the Lipid Spin (Summer 2007)

Transcription

A Publication of the National Lipid Association
THE
Lipid Spin
The Official Publication of the National Lipid Association
Volume 4 • Issue 2 • Summer 2007
Clinical Insights
Cardiovascular Risk in Migrant
South Asians
Nicola Abate, MD
Associate Professor of Medicine
Director Lipid Clinic
UT Southwestern Medical Center
Dallas, Texas
Manisha Chandalia, MD
Associate Professor of Medicine
UT Southwestern Medical Center
Dallas, Texas
Migrants from the Indian subcontinent, here referred to as South
Asians, have been reported to be at high risk for both diabetes
and cardiovascular disease (CVD),1–5 two major causes of
disability and mortality in western countries. The incidence of
diabetes and CVD is increasing also in developing countries,
including those in the South Asian region. Obesity and central
fat distribution are important predictors of both diabetes and
cardiovascular disease and appear to play a major pathogenetic
role in these two disease entities. The growing “westernization”
of South Asian countries and adoption of “obesogenic”
lifestyles may therefore contribute to the alarming increase in
the prevalence of diabetes and CVD. However, recent studies
suggest that South Asians are at increased risk for any level of
obesity and central fat distribution, when compared to persons
of European descent. It is possible that ethnic-related lifestyle
factors, including diet, may explain some of the excessive
risk. However, a major role may also be played by genetic
susceptibility.
Relationship between lifestyle factors and risk for CVD in
South Asians
A wealth of epidemiological data shows that the prevalence of
CVD in various ethnic groups is influenced by environmental
factors.6–16 This is also true for South Asians. It has been
reported that the prevalence of CVD in the migrant South
Asian population is higher than in the same ethnic group living
in its country of origin.5 This observation suggests that the
lifestyle changes associated with the process of urbanization/
westernization may largely explain the progressive increase in
the prevalence of type 2 diabetes and CVD in this ethnic group.
However, a comparison of the prevalence of diabetes and CVD
in South Asians and persons of European descent living within
the same environmental conditions suggests that South Asians
have an unusual excess of both diseases, incompletely explained
by lifestyle and related traditional risk factors.
Diet and exercise
Reduced fiber intake and increased consumption of animal
fats and processed carbohydrates are the main changes in
dietary habits described in westernized societies and adopted
by migrant populations. Both animal fats and carbohydrates
have been associated with excessive predisposition to diabetes,
mainly through development of obesity.20,21 Increased CVD
risk factors, such as hypercholesterolemia and hypertension
may be mediated by excessive saturated fat and salt intake
adopted by migrant populations to western countries. Reduced
Continued on page 4
in this issue . . .
• Clinical Insights...............................................1
• President’s Column...........................................2
• Practical Pearls............................................. 11
• Lipid Luminations........................................... 12
• Education Programs........................................ 13
• News & Notes............................................... 14
• ABCL 2006 Listing of Diplomates....................... 19
• Meetings and Events Calendar........................... 20
LIPID SPIN SUMMER 2007
President’s Column
Hold on tight … we’re on
the move
JAMES M. MCKENNEY, PharmD
NLA President
President and CEO, National Clinical
Research
Professor Emeritus, Virginia Commonwealth
University
Richmond, Virginia
Last year at this time I reported to you the results of the NLA
Strategic Planning Committee’s effort to devise a 5-year plan
for growth and development. We ultimately drafted a list
of 26 recommendations, which were subsequently adopted
by the NLA board of directors as an action plan. In April of
this year, we reconvened the Committee to take stock of our
progress to date and determine what, if any, adjustments or
new policy or programs should be created to serve the mission
of the organization and needs of our membership. These
recommendations will appear before the membership this May
for approval but I wanted to provide you with a glimpse into
what the NLA agenda has in store. If you want to let us know
your ideas, please send an e-mail to the NLA office, addressed to
any of its officers.
Leadership and Organization
Our mission statement remains on target, but as leaders we
are setting our sights on ensuring that our organization is
represented by a strong and diverse board of professionals—
both physicians and allied health professionals—from every
avenue of practice in the clinical setting. Your board and
committees are volunteers and we applaud their spirit and call
to service as we seek to identify new leaders from every area
of the country. Identifying leaders within committees, noting
service on regional boards, and ultimately rewarding success at
the national level form the basis of our leadership succession
plan. The recommendations are supportive of board member
development but also recognize that the board members need to
turn over leadership to members rising in the membership ranks.
Further, we are adding “in training” positions to all of our
regional and national boards in the coming years to ensure we
maintain a connection with the new segment of professionals
that have an interest in our subspecialty.
Administrative Organization and Finance
The NLA has grown incredibly in terms of membership and
funding resources for our programs. This is a testament to our
outstanding agenda and quality of medical education activities.
To match this quick pace, we needed to create a few policies
and safeguards for the membership resources and ourselves. We
recommend an annual audit conducted by an independent CPA,
the adoption of a documentation policy that affords reliable
recordkeeping but also recognizes storage and archiving issues.
Further, the NLA Executive Committee has also been the Finance
Committee, but beginning this year the Finance Committee will be
reborn. The chapter Treasurers will meet with the NLA Treasurer
to review finance contracts, develop budgets and evaluate
the transaction of all financial matters. It is felt that the NLA
should further diversify its sources of funding beyond industry
contributions. The NLA will also review its honorarium policy to
ensure standardization and reasonability.
