Official Publication of the National Lipid Association LipidSpin Inflammation and Cardiometabolic Risk Also in this issue: Clinical Trial Evidence for the Role of Reducing Inflammation for Cardiovascular Disease Prevention Identifying and Managing the Patient with High Inflammatory Burden Dietary Patterns and Systemic Inflammation: Examining the Connection This issue is sponsored by the Pacific Lipid Association. Volume 17 Issue 1 2019 visit www.lipid.org NATIONAL LIPID ASSOCIATION Turnberry Isle Miami 19999 W. Country Club Dr. SCIENTIFIC 9 Aventura, FL 33180 1 SESSIONS Group Rate: $229/night++ 0 Reservation Cut-Off Date: MIAMI 2 April 14, 2019 Pre-Conference Courses | May 15-16 Make your plans to join the NLA in 2019 for these premier events! lipid.org/conferences FEBRUARY 22-24 SEPTEMBER 13-15 2019 2019 PORTLAND MINNEAPOLIS Hilton Portland Downtown Renaissance Minneapolis Hotel, the Depot 921 SW Sixth Avenue, Portland, OR 97204 225 Third Avenue South, Minneapolis, MN 55401 Group Rate: $185/night++ Group Rate: $179/night++ Reservation Cut-Off Date: January 21, 2019 Reservation Cut-Off Date: August 14, 2019 Pre-Conference Courses | February 21-22, 2019 Pre-Conference Courses | September 12-13, 2019 In This Issue: 2019 (Volume 17, Issue 1) Editors DANIEL E. SOFFER, MD, FNLA* 2 From the NLA President 18 Practical Pearls Clinical Associate Professor of Medicine New Clinical Guidelines: Paving the Top 10 Ways to Reduce Inflammation University of Pennsylvania — Cezary Wójcik, MD, PhD, DSc, FNLA* Internal Medicine and Preventive Cardiology Road Ahead University of Pennsylvania Health System — Alan S. Brown, MD, FNLA* Philadelphia, PA — Daniel E. Soffer MD, FNLA* — Kaye-Eileen Willard MD, FNLA* KAYE-EILEEN WILLARD, MD, FNLA* 20 Case Study Medical Director, Lipid Clinic and Physician Advisor Identifying and Managing the Patient Ascension Wisconsin All Saints Racine, WI 4 From the PLA President with High Inflammatory Burden President’s Views — Michelle Taylor, CCRN, ANP Associate Editors — Nathan D. Wong, PhD, FNLA — Rob Greenfield, MD, FNLA* Lori A. Alexander, MSHS, RD, CCRC, CLS, FNLA; Christie M. Ballantyne, MD, FNLA*; Thomas A. Barringer, MD, FNLA*; Carolyn Burns, MD*; Ashley D. Davila, RN, MSN, Chapter Update CNS, CLS; Daniel A. Duprez, MD, PhD, FNLA; Debra A. 5 Editor’s Corner 23 Friedrich, DNP, ARNP, FNP, BC, CLS, FNLA; Raymond A. Sparking the Conversation on Focus on Member Engagement Gaskins, MD*; Douglas S. Jacoby, MD, FNLA*; Laney K. Inflammatory Disease Management — Nathan D. Wong, PhD, FNLA Jones, PharmD, MPH; Matthew D. Kostoff, PharmD, CLS; — Eric K. Gupta, PharmD, CLS, FNLA Spencer D. Kroll, MD, PhD, FNLA*; Merle Myerson, MD, — Daniel E. Soffer MD, FNLA* EdD, FNLA*; Hal Roseman, MD, FNLA*; Khalid H. Sheikh, — Michael D. Shapiro, DO, FNLA* MD, FNLA*; Mark Sherman, MD, FNLA; Leandro Slipczuk, — Carol Kirkpatrick, PhD, MPH, RDN, CLS, FNLA MD, PhD; and Nathan D. Wong, PhD, FNLA 7 Clinical Feature — Yehuda Handelsman, MD, FNLA Executive Director Clinical Trial Evidence for the BRIAN HART, JD Role of Reducing Inflammation for 25 Specialty Corner National Lipid Association Cardiovascular Disease Prevention Dietary Patterns and Systemic LipidSpin is published five times a year by the — Bruce A. Warden, PharmD, BCPS-AQ Inflammation: Examining the National Lipid Association — Cezary Wójcik, MD, PhD, DSc, FNLA* 6816 Southpoint Parkway, Suite 1000 — Michael D. Shapiro, DO, FNLA* Connection Jacksonville, FL 32216 — Alyssa Lynott, RDN, LD Phone: 904-998-0854 | Fax: 904-998-0855 — Carol Kirkpatrick, PhD, MPH, RDN, CLS, FNLA Copyright ©2019 by the NLA. All rights reserved. 11 Guest Editorial — Geeta Sikand, MA, RDN, CDE, CLS, FNLA Visit us on the web at lipid.org. High-sensitivity C-reactive Protein Versus Coronary Artery Calcium 29 Member Spotlight The National Lipid Association makes every effort to provide accurate information in the LipidSpin at the Scoring: Dissecting a Biological Wenjun Fan, MS time of publication; however, circumstances may alter Target from a Cardiovascular Risk certain details, such as dates or locations of events. Any changes will be denoted as soon as possible. The NLA Assessment Tool 30 Education, News and Notes invites members and guest authors to provide scientific — Anurag Mehta, MD and medical opinion, which do not necessarily reflect the — Amit Khera, MD, MSc policy of the Association. 