Official Publication of the National Lipid Association pot·pour·ri LipidSpin noun /,pou pu’ri:/ 1. a mixture of dried flower petals, leaves, and spices that is used to make a room smell pleasant 2. a collection of different things1 STATINS STATINS Special Freelance Edition Featuring: Omega-3 Fatty Acid Fish Oil Dietary Supplements for Disease Management: Are They Appropriate for Patients? Also in this issue: Search for the Secondary Cause: Worth the Pause Clinical Conundrum: The Estimated LDL-C Below 40 mg/dL This issue sponsored by the National Lipid Association Special Issue 2016 visit www.lipid.org Get Certied in Lipid Management Advance Your Career Improve Patient Care Enhance Your Professional Stature and Credibility Demonstrate Your Commitment to Continued Professional Development in Dyslipidemia Testing Window Fall 2016 Testing Window September 25, 2016 - November 5, 2016 (application deadline: Friday, September 16, 2016) Applications must be postmarked by the application deadline. Pharmacists, Nurses, Physicians, Physician Assistants, Dietitians, Exercise Specialists, Industry and Research Professionals Physicians The Accreditation Council for Clinical Lipidology The only advanced certication program of its kind oers two levels to recognition: available to physicians who wish to validate their Basic Competency in Clinical Lipidology Exam: rigorous training and expertise in lipidology. For individuals with general involvement in lipidology who want to sharpen their skills and The American Board of Clinical Lipidology was knowledge in lipid management. established to assess the level of knowledge required to be certied as a Clinical Lipidologist, to Clinical Lipid Specialist Certication Program: encourage professional growth in the practice Provides an opportunity for health care of lipidology, and to enhance physician practice professionals who provide specialized care to behavior to improve the quality of patient care. patients with dyslipidemia and related cardiometabolic conditions to become certied as clinical lipid specialists. www.lipidboard.org www.lipidspecialist.org In This Issue: Editors 2 From the NLA President 24 Statin Therapy in the Very DANIEL SOFFER, MD, FNLA* Newly Published Guidance for Non- Elderly (>80) With CAD: Balancing Clinical Associate Professor of Medicine Statin Therapies from the American the Benefits and Risks University of Pennsylvania — Judith A. Collins, MSN, APRN-BC, FPCNA, FNLA Internal Medicine and Preventive Cardiology College of Cardiology University of Pennsylvania Health System — Joyce L. Ross, MSN, FNLA Philadelphia, PA 27 The Potential Role of Universal JOSEPH J. SASEEN, PharmD, BCPS, BCACP, CLS, FNLA 4 From the LipidSpin Editor Genetic Screening for Familial Professor, Clinical Pharmacy and Family Medicine HOPE Springs Eternal for Defective Apolipoprotein B-100 in University of Colorado Denver Intermediate-Risk Primary Prevention Southern Pennsylvania Anschutz Medical Campus — Rolf L. Andersen, MD, FACC, FNLA Aurora, CO Patients — Joseph J. Saseen, PharmD, FNLA — Lars Andersen, BA Managing Editor MELISSA HEYBOER National Lipid Association 6 From the LipidSpin Editor 29 Omega-3 Fatty Acid Fish Oil Dietary Supplements for Disease Executive Director Looking Back, Moving Forward BRIAN HART, JD — Daniel Soffer, MD, FNLA Management: Are They Appropriate National Lipid Association for Patients? 7 The Advent of PCSK9 Inhibitors in — R. Preston Mason, PhD LipidSpin is published five times a year by the — Daniel E. Hilleman, PharmD National Lipid Association Real Life 6816 Southpoint Parkway, Suite 1000 — Cezary Wójcik, MD, FNLA Jacksonville, FL 32216 32 Pseudohypertriglyceridemia in a Phone: 904-998-0854 | Fax: 904-998-0855 9 Search for the Secondary Cause: Teenager: Evaluation, Management, Copyright ©2016 by the NLA. Implications, and Literature Review All rights reserved. Worth the Pause — Allison Ducharme-Smith, MD — James J. Maciejko, MS, PhD, FACC — Premchand Anne, MD, MPH, FACC Visit us on the web at www.lipid.org. — Balint Laczay, MD — Viraj Prakash Raygor, MD — Manisha Ravi The National Lipid Association makes every effort to — Neil J. Stone, MD, FNLA provide accurate information in the LipidSpin at the 34 Sanofi Regeneron Young time of publication; however, circumstances may alter Investigator Award Winner certain details, such as dates or locations of events. Any 12 Clinical Conundrum: The changes will be denoted as soon as possible. The NLA — Imran Baig, MD invites members and guest authors to provide scientific Estimated LDL-C Below 40 mg/dL and medical opinion, which do not necessarily reflect — Donald G. Lamprecht Jr., PharmD, BCPS, FNLA the policy of the Association. — Sheila L. Stadler, PharmD, BCPS-AQ Cardiology 36 Red Yeast Rice as an Alternative Therapy