The NLA will continue to hold five annual scientific meetings
(four chapter and one national May meeting). However, staff
analysis revealed that although there was an attempt to ensure
that regional meetings address local audience needs, it is apparent
that each chapter continues to emphasize national speakers and
a multifaceted, comprehensive agenda, which is driving costs
higher. The Committee recommended that the NLA Board and
chapters closely examine budgetary constraints and look for
innovative programming that keeps regional participants involved
and remains cost effective, and that staff create specific program
chair and committee guidelines that explain the processes for
selection of venue, budgets, medical education requirements, and
participation of faculty in both national and regional events.
Lastly, our Finance Committee will discuss the establishment of a
charitable public foundation dedicated to working in the interest of
public education.
Communication and Public Policy
The Committee emphasized that the NLA needs to continue to
develop its policy and communications presence to not only
work in the interest of clinical professionals, but to also promote
lipidology and the benefits this area of medicine presents to the
public.
Attention then focused on how the NLA can become more active
in creating public policy statements regarding treatment, care
standards, and even issues related to patient reimbursement.
We envision the NLA President appointing task forces or
committees as needed when such issues arise. One standing
group, the Consumer Affairs Committee, already generates policy
statements as part of its assigned responsibilities. It is now time
for the Consumer Affairs Committee mission to be updated and
include the development of Website materials and other patient
information.
from each chapter. Further, each chapter should be responsible
for at least one edition of the Lipid Spin on a revolving basis.
The Committee recommended that the work of the Safety
Task Force continue, and that the Task Force should consider
producing a supplement report on the safety of combination
therapy. Also, the Task Force charge could be expanded to
include the issues of patient adherence, which would lead them
to examine the evidence for lifestyle and pharmacologic lipid
management.
The Committee felt strongly that our relationship with outside
organizations having similar goals should be enhanced
whenever possible.
The NLA should also examine the evidence for and establish
a policy on biomarker/advanced lipid testing used in the
management of lipid disorders. The NLA is already developing
a Self-Assessment Program on this issue. In addition, the
American Association of Clinical Chemistry and Centers
for Disease Control are working on guidelines that could be
evaluated by the NLA and if acceptable, adopted.
The key strategic additions of the Accreditation Council for
Clinical Lipidology (ACCL) and the release of the Journal
of Clinical Lipidology were both felt to be key initatives that
will help promote membership in the NLA. However, it was
reaffirmed that the NLA should explore additional ways to
recognize NLA members who demonstrate their commitment to
NLA goals and excellence in their practices.
The Committee recommended that the NLA continue to
pursue extending credentials to members in the form of formal
fellowship status. The NLA “fellow” would mirror other
programs of recognition offered by other professional medical
associations.
The Committee asked that the Board consider developing criteria
for evaluating a clinical lipidology practice as being a lipid
“Center of Excellence.” Any educational activities that could
have a positive impact toward this recognition would then be
designated in NLA education materials to help guide members
toward this goal.
The NLA Medical Education Department is currently
accredited for physician CME, but it cannot yet provide
independent accreditation for nurses, dietitians, and
pharmacists. We are aware of this issue and will target the
accreditation of all programs for all audiences as we go
forward.
New texts and the work of the ACCL examination board have
mandated additions to the NLA core curriculum. As a result, it
is critical that the NLA-SAP be revised in the coming year. The
NLA Self-Assessment and Self-Study programs have established
themselves as a major activity of the Association.
The Committee suggested that, similar to the Finance
Committee, the Education Committee should meet at least twice
a year to establish education priorities, review accreditation
standards, and review needs assessments.
Although the number of programs directed toward lipidologists
has expanded, it is still imperative that the NLA reach out to
primary care audiences and we will consider holding programs
at major primary care conferences such as PrimeED or at
groups such as the American College of Physicians (ACP) or
the American Academy of Family Practice (AAFP). By raising
the stature of the NLA, we’ll raise your visibility in the medical
community as well.
This is a long list of policy and program recommendations, but
it gives you a good picture of the direction we’ve established for
your Association. So, as the title of this address implies, jump in
the car, put on your seat belt, and be a part of our ride. We need
and invite your full participation in the year ahead!
The advent of the Journal left many in the Committee examining
the need for the Lipid Spin newsletter. It was suggested
that the Lipid Spin feature member profiles, success stories,
reimbursement issues, mini-education or SAP programs, focus
on tools for patient education and be informative with occasional
education offerings by the NLA and other organizations with
similar interests.
The Committee recommended that the Communications
Committee should reexamine the Lipid Spin and redefine its
content while ensuring that a member of its editorial staff come
Clinical Insights
Clinical Insights continued from page 1
fiber content in the diet has also been associated with increased
predisposition to diabetes.22,23 Besides diet composition, higher
daily energy intake, related to consumption of saturated fats and
refined carbohydrates, create predisposition to obesity, type 2
diabetes and CVD. For each kilogram of weight gain it has been
calculated that the risk for diabetes increases by about 4.5%.24
There are no detailed data available on the changes in dietary
habits in South Asians who migrate to western countries.
However, studies conducted with other ethnic groups living in
the US have shown that changes in dietary habits of migrant
populations are related to the process of acculturation. One
study that compared the dietary content of similarly aged
Japanese-American men living in Seattle with that of Japanese
men in Japan showed that the Japanese-American diet was
higher in calories, protein, fat and carbohydrates25 and lower in
fiber. The studies of migrant Japanese confirm that succeeding
generations of immigrants maintain intake of food attached to
their cultural identity longer than food that enhances the taste
and palatability of basic foods. When new food is incorporated
into diet of immigrants, they frequently include accessory food
groups, including sweets, snacks and soft drinks. Excess intake
of accessory foods may contribute to increased intake of fat,
sodium, sugar and calories.
