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Clinical Feature: the Evolution of Lipid, Lipoprotein, and Apolipoprotein Markers of CVD Risk and Therapeutic Targets—Is It Ti Official Publication of the National Lipid Association LipidSpin Clinical Feature: The Evolution of Lipid, Lipoprotein, and Apolipoprotein Markers of CVD Risk and Therapeutic Targets—Is it Time to Abandon the Cholesterol Content of Atherogenic Lipoproteins? Also in this issue: “HDL-P vs. ApoA1 vs. HDL-C” in Context of the HDL-Hypothesis Controversy The Role of Remnant Lipoproteins in Atherogenesis This issue sponsored by the Pacific Lipid Association Volume 11 Issue 2 Spring 2013 visit www.lipid.org In This Issue: Spring 2013 (Volume 11, Issue 2) Editors 2 From the NLA President JAMES A. UNDERBERG, MD, MS, FACPM, FACP, FNLA* Our Pursuit Continues Preventive CV Medicine, Lipidology and Hypertension —Peter P. Toth, MD, PhD, FNLA* Clinical Assistant Professor of Medicine NYU Medical School and Center for CV Prevention New York, NY 3 From the PLA President Look for the NLA Community logo to discuss articles online at www.lipid.org ROBERT A. WILD, MD, PhD, MPH, FNLA* Apolipoproteins in Clinical Practice Clinical Epidemiology and Biostatistics and —J. Antonio G. López, MD, FNLA Clinical Lipidology Professor Oklahoma University Health Sciences Center Letter from the Lipid Spin Editors Oklahoma City, OK 4 27 Practical Pearls The Times They Are A-changin’ Cardiac Auscultation for the Managing Editor —Robert A. Wild, MD, PhD, FNLA* MEGAN L. SEERY Lipidologist: A Systolic Murmur You National Lipid Association Do Not Want to Miss! 5 Clinical Feature —J. Antonio G. López, MD, FNLA* Executive Director CHRISTOPHER R. SEYMOUR, MBA Is it Time to Abandon the —John R. Nelson, MD, FNLA* National Lipid Association Cholesterol Content of Atherogenic Contributing Editor Lipoproteins? 30 Case Study KEVIN C. MAKI, PhD, CLS, FNLA —Paul D. Rosenblit, MD, PhD, FNLA* Digging Deeper—A Case for —Edward A. Gill, MD, FNLA* Associate Editor for Patient Education —Robert G. Thompson, MD* Apolipoproteins and Lifestyle in VANESSA L. MILNE, MS, NP, CLS Office Practice Cardiac Vascular Nurse and Family Nurse Practitioner —Rob Greenfield, MD, FNLA* Bellevue Hospital Lipid Clinic 12 Guest Editorial —Susan Given, cFNP, MN, BSN New York, NY The Role of Remnant Lipoproteins in Lipid Spin is published quarterly by the Atherogenesis Chapter Update —John R. Nelson, MD, FNLA* 32 National Lipid Association —B. Alan Bottenberg, DO, FNLA* 6816 Southpoint Parkway, Suite 1000 —Paul N. Hopkins, MD, MSPH* Jacksonville, FL 32216 Phone: 904-998-0854 | Fax: 904-998-0855 Member Spotlight: EBM Tools for Practice 34 Copyright ©2013 by the NLA. 16 Daniel Steinberg, MD, PhD All rights reserved. “HDL-P vs. ApoA1 vs. HDL-C” in Context of the HDL-Hypothesis 35 Education, News and Notes Visit us on the web at www.lipid.org. Controversy —Michael D. Shapiro, DO* The National Lipid Association makes every effort to 36 Events Calendar provide accurate information in the Lipid Spin at the —Eliot A. Brinton, MD, FNLA* time of publication; however, circumstances may alter certain details, such as dates or locations of events. 37 Foundation Update Any changes will be denoted as soon as possible. 18 Lipid Luminations The NLA invites members and guest authors to Lipoprotein(a)—Clinical Significance, provide scientific and medical opinion, which do not References necessarily reflect the policy of the Association. Evaluation, and Management 38 —P. Barton Duell, MD 41 Patient Tear Sheet 22 Specialty Corner Nephrology Corner—Limitations of Statin Use and Adjuvant Therapies in Stage IV CKD and Dialysis *indicates ABCL Diplomate status —Michael J. Bloch, MD* —Ali Olyaei, PharmD 1 From the NLA President: Our Pursuit Continues PETER P. TOTH, MD, PhD, FNLA President, National Lipid Association Director of Preventative Cardiology CGH Medical Center Sterling, IL Professor of Clinical Family and Community Medicine University of Illinois School of Medicine Peoria, IL Diplomate, American Board of Clinical Lipidology and Research. Additionally, we discussed and execution of the Spring CLU. After ongoing and new endeavors in the areas of the conference concluded, Foundation of Communications and Membership. the NLA President Anne Goldberg, MD, hosted some of our partner organizations Discuss this article at www.lipid.org/lipidspin We have made targeted recommendations during our inaugural FH Roundtable in New regarding Leadership Development and Orleans. At the Roundtable, these groups Member Responsibilities. In particular, discussed forming a collective identity chapter leaders and members at the known as the FH Consortium, with the The NLA has consistently held a determined regional levels will be given greater goal of further moving FH awareness to the focus