Lipidology
P re f a c e T h e Wo r l d a n d L i p i d o l o g y as I t R e l a t e s t o C a rd i o l o g y
Edward A. Gill, MD, FASE, FAHA, FACC, FACP, FNLA
Kathleen L. Wyne, MD, PhD
Christie M. Ballantyne, MD, FACC, FACP, FAHA, FNLA
What are hyperlipidemia and dyslipidemia? What is a Lipidologist? Is there a specialty dedicated to the diagnosis and treatment of lipid disorders? Should there be such a specialty? If so, how should it be recognized? What patients should be managed by Lipidologists? These are the questions that we hope the reader will be pondering as they peruse through the articles of this issue of Cardiology Clinics devoted to “Practical Lipidology for the Cardiovascular Specialist.” In order to define hyperlipidemia or dyslipidemia, on approach is to recognize this state as total l cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride, apolipoprotein (apo)-B, or Lp(a) levels above the 90th percentile. Also, high density lipoprotein-cholesterol (HDL-C) or apo A-I levels below the 10th percentile for the general population is another. Cardiovascular disease continues to be the greatest killer of Americans despite remarkable progress in neutralizing its devastating effects. In fact, acute myocardial infarction decreased in prevalence throughout the 1990s and 2000s, especially ST elevation MI. In addition, mortality from acute MI decreased by as much as 50% in the 1990s and 2000s.1 Cardiovascular disease is in fact growing in developing countries, and despite improvement in the United States, it is estimated that the global burden of coronary heart disease (CHD) increased by 29% between 1990 and 2010 due to increases in therapy and longevity along with global population growth.1 There is
significant regional variation in CHD mortality with the largest number of deaths seen in South Asia. Meanwhile, the highest death rate for CHD is seen in Eastern Europe and Central Asia.1 The burden of cardiovascular disease in ethnic groups is hence emphasized and discussed in detail by Dr Palaniappan. It cannot be emphasized enough that cardiovascular disease is largely preventable and, at the very least, can be delayed. Prevention has never been more possible today with the combination of tailored exercise, diet, and pharmacologic treatments, despite that our great pharmacologic therapies and lifestyle change are constantly being counterbalanced by an epidemic of obesity and type 2 diabetes. The field of Lipidology experienced a dramatic turn of events in November 2013 when the ACC/ AHA guidelines for treatment of cholesterol disorders were released and published simultaneously in Circulation and JACC.2 These guidelines have been discussed hugely over the past 18 months and we continue to do so within this issue. Drs Jacobson and Adhyaru discuss the ACC/AHA guidelines and contrast them to recommendations recently released by the National Lipid Association. The two key issues have been the lack of recommendations of lipid level goals, specifically LDL goals, and the lack of recommended roles of lipidlowering agents beyond the statins. In addition, Drs Goldberg and Bouhairie discuss familial hypercholesterolemia from the
Cardiol Clin 33 (2015) xiii–xiv http://dx.doi.org/10.1016/j.ccl.2015.03.001 0733-8651/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
cardiology.theclinics.com
Editors
xiv
Preface pathophysiology to treatment of these patients with strikingly high LDL cholesterol levels, and Drs Ballantyne, Bilen, and Pokharel take us through the newest breakthroughs in genetics and their role in diagnosing and treating lipid disorders. This issue will take the reader on a journey of lipid recognition, appreciation of pathophysiology, and treatment of lipid disorders and will certainly recognize the difficulty we as caregivers face with the precise treatment of these disorders, particularly with regard to the need or lack thereof of LDL or other goals such as non-HDL, and with regard to which pharmacologic agents to prescribe. In the end, we believe the importance of lifestyle means of prevention, including weight loss, maintenance of ideal body weight, diet, and exercise, needs to be emphasized. The guest editors would like to thank Dr Rosario Freeman for the invitation to put together this issue of Cardiology Clinics. It has been a pleasure to do so, and we have enjoyed working with all the contributors. A special thanks to the staff at Elsevier, particularly, Adrianne Brigido and Susan Showalter, for establishing goals and timelines, and for keeping us on track. Edward A. Gill, MD, FASE, FAHA, FACC, FACP, FNLA Division of Cardiology UW Department of Medicine Harborview Medical Center Echocardiography University of Washington School of Medicine Seattle University 325 Ninth Avenue, Box 359748 Seattle, WA 98104-2499, USA
Kathleen L. Wyne, MD, PhD Division of Endocrinology The Ohio State University 566 McCampbell Hall 1581 Dodd Drive Columbus, OH 43210, USA Christie M. Ballantyne, MD, FACC, FACP, FAHA, FNLA Sections of Cardiovascular Research and Cardiology Baylor College of Medicine Center for Cardiovascular Disease Prevention Houston Methodist DeBakey Heart and Vascular Center 6565 Fannin, M.S. A-601 Houston, TX 77030, USA E-mail addresses: [email protected] (E.A. Gill) [email protected] (K.L. Wyne) [email protected] (C.M. Ballantyne)
REFERENCES 1. Moran AE, Forouzanfar MH, Roth GA, et al. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation 2014;129:1493–501. 2. Stone NJ, Robinson JG, Lichtenstein AH. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. Circulation 2014;129: S1–45.