Reduced physical activity is observed in association with the
urbanization and westernization process and seems to affect the
risk of diabetes and CVD independently of diet. The level of
physical activity has been reported to be higher in ethnic groups
living in their countries of origin as compared to the same
ethnic groups living in the US.26 Although recent comparisons
of dietary trends among ethnic groups in the US have shown
a narrowing in dietary differences,27 excess of caloric intake
and reduced physical activity seems to be more accentuated in
minorities than in European-Americans.28
Traditional and non-traditional CVD risk factors in South
Asians
The increased risk for CVD in migrant South Asians is partly
but not entirely explained by a high prevalence of type 2
diabetes. High prevalence of insulin resistance may also
contribute to the excessive risk. No conclusive evidence is
available in regard to the role of other traditional risk factors,
such as hypercholesterolemia, hypertension and smoking.
Some metabolic abnormalities, such as a pro-inflammatory
state and hyperhomocysteinemia have recently been linked
to excessive CVD risk independent of traditional risk factors.
These conditions are also indicated to be non-traditional risk
factors and their presence may suggest the need for more
aggressive treatment protocols for CVD risk reduction. We
have observed that migrant South Asians living in Dallas,
Texas, tend to have both pro-inflammatory states and increased
plasma concentrations of homocysteine, as compared to the
local population of persons of European descent. Elevation of
plasma hs-CRP concentrations are considered a manifestation
of a pro-inflammatory state. Plasma hs-CRP concentrations are
often elevated in pre-diabetes and diabetes. In a comparison of
non-diabetic migrant South Asians and Caucasians of similar
age and BMI, plasma hs-CRP was significantly higher in the
South Asians and it was associated with excessive insulin
resistance.29 In another comparison of the two ethnic groups
living in Dallas, migrant South Asians had significantly
increased plasma homocysteine concentrations despite normal
plasma folate.30 Lower plasma concentrations of vitamin B12
and lower insulin sensitivity partly explained this finding but
only partially explained the ethnic differences described. In one
study, increased plasma concentrations of Lp(a) were reported
in migrant Asian Indians living in the UK.31 Several other
emerging risk factors for CVD, including fibrinolytic factors,
neurohormones, and markers of infections are being studied as
contributors to excessive CVD risk in South Asians.
Prevention of diabetes and CVD in migrant South Asians:
diet, exercise, stress management and weight control
Diet composition, caloric content and exercise are major
variables that affect risk for cardiovascular disease. Therefore,
modification in diet composition, caloric content and levels
of exercise may reduce cardiovascular risk in migrant South
Asians. Specific randomized trials with morbidity and mortality
endpoints are not available for this population. We have
previously shown that in mild diabetic patients, high fiber
diet (50 grams a day) is a feasible and effective intervention
in improving glycemic control and reducing 24-hour plasma
insulin levels.32 Studies have also provided preliminary evidence
for reduced risk of diabetes—a cardiovascular risk equivalent
condition—with increased intake of whole grains and dietary
fiber. In both the Nurse’s Health Study33 and the Iowa women’s
health study,34 increased intake of whole grain foods was
associated with significant reduction in the incidence of type
2 diabetes. Therefore, consumption of fiber and a low-fat diet
is to be encouraged in migrant South Asians. Among dietary
fats, it has been observed that saturated fats worsen insulin
resistance and hyperlipidemia and therefore increase risk for
both diabetes and CVD. On the other hand, monounsaturated
fats tend to reduce risk for diabetes and CVD.34 Diets rich in
carbohydrates and low in total fat also improve glucose tolerance
compared to diets rich in fats.35 The total intake of saturated fat
should not exceed 7–10%. Therefore, if saturated fats need to
be replaced, they can be replaced with either carbohydrates or
monounsaturated fats. There is, however, concern that when
high monounsaturated fat diets are eaten ad libitum, they
may result in increased energy intake and weight gain. Each
individual’s metabolic profile and need to lose weight will
determine the dietary recommendations. For example, a diet in
which 60–70% of energy is to be derived from carbohydrates
and monounsaturated fat may emphasize carbohydrate intake for
the patient to achieve weight loss and monounsaturated fat for
the patient to improve plasma triglyceride levels or postprandial
glycemia. Furthermore, South Asian patients may be more
comfortable with a high carbohydrate diet, whereas a patient of
European descent may prefer a monounsaturated fat-containing
diet. Fat intake should therefore be individualized and designed
to fit ethnic and cultural backgrounds.36
Epidemiological studies have shown that the processes of
migration and acculturation have resulted in a progressive
increase in dietary fat, sugar and caloric content with a
concomitant reduction of fiber content in the diet of various
ethnic groups living in the US. Modification of the acculturation
process is possible by emphasizing the health advantages of
various ethnic diets.
Regular exercise reduces risk for CVD and diabetes. It
also improves management of diabetes through two main
mechanisms: promotion of weight maintenance and direct
improvement in insulin resistance. Various mechanisms
are possible to explain a direct effect of exercise on insulin
resistance. Regular exercise increases the number of capillaries
surrounding muscle fibers and also increases the skeletal
muscle fiber composition that favors insulin-mediated glucose
disposal.37 Bouts of exercise stimulate translocation of GLUT4 to the plasma membrane and increase glucose transport in
skeletal muscle.38 Bradikinin may also play a role in exerciseinduced glucose transport, since it is released from muscle
during exercise and, in cells expressing bradikinin receptors, it
stimulates GLUT-4 translocation.39 Avoiding weight gain after
reaching adult weight was proposed as an appropriate health
goal, yet data on the health consequences of weight gain in
South Asians is sparse.