on promoting the highest levels of responsibility for projects, and chapter national stage and assisting patients with education and professional development. leaders will develop annual plans. Chapter finding treatment. We are defined by the quality of our bylaws will be made uniform so they are outstanding leadership, members, partners consistent throughout the association. In Moving ahead, I look forward to seeing and staff. As a result, we are continuously addition, some NLA committees will review you at our Annual Scientific Sessions in challenged to assess and refine our and refine their charges and initiatives. Las Vegas from May 30-June 2. I always work in an attempt to produce the best enjoy the NLA meetings because they are and most innovative programming in The strategic planning recommendations characterized by people who are passionate Clinical Lipidology, leading to a direct will be brought before the NLA Board for about ideas and who share common values and measurable impact in our medical consideration during our Annual Scientific and intellectual energy. Let’s gather once community and across the globe. Sessions in Las Vegas this coming May. I again to share with and learn from one look forward to sharing our strategic plan another in our pursuit of new knowledge as With our core mission in mind, a group of with you once adopted and approved. well as personal and career achievement. n NLA leaders met in Miami from February 8-10 for biannual strategic planning, where Additionally, the NLA hosted yet another we were faced with important topics about successful regional meeting, the Spring resources and positioning the association Clinical Lipid Update, in New Orleans this far into the future. I am gratified to report past February. The conference was co- that we emerged with clear priorities in hosted by the Midwest Lipid Association the areas of Professional Education, Policy and Southwest Lipid Association, who Statements, and Practice Management provided key expertise in the planning 2 LipidSpin From the PLA President: Apolipoproteins in Clinical Practice J. ANTONIO G. LÓPEZ, MD, FACC, FAHA, FACP, FCCP, FNLA Pacific Lipid Association President Director, Preventive Cardiology and Cardiovascular Rehabilitation Director, Lipid Clinic and LDL Apheresis Program Chair, Department of Cardiology Saint Alphonsus Regional Medical Center Boise, ID Diplomate, American Board of Clinical Lipidology I am pleased to present to the National Past-President John R. Nelson, MD. Lipid Association the Spring 2013 issue of For this issue of the Lipid Spin, I am also the Lipid Spin. The Pacific Lipid Association thankful for the work of the editors, Jamie serves the states of Washington, Oregon, Underberg, MD, and Robert Wild, MD, California, Idaho, Montana, Nevada, PhD. This issue would not have been Discuss this article at www.lipid.org/lipidspin Utah, Alaska, and Hawaii. The theme of completed without the assistance of the this Spring issue is “Roles of Common NLA staff and, in particular, Megan Seery. Apolipoproteins in Cardiovascular Disease (CVD) and How They Affect Our An important mission of the PLA and Clinical Practice.” The authors discuss NLA is to promote responsible outreach apolipoproteins, their relevance, a review to all regions of the country to make of the literature and the implications available the benefits of the NLA in for clinical practice. I am proud of the every community. I encourage all of our contributions of our PLA members. members to continue our collective effort in achieving this goal. I am honored that pioneering lipid researcher, Daniel Steinberg, MD, We invite you to attend the 2013 NLA PhD, professor emeritus of medicine at Annual Scientific Sessions in our own the University of California-San Diego, Las Vegas, Nevada, from May 30-June 2. is featured in this issue as the member The PLA will serve as the regional host spotlight. Dr. Steinberg is one of the for the sessions at the Red Rock Hotel original proponents of the cholesterol in Las Vegas. You will not want to miss hypothesis of atherosclerosis. San Diego, out on the latest in lipid research and California is my hometown. applications. n At this midterm juncture of my presidency, I am thankful for the support of B. Alan Bottenberg, DO, President-elect; Paul D. Rosenblit, MD, PhD, Treasurer; Wayne S. True, MD, Secretary; and Immediate Official Publication of the National Lipid Association 3 Letter From the Lipid Spin Editors: The Times They Are A-changin’ 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 Services are now rewarding efforts to deliver judgment and patient preferences with lifestyle interventions in a practical and systems management. We are making strides meaningful way. I am also pleased
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