31 Events Calendar Join the conversation on NLA social media! EBM Tools for Practice 14 Foundation Update Best Biomarkers for Inflammation 32 — Anne C. Goldberg, MD, FNLA facebook.com/nationallipid — Terrance J. Moran, MD, FNLA* twitter.com/nationallipid References Let’s Get Social facebook.com/nationallipid 16 Lipid Luminations 33 linkedin.com/company/national- Medications that Reduce twitter.com/nationallipidlipid-association Inflammation Also May Reduce 36 NLA Tear Sheet Cardiovascular Disease instagram.com/nationallipidinstagram.com/nationallipid — Eric K. Gupta, PharmD, CLS, FNLA linkedin.com/company/ lipid.org *indicatesnational-lipid-association ABCL Diplomate status Official Publication of the National Lipid Association 1 From the NLA President and Editors of LipidSpin: New Clinical Guidelines: Paving the Road Ahead ALAN S. BROWN, MD, FNLA DANIEL E. SOFFER, MD, FNLA President, National Lipid Association Editor, LipidSpin Director, Division of Cardiology Clinical Associate Professor of Medicine Advocate Lutheran General Hospital University of Pennsylvania Co-Director, Cardiology Service Line Internal Medicine and Preventive Cardiology Advocate Medical Group University of Pennsylvania Health System Clinical Associate Professor Philadelphia, PA Loyola Stritch School of Medicine Diplomate, American Board of Clinical Lipidology Park Ridge, IL Diplomate, American Board of Clinical Lipidology KAYE-EILEEN WILLARD, MD, FNLA Editor, LipidSpin Medical Director, Lipid Clinic and Physician Advisor Ascension Wisconsin All Saints Racine, WI Diplomate, American Board of Clinical Lipidology one-size-fits-all. The guidelines would on their merits (and shortcomings). have to be concise, clear, evidence-based, Based upon the response to retention flexible, universal, simple. They would hypothesis of atherosclerosis, observational, Discuss this article at have to provide the best advice for the genetic and clinical trial evidence, www.lipid.org/lipidspin greatest number of patients without therapeutic lipid and lipoprotein compromising advice to individuals. We management of ASCVD risk should think the 2018 Cholesterol Clinical Practice emphasize the following: Guidelines (CPGs)(1) accomplished that, “Knowing is not enough; we must apply. and we applaud the effort of the Writing • A healthy lifestyle is the foundation of Willing is not enough; we must do.” Committee. care for all individuals. This remark by Goethe introduces readers • One should reduce apolipoprotein B to the rationale for the Institute of Medicine As you know, the American Heart (apoB) containing lipoprotein levels of the National Academies Committee Association (AHA) and American College (primarily represented by the low- on Standards for Developing Trustworthy of Cardiology (ACC) enlisted the assistance density lipoprotein cholesterol (LDL- Clinical Practice Guidelines: Guidelines We of 10 other stakeholder organizations, C)) as much as possible by enhancing Can Trust 2011. including the National Lipid Association peripheral clearance of atherogenic (NLA), to ensure best practices, consensus lipoproteins, using statin drugs as the If you were asked to compose a set of and distribution of their recommendations foundation of pharmacotherapy. guidelines to advise clinicians on the best making up the 2018 Guidelines on the • The statin dose should be one used approach to cholesterol management, how Management of Blood Cholesterol, released in randomized placebo controlled would you write them? What if that same at AHA Scientific Sessions in November clinical trials (RPCTs), higher intensity set of guidelines was meant to inform 2018. Look for an upcoming LipidSpin issue preferred over moderate, and the goals health systems? Insurers? Other national dedicated exclusively to the Guidelines, for intensity of response should be health systems? They would have to be where NLA member authors will weigh in matched to ASCVD risk. 2 LipidSpin • Volume 17, Issue 1 • January 2019 • Since clinicians and patients do not 10-year risk of 7.5%-19.9% (intermediate Individual clinicians and patients can always know their pre-treatment lipid risk), risk-enhancing factors favor treat “beyond the Guidelines,” but should levels, there should also be thresholds initiation of statin therapy. recognize they do so with less evidence over which intensification of therapy 9. In adults 40-75 years without DM supporting care. In fact, there are many should be considered. and with LDL-C ≥70-189 mg/dL, at a examples where this makes sense, but • Since there is a high rate of attrition 10-year ASCVD risk of ≥7.5%-19.9%, it is not difficult to come up with a list with statin therapy, regular monitoring if a decision about statin therapy is of examples where this backfired (using to ensure medication tolerability, uncertain, consider measuring CAC. extended release niacin in our patients response to therapy and adherence to 10. Assess adherence and percentage achieving low LDL-C with moderate care is recommended. This begins with response to LDL-C–lowering intensity statin? Alpha-blockers as education and a shared discussion, and medications and lifestyle changes monotherapy for hypertension?