Screening and goals of prevention strategies
The NCEP-ATP III40 has provided recommendations for
cardiovascular risk-factor screening for the US population.
Screening for cardiovascular risk factors, such as dyslipidemia
and hypertension should be performed in the pediatric
population at 20 years. Goals of treatment should include
compliance with low saturated fat, low sodium and a high fiber
diet, 5–10% weight loss (in overweight individuals) and regular
exercise. Other important goals of treatment should include:
blood pressure <120/80 mm Hg; LDL-cholesterol <100 mg/dL;
non-HDL-cholesterol <130 mg/dL (for patients with plasma
triglycerides >200 mg/dL); HbA1c <7% (for diabetics). Patient
education and close follow-up by dietitians or nurses should be
provided to assure long-term adherence to primary prevention
programs. The use of statins in migrant South Asians is often
undervalued. Because of the frequent reduction in HDL-C
and increase in plasma triglyceride concentrations rather than
LDL-C increase, migrant South Asians are often considered for
niacin and fibrate therapy rather than statins. It is worthwhile to
emphasize that NCEP guidelines do not suggest a goal for HDLC or for triglycerides to reduce cardiovascular risk.
These lipid parameters should rather be viewed as contributors
to cardiovascular risk. LDL-C and non-HDL-C are the goals
of treatment in patients with hypertriglyceridemia and lowHDL-C. A recent trial with rosuvastatin has been completed with
migrant South Asians living in the US. The results of that study
are expected to be published in the near future and will provide
information on the effectiveness and safety of this particular
statin for migrant South Asians. Outcome trials would be of
great interest for the prevention of cardiovascular disease in
this population, which is rapidly growing in the US. However,
the projected figures of increasing prevalence of CVD in the
South Asian population call for immediate intervention. We
believe that both public and health care professional education
to increase awareness for CVD in migrant South Asians is
mandatory and urgent.
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Certification in Clinical Lipidology
The Pursuit of Excellence
The American Board of Clinical Lipidology is an independent certifying organization offering the only
certification program for physicians specializing in Clinical Lipidology. The ABCL has established a
rigorous credentialing process and an examination that assesses and validates the specialized knowledge
and advanced training required to practice in this dynamic and complex field.
To become credentialed, candidates must earn 200 credit hour equivalents or “points” based on
documented participation in “lipid-focused” CME and expertise in lipid management.
The credentialing criteria have been designed to provide any physician with demonstrated knowledge
and experience in Lipidology an avenue to become certified as a clinical lipid specialist.
2007 ABCL Fall Examination
For eligibility requirements
and an application, go to
www.lipidboard.org
or call 904.674.0752
Millennium Hotel Minneapolis
Minneapolis, Minnesota
Friday, September 28, 2007
Application Deadline:
Postmarked by August 27, 2007
Register Now and Join Us in Beautiful Savannah, Georgia!
This is an extra-special
meeting of the Southeast Lipid
Association—it’s SELA’s 10th
Anniversary Forum!
Held in elegant Savannah,
Georgia, this meeting will
feature thought leaders in
lipidology presenting:
the
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10th A rum!
Fo
Cutting-edge Scientifc Sessions
Practical clinical workshops
Updated and new courses
Special topics will include:
CHD in Women
Raising HDL—Where Do We
Stand?
Lipids and Vitreoretinal Disease
The Southeast
Lipid Association
10th Annual
Scientific Forum
And much more!
"
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The Southeast Lipid Association is a Chapter of the National Lipid Association
Program Registration
Hotel Reservations
Register with the form included in this program,
visit www.lipid.org to register online, or call the
NLA office at 904-998-0854 for more information.
Some courses, workshops, and social events
require separate registration fees. See
Registration Form for details.
The Westin Savannah Harbor
1 Resort Drive
Savannah, Georgia 31421
Call 800-228-3000 and ask for the Southeast Lipid
Association room rate of $160/night plus resort
fee of $10/night. Offer ends July 2, 2007.
Southeast Lipid Association 10th Annual Scientific Forum
SCIENTIFIC PROGRAM
Program Co-Chairs: Carol Mason, ARNP, Terry Jacobson, MD, and Daniel Wise, MD
Friday, August 3, 2007
11:25 am
Co-Sponsored by the Carolinas-Georgia-Florida Chapter of the
American Society of Hypertension and the Consortium for
Southeastern Hypertension Control
Keynote Address – SELA 10th Anniversary
4:00 pm
Leadership in Clinical Lipidology: Where Do
We Stand on Prevention?