P re f a c e T h e Wo r l d a n d L i p i d o l o g y as I t R e l a t e s t o C a rd i o l o g y
Edward A. Gill, MD, FASE, FAHA, FACC, FACP, FNLA
Kathleen L. Wyne, MD, PhD
Christie M. Ballantyne, MD, FACC, FACP, FAHA, FNLA
What are hyperlipidemia and dyslipidemia? What is a Lipidologist? Is there a specialty dedicated to the diagnosis and treatment of lipid disorders? Should there be such a specialty? If so, how should it be recognized? What patients should be managed by Lipidologists? These are the questions that we hope the reader will be pondering as they peruse through the articles of this issue of Cardiology Clinics devoted to “Practical Lipidology for the Cardiovascular Specialist.” In order to define hyperlipidemia or dyslipidemia, on approach is to recognize this state as total l cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride, apolipoprotein (apo)-B, or Lp(a) levels above the 90th percentile. Also, high density lipoprotein-cholesterol (HDL-C) or apo A-I levels below the 10th percentile for the general population is another. Cardiovascular disease continues to be the greatest killer of Americans despite remarkable progress in neutralizing its devastating effects. In fact, acute myocardial infarction decreased in prevalence throughout the 1990s and 2000s, especially ST elevation MI. In addition, mortality from acute MI decreased by as much as 50% in the 1990s and 2000s.1 Cardiovascular disease is in fact growing in developing countries, and despite improvement in the United States, it is estimated that the global burden of coronary heart disease (CHD) increased by 29% between 1990 and 2010 due to increases in therapy and longevity along with global population growth.1 There is
significant regional variation in CHD mortality with the largest number of deaths seen in South Asia. Meanwhile, the highest death rate for CHD is seen in Eastern Europe and Central Asia.1 The burden of cardiovascular disease in ethnic groups is hence emphasized and discussed in detail by Dr Palaniappan. It cannot be emphasized enough that cardiovascular disease is largely preventable and, at the very least, can be delayed. Prevention has never been more possible today with the combination of tailored exercise, diet, and pharmacologic treatments, despite that our great pharmacologic therapies and lifestyle change are constantly being counterbalanced by an epidemic of obesity and type 2 diabetes. The field of Lipidology experienced a dramatic turn of events in November 2013 when the ACC/ AHA guidelines for treatment of cholesterol disorders were released and published simultaneously in Circulation and JACC.2 These guidelines have been discussed hugely over the past 18 months and we continue to do so within this issue. Drs Jacobson and Adhyaru discuss the ACC/AHA guidelines and contrast them to recommendations recently released by the National Lipid Association. The two key issues have been the lack of recommendations of lipid level goals, specifically LDL goals, and the lack of recommended roles of lipidlowering agents beyond the statins. In addition, Drs Goldberg and Bouhairie discuss familial hypercholesterolemia from the
Cardiol Clin 33 (2015) xiii–xiv http://dx.doi.org/10.1016/j.ccl.2015.03.001 0733-8651/15/$ – see front matter Ó 2015 Published by Elsevier Inc.
cardiology.theclinics.com
Editors
xiv
Preface pathophysiology to treatment of these patients with strikingly high LDL cholesterol levels, and Drs Ballantyne, Bilen, and Pokharel take us through the newest breakthroughs in genetics and their role in diagnosing and treating lipid disorders. This issue will take the reader on a journey of lipid recognition, appreciation of pathophysiology, and treatment of lipid disorders and will certainly recognize the difficulty we as caregivers face with the precise treatment of these disorders, particularly with regard to the need or lack thereof of LDL or other goals such as non-HDL, and with regard to which pharmacologic agents to prescribe. In the end, we believe the importance of lifestyle means of prevention, including weight loss, maintenance of ideal body weight, diet, and exercise, needs to be emphasized. The guest editors would like to thank Dr Rosario Freeman for the invitation to put together this issue of Cardiology Clinics. It has been a pleasure to do so, and we have enjoyed working with all the contributors. A special thanks to the staff at Elsevier, particularly, Adrianne Brigido and Susan Showalter, for establishing goals and timelines, and for keeping us on track. Edward A. Gill, MD, FASE, FAHA, FACC, FACP, FNLA Division of Cardiology UW Department of Medicine Harborview Medical Center Echocardiography University of Washington School of Medicine Seattle University 325 Ninth Avenue, Box 359748 Seattle, WA 98104-2499, USA
Kathleen L. Wyne, MD, PhD Division of Endocrinology The Ohio State University 566 McCampbell Hall 1581 Dodd Drive Columbus, OH 43210, USA Christie M. Ballantyne, MD, FACC, FACP, FAHA, FNLA Sections of Cardiovascular Research and Cardiology Baylor College of Medicine Center for Cardiovascular Disease Prevention Houston Methodist DeBakey Heart and Vascular Center 6565 Fannin, M.S. A-601 Houston, TX 77030, USA E-mail addresses: [email protected] (E.A. Gill) [email protected] (K.L. Wyne) [email protected] (C.M. Ballantyne)
REFERENCES 1. Moran AE, Forouzanfar MH, Roth GA, et al. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation 2014;129:1493–501. 2. Stone NJ, Robinson JG, Lichtenstein AH. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. Circulation 2014;129: S1–45.
