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National Lipid Association Annual Summary of Clinical Lipidology 2016 Journal of Clinical Lipidology (2016) 10, S1-S43 National Lipid Association Annual Summary of Clinical Lipidology 2016 Harold E. Bays, MD, FNLA*, Peter H. Jones, MD, FNLA, Carl E. Orringer, MD, FNLA, W. Virgil Brown, MD, FNLA, Terry A. Jacobson, MD, FNLA Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA (Dr Bays); Baylor College of Medicine, Houston, TX, USA (Dr Jones); University of Miami Leonard M. Miller School of Medicine, Miami, FL (Dr Orringer); Emory University School of Medicine, Atlanta, GA, USA (Dr Brown); and Department of Medicine, Emory University, Atlanta, GA, USA (Dr Jacobson) KEYWORDS: Abstract: The National Lipid Association (NLA) Annual Summary of Clinical Lipidology is a yearly Clinical Lipidology; updated summary of principles important to the patient-centered evaluation, management, and care Dyslipidemia; of patients with dyslipidemia. This summary is intended to be a ‘‘living document,’’ with future annual National Lipid updates based on emerging science, clinical considerations, and new NLA Position, Consensus, and Association; Scientific Statements, thus providing an ongoing resource that applies the latest in medical science to- Annual Summary; wards the clinical management of patients with dyslipidemia. Topics include the NLA Recommenda- Cholesterol; tions for Patient-Centered Management of Dyslipidemia, genetics, Familial Hypercholesterolemia, Recommendations; secondary causes of dyslipidemia, biomarkers and advanced lipid testing, nutrition, physical activity, Guidelines obesity, adiposopathy, metabolic syndrome, diabetes mellitus, lipid pharmacotherapy, lipid-altering drug interactions, lipoprotein apheresis, dyslipidemia management and treatment based upon age (chil- dren, adolescents, and older individuals), dyslipidemia considerations based upon race, ethnicity and gender, dyslipidemia and human immune virus infection, dyslipidemia and immune disorders, adher- ence strategies and collaborative care, and lipid-altering drugs in development. Hyperlinks direct the reader to sentinel online tables, charts, and figures relevant to lipidology, access to online atheroscle- rotic cardiovascular disease risk calculators, worldwide lipid guidelines, recommendations, and position/scientific statements, as well as links to online audio files, websites, slide shows, applications, continuing medical education opportunities, and patient information. Ó 2016 National Lipid Association. All rights reserved. Bays HE, Jones PH, Orringer CE, Brown VW, Jacobson TA. On behalf of Contents the NLA Annual Summary of Clinical Lipidology Working Group: Aberg JA, Aspry KE, Ballantyne CM, Bays HE, Bramlett DA, Braun LT, Brinton EA, Brown AS, Brown WV, Daniels S, Deedwania P, Duell PB, Eckel R, Fazio I. INTRODUCTION S, Ferdinand KC, Goldberg AC, Guyton JR, Hemphill LC, Jacobson TA, Jones Updates ............................. S3 PH, Kellick K, Kris-Etherton P, La Forge R, Liao KP,Maki KC, Moriarty PM, Principles............................ S3 Morris PB, Orringer CE, Rosenson RS, Ross JL, Saseen JJ, Sikand G, Under- Appendix A and B Hyperlink Format ........ S3 berg JA, Vijay K, Westman EC, Wild RA, Willard K-E, Wilson DP. Lipid Recommendations, Lipid Guidelines, and * Corresponding author. Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville, KY 40213. ASCVD Risk Calculators ............... S3 E-mail address: [email protected] Review Board Charge 2016 ............... S3 Submitted August 10, 2015. Accepted for publication September 3, Review Board Members 2016 ............. S4 2015. 1933-2874/$ - see front matter Ó 2016 National Lipid Association. All rights reserved. http://dx.doi.org/10.1016/j.jacl.2015.08.002 S2 Journal of Clinical Lipidology, Vol 10, No 1S, February 2016 II. NLA RECOMMENDATIONS FOR Physical activity ........................ S16 PATIENT-CENTERED MANAGEMENT OF Effects of physical activity on lipid levels .... S16 DYSLIPIDEMIA Physical activity, lipids, and weight loss ..... S17 Lipid evaluation and management principles ... S5 VIII. OBESITY, ADIPOSOPATHY, METABOLIC National Lipid Association (NLA) Officers SYNDROME, AND DIABETES MELLITUS and Editors 2016 ..................... S6 Lipid treatment targets................... S7 Obesity as a disease ................... S17 Adiposopathic mixed dyslipidemia ......... S18 Non–high-density lipoprotein cholesterol Adiposopathy and the metabolic (non–HDL-C) ..................... S7 syndrome ......................... S18 Low-density lipoprotein cholesterol (LDL-C) .S7 Adiposopathy and Non–HDL-C ........... S18 Apolipoprotein B (apo B) .............. S7 Clinical management of obesity, adiposopathy, Triglycerides ....................... S7 metabolic syndrome, and diabetes mellitus ... S18 High-density