—John R. Guyton, MD
Thiazide-Type Diuretics as Initial Therapy –
The Reasons Why
—Jan N. Basile, MD
Opening Sessions – Special Topics in Lipidology
4:30 pm
CHD in Women
—Marian C. Limacher, MD, FACC
5:00 pm
Vitreoretinal Disease and the Role of Lipids
—Suber S. Huang, MD, MBA
5:30 pm
Metabolic Syndrome and Hypogonadism
—Gregory S. Cohn, MD
6:00 pm
Welcome Reception
7:00 pm
Satellite Dinner Symposium
Renin-Angiotensin System Antagonists as Initial
Therapy – The Reasons Why
—Michael A. Moore, MD
12:30 pm
Lunch
1:30 pm
Annual SELA Business Meeting
1:40 pm
Current and Future Approaches to the
Management of Obesity
—J. Michael Gon�ale��Campoy, MD, PhD
2:15 pm
Update on Lipid Lowering Drug Safety
—Terry A. Jacobson, MD
Saturday, August 4, 2007
2:50–3:00 pm Wrap�up and Final Q&A Session
7:00 am
3:15 pm
Breakfast
Plenary Sessions – Controversies in Lipidology
8:00 am
The Treatment of Hypertension – Point/
Counterpoint
1. Complex Cases in Dyslipidemia Management
—Carol M. Mason, ARNP and Sandra Kreul,
MSN, ARNP
Aggressive LDL Lowering and Its Impact on
Atherosclerosis Progression
—John R. Crouse, MD
8:35 am
Raising HDL: Where Do We Stand?
—Peter P. Toth, MD, PhD
9:10 am
Managing Dyslipidemia in Diabetes
—Ronald B. Goldberg, MD
9:45 am
Characterizing Dyslipidemia: Apo B vs.
Non-HDL vs. Particle Concentration
—Peter W. Wilson, MD
10:20 am
Refreshment Break
10:50 am
Atherosclerosis Imaging – Who Should Be
Imaged and Which Tests to Order
—Wendy S. Post, MD
Concurrent Workshops
(50-minute workshops, repeated)
2. Adherence/Compliance With Guidelines: Are
We Meeting Our Patients Expectations?
—Barbara S. Wiggins, PharmD
3. Clinical Management of Metabolic Syndrome:
Tools for Practice
—Frances M. Saheb�amani, PhD, ARNP
4. Practical Exercise Strategies for Dyslipidemia and
the Metabolic Syndrome
—Ralph La Forge, MSc
5:00 pm
Adjourn for the Day
7:00–10:00 pm President’s Reception and Dinner
August 3–5, 2007 • Westin Hotel, Savannah, GA
Sunday, August 5, 2007
7:00 am
Breakfast
NLA Elective Courses
See Descriptions Below—Separate
Registration Required
8:00 am–Noon
8:00–11:00 am
NLA Lipid Clinic Operations &
Development Course
Noon
Meeting Adjourns
NLA Nutrition Counseling Workshop
Lipid Clinic Operations
& Development Course
Course Date & Time:
Sunday, August 5, 2007,
8:00 am–11:00 am
Course Date & Time:
Sunday, August 5, 2007,
8:00 am–Noon
Course Chair:
Ralph La Forge, MSc
Course Chairs:
Cost:
$80 NLA Member / Register via
Registration Form on page 10
Penny Kris-Etherton, RD, PhD, and
Neil Stone, MD
Cost:
$75 NLA Member / Register via
Registration Form on Page 10
Participants in this course will be presented with key
considerations on how to develop and successfully operate a
lipid and metabolic syndrome clinic. The course will examine the
characteristics of successful lipid clinic programs and will cover
program organi�ation from both an operational and clinical
framework. All participants will receive valuable supplementary
materials for use in their lipid practice including flow sheets,
patient education materials, forms and more.
This activity is designed for physicians and all health care
professionals interested in developing or enhancing their lipid
clinic operations.
Course Curriculum
• Financial Aspects of Clinic Management
• Coding Essentials
• Pro Forma Business Plans
• Level I and Level II Clinic Development
• Clinical Pathway Development
• Program Organi�ation
Included in Course Fee
� CD�ROM containing key resource materials for effective
clinic operations
Sponsored for CME credit by the National Lipid Association.
For complete information, agenda, and faculty list,
visit www.lipid.org.
This half�day workshop will consist of a mix of didactic and
small�group role�playing and is designed to assist all levels
of healthcare practitioners with nutritional counseling. It
will include discussions on building rapport and listening
skills, application of principles and techniques involved in
interviewing, assessing and providing nutrition counseling,
and developing goals/outcomes and therapeutic relationships
with patients/clients. Small group role�playing will focus on
case�study evaluation and simulated nutrition counseling with
patients.
This workshop is designed for physicians, physician assistants,
nurses, dietitians, exercise physiologists and other healthcare
professionals who manage patients with lipid disorders.
Course Curriculum
• Dietary Strategies for Lipid Management
• Introduction to Basic Counseling Skills and Motivational
Interviewing
• Behavioral Strategies for Implementing Change
• Counseling Strategies for Adults, Children, and Special
Populations
• Role�playing Activity
Sponsored for CME credit by the National Lipid Association.
Sponsored for CE credit by the Institute for Continuing
Healthcare Education.
Educational grant support provided by Unilever.
For complete information, agenda, and faculty list,
visit www.lipid.org.
10th AnnuAl Scientific forum of the
SoutheASt lipid ASSociAtion
August 3–5, 2007
The Westin Savannah Harbor ~ Savannah, Georgia
1
Guest name(s), if attending meeting:
First Name
Middle Initial
Last Name
Mailing Address
Membership status:
City
State or Province
Phone
3
MD
DO
PhD
RN
NP
Circle fee based on attendee type
10th Annual Scientific Forum
August 3–4
Includes course syllabus and one
admission badge to Exhibit Hall
for all food functions.
