Association This activity has been approved for AMA PRA Category 1 Credit™ This activity is eligible for CDR credit CE credit provided by Postgraduate Institute for Medicine This activity is eligible for ACPE and ANCC credit See final activity program for specific details In This Issue: Fall 2013 (Volume 11, Issue 4) Editors 2 From the NLA President JAMES A. UNDERBERG, MD, MS, FACPM, FACP, FNLA* Spreading the Word Preventive CV Medicine, Lipidology and Hypertension —Matthew K. Ito, PharmD, CLS, FNLA Clinical Assistant Professor of Medicine NYU Medical School and Center for CV Prevention New York, NY 3 From the SELA President and Immediate Look for the NLA Community logo to discuss Past President articles online at www.lipid.org ROBERT A. WILD, MD, PhD, MPH, FNLA* Clinical Epidemiology and Biostatistics and Statin Intolerance Clinical Lipidology Professor —Ralph La Forge, MSc, CLS, FNLA Oklahoma University Health Sciences Center —Paul E. Ziajka, MD, PhD, FNLA* Oklahoma City, OK Managing Editor 4 Letter from the Lipid Spin Editors 21 Practical Pearls EMILY T. PARKER, MA NLA CME: A Culture of Policing Vitamin D Deficiency and Statin National Lipid Association Ourselves Intolerance Executive Director —Robert A. Wild, MD, PhD, MPH, FNLA* —Debra A. Friedrich, DNP, ARNP, FNP-BC, CHRISTOPHER R. SEYMOUR, MBA FNLA National Lipid Association 5 Clinical Feature Contributing Editor An Update on Statin Safety with an 23 Case Study KEVIN C. MAKI, PhD, CLS, FNLA Muscle-Related Statin Intolerance Emphasis on Differences —Nicole Gaskins Greyshock, MD* Associate Editor for Patient Education —Demir Baykal, MD, FACC, FASE, CCT* VANESSA L. MILNE, MS, NP, CLS —John R. Guyton, MD, FNLA* Cardiac Vascular Nurse and Family Nurse Practitioner Bellevue Hospital Lipid Clinic Guest Editorial New York, NY 9 Member Spotlight: Managing the Statin-Intolerant 26 Barbara Wiggins, PharmD Lipid Spin is published quarterly by the Patient: Low-Dose/Low-Frequency National Lipid Association Treatment Regimens 6816 Southpoint Parkway, Suite 1000 —Mary Honkanen, MD, ABIM, FNLA* 27 Education, News and Notes Jacksonville, FL 32216 Phone: 904-998-0854 | Fax: 904-998-0855 Foundation Update Copyright ©2013 by the NLA. 13 EBM Tools for Practice 28 All rights reserved. Evidence-Based Approach to the 29 References Visit us on the web at www.lipid.org. Use of CoQ10 to Deal with Statin Intolerance The National Lipid Association makes every effort to —Jennifer M. Welding, PharmD, CTTS 32 Events Calendar provide accurate information in the Lipid Spin at the —Bishoy Ragheb, PharmD, BCACP, CDE, CTTS time of publication; however, circumstances may alter certain details, such as dates or locations of events. 33 Provider Tear Sheet Any changes will be denoted as soon as possible. Lipid Luminations The NLA invites members and guest authors to 16 provide scientific and medical opinion, which do not Lowering LDL Using Non-Statin necessarily reflect the policy of the Association. Regimens —Casey Elkins, DNP, NP-C, CLS 19 Specialty Corner Tolerability of Statin Therapy in Children *indicates ABCL Diplomate status —Jessica Lilley, MD 1 From the NLA President: Spreading the Word MATTHEW K. ITO, PHARMD, CLS, FNLA National Lipid Association President Professor of Pharmacy Practice Oregon State University/Oregon Health and Science University Portland, OR Diplomate, Accreditation Council for Clinical Lipidology during National Cholesterol Education treatment, develop the best treatment plan Month this September. between you and your patient, provide optimal patient education to ensure patient As a Doctor of Pharmacy and President adherence and persistence to therapeutic Discuss this article at www.lipid.org/lipidspin of the National Lipid Association (NLA) lifestyle changes and pharmacotherapy, this year, I am committed to raising and continue to assess for subclinical awareness about this disorder. I want atherosclerosis to further guide the As a teen, I did all the things other both patients and health care providers to intensity of therapy. In the near future, 14-year-old boys did: played sports, know exactly how important early diagnosis if emergent therapies in clinical trials hung out with friends, and raced dirt and aggressive treatment is—from my are approved, these