for Hyperlipidemia CETP Inhibitors Remaining in — Ram Y. Gordon, MD 15 — David J. Becker, MD Clinical Development: A History and Update for Clinicians — Sean D. Stewart, PharmD, BCACP, FNLA 38 Foundation Update 40 Member Acknowledgement 18 Coronary Artery Calcium Scoring in Decision Making: the MESA Score 43 Education, News and Notes — Edward Goldenberg, MD, FNLA — Steven Meng, MD 44 Events Calendar 21 Omega-3 Fish Oil: 45 References *indicates ABCL Diplomate status Cardioprotective or Not? — Terrance J. Moran, MD, FACC, FAHA 49 Patient Tear Sheet Official Publication of the National Lipid Association 1 From the NLA President: Newly Published Guidance for Non-Statin Therapies from the American College of Cardiology JOYCE L. ROSS, MSN, CRNP, FPCNA, FNLA President, National Lipid Association Consultative Education Specialist Cardiovascular Risk Intervention University of Pennsylvania Health System – Retired Philadelphia, PA Diplomate, Accreditation Council for Clinical Lipidology approved a new class of medications Algorithms found within the current termed proprotein convertase subtillisin/ document provide a suggested clinical kexin 9 or, most often referred to as, workflow for consideration of additional Discuss this article at PCSK9 inhibitors for high-risk patients who non-statin therapies. Ten points were www.lipid.org/lipidspin may require additional therapies to bring specifically highlighted to assist the the LDL-C to a more acceptable threshold. provider to fully understand and implement The recent results of the HPS2-THRIVE its recommendations. In April 2016, an expert consensus and IMPROVE-IT trials have also provided decision pathway on the role of non- new data that provided new evidence 1. The decision pathway was created to statin therapies for lowering LDL-C with regard to the addition of second non- address GAPS in recommendations in the management of atherosclerotic statin agents when additional lowering is for LDL-C lowering to reduce ASCVD cardiovascular disease (ASCVD) risk was warranted. in high-risk subsets based on recent published in the Journal of the American clinical trial evidence and the College of Cardiology. This document, The publication of these new guidelines introduction of a new class of lipid- which was endorsed by the National Lipid are in concert with the standards and lowering medication Association (NLA), and with the diligent recommendations made by the NLA, and 2. The 2013 ACC/AHA cholesterol and consistent work of our Immediate we are excited to endorse the work of guidelines identified four major statin Past President Carl Orringer, MD, as the initial “think tank,” which resulted in benefit groups, which remain intact one of its authors, provides practical this publication. We are further pleased to and include: guidance for clinicians and patients in report that Dr. Orringer has accepted the situations that were not covered by the invitation of the ACC committee when it a. Patients > 21 with clinical joint 2013 American College of Cardiology/ convenes this Fall in Washington, DC, as ASCVD American Heart Association (ACC/AHA) it moves its work forward assessing and guidelines. The need for such a document making recommendations for barriers b. Adults > 21 years of age with was emphasized by recent additions to around implementation of evidence-based LDL-C > 190 mg/dL (after ruling the body of knowledge for risk factor LDL-C lowering therapies for ASCVD out secondary causes) reduction in cardiovascular disease. Since reduction. We are grateful for the ongoing the publication of the last guidelines, energy that he brings to this work and look c. Adults 40–75 years old without the Food and Drug Administration has forward to outcomes from this meeting. known ASCVD but with diabetes, with LDL-C 70-189 mg/dL 2 LipidSpin • Volume 14, Issue 4 • August 2016 d. Adults 40–75 years without 8. In cases of suspected statin for most patients. ASCVD or diabetes, with an intolerance, the provider should LDL-C 70–189 mg/dL, and an include temporary discontinuation 3. Bile acid sequestrants (BAS) may be estimated 10-year risk for ASCVD of statin therapy, lower dosing, considered as second-line therapy who of > 7.5 percent, as determined re-challenge preferably with 2–3 are not able to tolerate ezetimibe, but by the pooled cohort equations. different statins that utilize different they should be avoided in patients metabolic pathways, and intermittent with triglycerides > 300 mg/dL. 3. The 2013 guidelines recommended (1–3 Xs weekly) dosing of long half- 4. PCSK9 inhibitors may be considered using either high- or moderate- life statins. intensity statin therapy for primary if LDL goals are not achieved on and secondary prevention, with 9. In selected high-risk patients (those maximally