(Saturday Night Dinner NOT Included)
Join NLA and register for Scientific Sessions
Ancillary Courses
Please see Pages 3, 4 & 6 for more info
Master’s Board Review Course*
August 2-3
(Includes NLA-SAP 3 vol. set)
Master’s Board Review Course
(Previously purchased NLA-SAP 3 vol. set) Lipid Management Training Course
August
2-3
Nutrition Counseling Workshop
August 5
Registration Fee Total
$225
PharmD
Non-Member
——
$325
RD
Trainee
$275
$0
$35
$850
$1100
$850
$100
$200
$100
$145
$75
$245
$175
$145
$75
$80
$180
$80
$ ____
$ ____
$ ____
Saturday Night Dinner-Registrant
1
$75 x ____
$ ____
Saturday Night Dinner- Guest(s)
$75 x ____
$ ____
Saturday Night Kids Party
$50 x ____
$ ____
Exhibit Hall Pass-Guest(s)
$40 x ____
$ ____
SELA Golf Tournament
$110 x ____
$ ____
Heart Healthy Cooking Class
$125 x ____
$ ____
$0 x ____
0
$ ____
Social Events and Guest Total
$ ____
Combined Total Sections 2,3 &4
$ ____
VISA
Master Card
AMEX
Check
Credit Card #
Signature
Name on Card
Other
Easy Ways To Register
Mail To:
NLA
8833 Perimeter Park Blvd #301
Jacksonville, FL 32216
Fax to:
NLA at 904-998-0855
Fax with credit card number
and signature
Online:
www.lipid.org
*Master’s Course
Additional discounts apply if
you have purchased individual
volumes of the NLA-SAP. For
those special discounts, register
online at www.lipid.org/
education
Registration: Registration and
payment must be received no
later then July 23 2007. After this
date a syllabus and name badge
cannot be guaranteedso register TODAY!
Cancellation: Telephone
cancellations will not be
accepted. A written notice of
cancellation must be received no
later then July 23, 2007. *Includes
Social Events and Guest Fees.
Special Dietary needs:
Payment Method
Make checks payable to the NLA
10
RPH
Social Events and Guest Fees
Please see Page 9 for more info
Practical Pedometer Course
5
PA
Member
Lipid Clinic Operations & Development Course
August 5 4
Country
Emergency Contact/Phone
Email
Check all that apply:
2
Zip
I am currently a member.
My application for membership has
been submitted and confirmed.
I will apply at www.lipid.org.
Please send me membership
information.
Exp. Date
ADA Compliance:
Attendees of the NLA Scientific
Sessions who need additional
reasonable accommodations or
who have special needs should
contact the NLA at 904-998-0854.
10
Practical Pearls
CHD Risk Estimation in
Clinical Practice
PETER P. TOTH, MD, PhD, FAAFP, FACC, FAHA, FICA
Visiting Clinical Associate Professor
University of Illinois School of Medicine
Peoria, Illinois
Director of Preventive Cardiology
Sterling Rock Falls Clinic
Sterling, Illinois
Cardiovascular disease (CVD) is a term that encompasses
coronary heart disease (CHD), cerebrovascular disease (including
stroke and transient ischemic attack), and peripheral arterial
disease (PAD). CVD remains the number-one source of morbidity
and mortality in most industrialized regions of the world. The
incidence of CVD is rising due to increasing life expectancy,
increased mechanization and availability of food, and burgeoning
epidemics in obesity, metabolic syndrome, and diabetes mellitus,
among other explanations. A substantial part of clinical care by
necessity is committed to the identification and management
of risk factors for CVD. Risk factors can be both modifiable
(e.g., cigarette smoking, elevated blood pressure or serum
cholesterol) and non-modifiable (e.g., age, gender). The need for
comprehensive, global risk-factor evaluation is a clinical issue that
most lipidologists understand instinctively and easily.
In the National Cholesterol Education Program’s Third Adult
Treatment Program (NCEP ATP III), it was advised that all
patients with 2 or more risk factors for CHD (see Table 1)
undergo Framingham risk scoring so that 10 year projected risk
for a CHD-related event could be more formally quantified.1
Framingham risk scoring does not specifically provide risk
estimation for stroke or PAD. Ten year projected risk is defined as
a percentage: low risk (or 0 to 1 risk factor ) 0–5%, moderate risk
Negative
HDL-C > 60 mg/dL
Positive
Cigarette smoking
HDL < 40 mg/dL
Hypertension (blood pressure > 140/90 mm Hg or use of
antihypertensive agents)
Family history of premature coronary artery disease
(CAD in male first-degree relative < 55 yrs; CAD in female firstdegree relative < 65 yrs)
Age (men ≥ 45 yrs, women ≥ 55 yrs)
Table 1. NCEP ATP III Risk Factors
<10%, moderately high risk 10-20%, and high risk >20%. Risk
classification defines low-density lipoprotein cholesterol (LDLC) and non-high-density lipoprotein cholesterol (non-HDL-C)
targets for therapy. Patients in the high-risk category have a CHD
risk equivalent. Framingham risk estimation is simple to perform.
The scoring system includes age, total cholesterol, high-density
lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP),
and smoking status. The Framingham risk score distinguishes
between treated and untreated SBP. Although LDL-C can be used
to define whether or not a patient has two or more risk factors, it is
not explicitly included in Framingham risk estimation because the
Framingham data are statistically more robust for total cholesterol.