lipoprotein cholesterol (HDL-C) S8 Weight management pharmacotherapy....... S19 Lipid treatment goals ................. S8 Lipid screening ..................... S8 Bariatric surgery ...................... S19 Atherosclerotic cardiovascular disease IX. LIPID PHARMACOTHERAPY (ASCVD) risk categories ............... S8 Statin Pharmacotherapy ................... S19 Atherosclerotic cardiovascular disease Non-statin Pharmacotherapy ............... S20 (ASCVD) risk assessment .......... S8 Statin Safety........................... S20 Very high ASCVD risk................... S9 Statin intolerance ..................... S20 High ASCVD risk.................... S9 Statin safety: muscle ................... S21 Moderate ASCVD risk ................ S9 Statin safety: liver..................... S21 Low ASCVD risk .................... S9 Statin safety: cognition ................. S21 III. GENETICS AND CLASSIFICATION OF Statin safety: diabetes mellitus ............ S22 DYSLIPIDEMIA PCSK9 inhibitors (Alirocumab, Evolocumab)..... S22 Hyperlipidemias ...................... S10 X. LIPID-ALTERING DRUG INTERACTIONS Hypolipidemias....................... S10 Pharmacokinetics and pharmacodynamics .... S22 Clinical role of genetic testing for dyslipidemia . S10 Drug metabolism ..................... S23 Illustrative examples of genetic dyslipidemias . S10 Transporters ......................... S23 EVALUATION AND MANAGEMENT OF Statin drug interactions ................. S23 FAMILIAL HYPERCHOLESTEROLEMIA ... S11 Genetics ........................... S11 XI. LIPOPROTEIN APHERESIS Lipids ............................. S11 Definition........................... S24 Diagnosis........................... S11 Lipoprotein apheresis clinical considerations . S24 Screening and genetic testing for Lipoprotein apheresis systems ............ S24 familial hypercholesterolemia ........... S11 Dextran Sulfate Apo B Lipoprotein Treatment priorities.................... S12 Adsorption System (Liposorber) ......... S24 Lipid-altering pharmacotherapies for FH: Heparin extracorporeal LDL apheresis general principles.................S12 (HELP) ........................... S24 Conventional plasmapheresis (plasma IV. SECONDARY CAUSES OF DYSLIPIDEMIA exchange) .............................. S25 V. ADDITIONAL LIPID PARAMETERS Evidence for clinical benefit of High-density lipoprotein cholesterol ........ S12 lipoprotein apheresis ................. S25 Low-density lipoprotein particle number ..... S13 Lipoprotein (a) ....................... S13 XII. DYSLIPIDEMIA IN CHILDREN AND ADOLESCENTS VI. BIOMARKERS AND ‘‘ADVANCED LIPID ASCVD risk for children, adolescents, and TESTING’’ young adults ,21 years of age .......... S25 Biomarkers as initial assessment of Lipid screening for children, adolescents, ASCVD risk .................. S14 and young adults ,21 years of age ....... S25 Biomarkers for on-treatment assessment of ASCVD risk assessment in children, ASCVD therapy ...................... S14 adolescents, and young adults ,21 years of age S26 VII. NUTRITION AND PHYSICAL ACTIVITY Management of dyslipidemia in children, Medical nutrition therapy.................. S15 adolescents, and young adults ,21 years of age S26 Triglyceride-induced pancreatitis ........... S15 Statin therapy in children, adolescents, and Medical nutrition therapy for dyslipidemia...... S15 young adults with dyslipidemia ,21 years Adherence to nutrition therapy ............ S16 of age ........................... S26 Bays et al NLA Annual Summary of Clinical Lipidology S3 Non-statin therapy for children, adolescents, Substantial updates to the 2015 NLA Annual Summary and young adults with dyslipidemia based upon Part 2 of the NLA Recommendations included ,21 years of age ................S26 sections regarding lifestyle therapies, groups with special considerations (e.g., children and adolescents, women, XIII. DYSLIPIDEMIA IN SELECT older patients, ethnic and racial groups), patients with resid- POPULATIONS ual risk, and strategies to improve patient outcomes by Dyslipidemia and older individuals ......... S27 increasing adherence and team-based collaborative care. Dyslipidemia and race/ethnicity ........... S27 Dyslipidemia and women................ S29 Principles XIV. DYSLIPIDEMIA IN PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV) . S30 The 2016 NLA Annual Summary of Clinical Lipidology XV. DYSLIPIDEMIA IN PATIENTS WITH was founded on evidence-based medicine and is generally INFLAMMATION ................... S31 consistent with established national and international lipid guidelines. Where definitive evidence was lacking, the best XVI. LIPID THERAPY ADHERENCE available evidence was applied. This summary should not be STRATEGIES AND TEAM-BASED interpreted as rules or directives with regard to the most COLLABORATIVE
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