therapies added to bikes. But around that time I learned I personal—and life-threatening--experience. maximum tolerated statin combination inherited a genetic disorder called Familial therapy could provide important reductions Hypercholesterolemia (FH). I encourage you to continue to educate in cardiovascular risk to our FH patients. your patients about FH through the When I was diagnosed with FH in 1974, many resources the National Lipid In addition, please spread the word about the medical community didn’t have ideal Association offers, including lipid.org, the FH Foundation’s new patient registry. guidance or treatment for it, especially for lipidfoundation.org and You can find more information at children and teens. In fact, I wasn’t treated learnyourlipids.com. www.thefhfoundation.org. for FH until my late 20s, just after statins were introduced. The only thing standing It is important to know that although I hope to see you at one of our upcoming between me and a life-changing—or life- not curable, FH and other dyslipidemias meetings. Best wishes to you and your ending—heart attack was a semi-strict diet are treatable. The aim of treatment is to families this holiday season. n and exercise. reduce your cholesterol to an acceptable level, thereby preventing or delaying That is why I was pleased to help ischemic vascular disease. As a lipidologist, spread the word, along with so many you can implement cascade screening in of my colleagues, about FH and other all first-degree relatives of the FH index dyslipidemias and cholesterol disorders case to help facilitate early detection and 2 LipidSpin From the Chapter President and Immediate Past-President: Statin Intolerance RALPH LA FORGE, MSc, CLS, FNLA President, Southeast Lipid Association Durham, NC Diplomate, Accreditation Council for Clinical Lipidology PAUL E. ZIAJKA, MD, PhD, FNLA Immediate Past-President, Southeast Lipid Association Director, Florida Lipid Institute Winter Park, FL Diplomate, American Board of Clinical Lipidology The SELA board decided to devote this Also, patients with statin intolerance are issue of Lipid Spin to the problem of statin at a clinical and economic disadvantage. In intolerance. In formal clinical trials statin patients with a history of coronary heart intolerance is reported in 2 to 3 percent disease statin intolerance is associated of study subjects, but longer term follow with an 80 percent relative risk increase Discuss this article at www.lipid.org/lipidspin up studies report a more realistic rate of for myocardial infarctions and a 53 15 to 20 percent. In an informal survey of percent relative risk increase for all cause the past-president’s (PZ) private practice mortality compared to similar patients lipid clinic 24 of the most recent 30 new able to tolerate statins. Dyslipidemic patients were referred because of statin patients unable to take statins have been intolerance. reported to incur a $400 to $900 greater total health care cost over an 18 month The most common problems reported observation period compared to similar by statin intolerant patients are muscle patients able to tolerate statin therapy. complaints (about 80%), but the full spectrum of statin intolerance includes This issue of Lipid Spin will examine some increased liver enzymes, allergic reaction, of the clinical strategies used to deal with headache, neuropathy, alopecia, memory statin intolerance, including switching to disturbances, glucose intolerance, statins with a better tolerability profile, gastrointestinal disturbances, insomnia, use of very low dose - low frequency statin arthralgias, exercise intolerance, administration, vitamin D supplementation, depression and dizziness. CoQ10 supplementation and the use of non-statin lipid lowering regimens. n Official Publication of the National Lipid Association 3 Letter From the Lipid Spin Editors: NLA CME: A Culture of Policing Ourselves ROBERT A. WILD, MD, PhD, MPH, FNLA Clinical Epidemiology and Biostatistics and Clinical Lipidology Professor Oklahoma University Health Sciences Center Oklahoma City, OK Diplomate, American Board of Clinical Lipidology lowest form of evidence. Often the stronger presentations are reviewed for compliance.
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