The Framingham risk score can be calculated by downloading
a program from the web (www.nhlbi.nih.gov/guidelines/
cholesterol). A variety of scoring sheets are available online
(see www.apollolipids.org) and Framingham risk calculators
have also been distributed nationwide by pharmaceutical
representatives. Despite considerable effort to make calculation
easy to perform and making resources widely available, health
care providers simply do not take the time to perform appropriate
risk stratification. Certainly, if a patient has CHD or a clinically
apparent CHD risk equivalent (PAD, history of a stroke, diabetes
mellitus, or abdominal aortic aneurysm), the target for LDL-C and
non-HDL-C is defined. However, in a primary care setting where
risk is in need of definition, too often no attempt at appropriate
risk quantification is made. This is a very strong contributor to
poor goal attainment in people who are at moderate risk or worse.
It almost never fails; I can ask a group of 500 or 800 providers in a
major American city to raise their hands if they routinely perform
Framingham risk scoring in patients with 2 or more risk factors
but no clinical evidence for CHD or a CHD risk equivalent.
Perhaps 5–10 hands go up. This is inappropriate given the fact that
risk scoring is one of the true cornerstones of NCEP ATP III.
It is extremely important to quantify risk. Frequently, the only
way to determine if someone is high risk is to calculate their
Framingham risk score. It is assumed by many physicians that
metabolic syndrome is a CHD risk equivalent. This is incorrect.
However, for some patients, especially if they are older and have
4 or 5 components of the metabolic syndrome, then they could in
fact be high risk. Distinguishing between moderate and moderately
high risk is also important, given the new therapeutic option of
decreasing LDL-C below 100 mg/dL and non-HDL-C below 130
mg/dL for patients of moderately high risk.2 One frequently heard
excuse for not performing Framingham risk calculations is that
everyone’s LDL-C should be less than 100 mg/dL or even < 70
mg/dL. NCEP does define an optimal LDL-C for anyone as being
< 100 mg/dL. However, NCEP’s recommendations are the most
rigorously evidence-based recommendations we currently have
in place for dyslipidemia management. It is not evidence based to
Continued on page 17
11
Lipid Luminations
From the Journals
RONALD B. GOLDBERG, MD
Professor of Medicine, University of Miami School of Medicine
Director, Lipid Disorders Center
Associate Director, Diabetes Research Institute
Miami, Florida
Whither HDL-C Raising?
The spectacular success resulting from the lowering of LDLcholesterol by means of statin therapy to reduce cardiovascular
events has fed hopes that raising HDL-cholesterol (HDL-C)
might further expand our ability to prevent CVD. The advent of
the cholesterol ester transfer protein (CETP) inhibitors which
may increase HDL-C by up to 100%, far in excess of available
HDL-C raising drugs such as niacin or fibrates, offered an
opportunity to test the hypothesis that raising HDL-C through
this mechanism would yield substantial additional benefit to
what statin drugs can offer. CETP inhibitors such as JTT 705
and torcetrapib raise HDL-C by partially inhibiting CETP, which
normally transfers cholesterol from HDL to VLDL and LDL,
providing an indirect route for reverse cholesterol transport,
since most of LDL-C is cleared by the liver. However, directing
cholesterol from HDL to LDL could be viewed as being a
pro-atherogenic effect of CETP in some individuals, given the
importance of LDL-C for atherogenesis. Inhibition of CETP
leads to greater retention of cholesterol by HDL leading to a rise
in HDL-C, routing HDL-cholesterol away from LDL directly to
the liver for clearance via scavenger receptors (SR-B1), and was
shown in studies in rabbits to reduce atherosclerotic lesion size.
On the strength of substantial mechanistic, experimental,
and short-term clinical trial data with torcetrapib, a large
multicenter, outcome-based clinical trial comparing atorvastatin
versus torcetrapib plus atorvastatin known as ILLUMINATE
was then undertaken, as well as two other smaller trials using
intravascular or carotid ultrasound to study the effects of
torcetrapib on coronary plaque and carotid wall thickness.
However on December 6, 2006, the FDA issued a statement
that owing to an increase in cardiovascular events in the
combination drug group, ILLUMINATE was being immediately
halted. This unexpected and disappointing news raised many
questions, among which was the issue of whether the increased
cardiovascular events may have been due to an unexpected side
effect of the drug, for example its recently discovered effect to
raise blood pressure. Such an explanation might then leave intact
the theory that CETP inhibition is anti-atherogenic, offering
hope that other members of this class might yet be effective. The
12
results of the 2-year intravascular ultrasound study of the effects
of treatment with torcetrapib plus atorvastatin versus atorvastatin
alone on coronary atheroma volume were thus awaited with
interest.
The Investigation of Lipid Level Management Using Coronary
Ultrasound to Assess Reduction of Atherosclerosis by CETP
Inhibition and HDL Elevation (ILLUSTRATE) trial1 was
a prospective, multicenter, double-blind clinical trial that
randomized 1,188 subjects from North America and Europe with
clinically indicated cardiac catheterization results showing at
least one stenosis on angiography with at least 20% narrowing
and with the target vessel having less than 50% obstruction
throughout a segment 40 mm or longer. After undergoing
intravascular ultrasonography of this coronary artery segment,
subjects received treatment with atorvastatin titrated (mean
dose 23 mg/day) to reduce levels of LDL-C to <100 mg/dL,
and then were randomly assigned to receive either atorvastatin
monotherapy or atorvastatin plus 60 mg of torcetrapib daily.
After 24 months, disease progression was measured by repeated
intravascular ultrasonography in 910 patients (77%). At this
point, patients in the torcetrapib–atorvastatin group had a 61%
relative increase in HDL-C levels (72 mg/dL versus 44 mg/dL)
and a 20% relative decrease in LDL-C levels (71 mg/dL vs
87 mg/dL), as compared with patients in the atorvastatin-only
group. Torcetrapib was also associated with an increase in
systolic blood pressure of 4.6 mm Hg. The percent atheroma
volume (the primary efficacy measure) increased by 0.19% in
the atorvastatin-only group and by 0.12% in the torcetrapib–
atorvastatin group (p=0.72). A secondary measure, the change in
normalized atheroma volume, showed a small favorable effect
for torcetrapib (p=0.02), but there was no significant difference
in the change in atheroma volume for the most diseased vessel
segment. The frequency of major adverse cardiovascular events
was similar in the two study groups. However, patients in the
torcetrapib–atorvastatin group had more investigator-reported
hypertensive adverse events (23.7% vs. 10.6%) and more bloodpressure values greater than 140/90 mm Hg (21.3% vs. 8.2%).
The investigators point out that even the torcetrapib-associated
decrease in normalized atheroma value (secondary endpoint)
was considerably smaller than that seen in studies with high
dose statins or with infused apo A-I Milano, and that overall
the plaque volume change with torcetrapib and atorvastatin was
smaller than what would be expected based upon the reduction
in LDL-C achieved with the combination. Overall, despite the
robust increase in HDL-C and the additional LDL-C lowering
produced by torcetrapib, it was concluded that the drug had
no significant effect on atheroma volume although there was
Continued on page 17
Education Programs
LEVEL I–II
Lipid Management Training Course
This intermediate level course will present a comprehensive indoctrination to clinical lipidology and will provide essential information and resource materials for the systematic management of dyslipidemia in a lipid clinic program.
New in 2007 – Updated curriculum
2007 Course Dates
Held prior to NLA Regional Scientific Meetings
August 2–3, Savannah, GA • September 27–28, Minneapolis, MN
LEVEL II–III
NLA Nutrition Counseling Workshop – New Course
This half-day workshop is designed to assist all levels of healthcare practitioners in improving their nutrition
counseling skills. It will include discussions on building rapport and listening skills, application of principles and
techniques involved in interviewing, assessing and providing nutrition counseling, and developing goals/outcomes
and therapeutic relationships with patients/clients. Small group role-playing will focus on case-study evaluation and
simulated nutrition counseling with patients.
2007 Course Date
Held at NLA Regional Scientific Meetings
August 5, Savannah, GA
For complete information and to register, visit www.lipid.org/education
LEVEL IV
National Lipid Association Self-Assessment Program
The NLA-SAP series is a comprehensive, interactive clinical problem-solving program that objectively validates, strengthens and reinforces your knowledge of clinical lipidology.
Volume I: Diagnosis & Management of Dyslipidemia
Volume II:
The Metabolic Syndrome
Volume III: Vascular Biology & Advanced Lipid Metabolism
Each module provides up to 60 hours of AMA PRA Category 1 Credit™. Credit hours earned by completing the NLA-SAP
series can be applied toward meeting the credentialing requirements for the ABCL and ACCL certifying examinations.
Order online at www.lipid.org/sap
Masters in Lipidology – Advanced Training and Board Review Course
This intensive 2-day board review course is offered by the NLA to members seeking an in-depth, advanced review
of the specialty and/or certification by the American Board of Clinical Lipidology or the Accreditation Council for
Clinical Lipidology. The 3-volume NLA Self-Assessment Program (NLA-SAP) is included in the course fee.
New in 2007 – Expanded curriculum and individual tracks for physicians and mid-level providers preparing for
certification
2007 Course Dates
Held prior to NLA Regional Scientific Meetings
August 2–3, Savannah, GA • September 27–28, Minneapolis, MN
For complete information and to register, visit www.lipid.org/education
ONLINE PROGRAMS
An all-inclusive online education resource for
NLA members that provides access to:• Online
CME/CE activities
• Live and enduring webcasts
• NLA presentation highlights
• Interactive newsletters
NLACME.COMmunity
MAY FEBRUARY SEPTEMBER AUGUST
Upcoming Meetings
www.lipid.org/education
August 3–5, 2007
10th Annual Scientific
Forum of the Southeast
Lipid Association
The Westin Savannah
— Savannah
Georgia
September 28–30, 2007
Forum of the Midwest
Lipid Association
The Millennium Hotel
— Minneapolis
Minnesota
February 22–24, 2008
Forum of the Northeast
Lipid Association
The Loews Hotel
—Philadelphia
Pennsylvania
May 29–June 1, 2008
National Lipid Association
Annual Scientific Sessions
The Westin
— Seattle
(With the Pacific Lipid Assoc)
Washington
LIPID EDUCATION ONLINE
• Professional development tracking tools
• Auto log-in for NLA members
• And much more to come.
NLA 2006 Scientific Meeting Highlights
Now Online – CME/CE certified
Visit nlacme.com to learn more
13
News & Notes from the National Office
Dr. Anne Goldberg Assumes Leadership as
5th NLA President At the Annual Scientific Sessions in Scottsdale, Arizona, Anne
Goldberg, MD, will formally take over command of the NLA
from Dr. James McKenney, who ends his term at the meeting. Dr.
Goldberg received her BA with honors from Harvard University
in 1973 and her MD from the University of Maryland Medical
School in 1977. She completed internship and residency in Internal
Medicine at Michael Reese Hospital in Chicago and fellowship in
Endocrinology and Metabolism at Washington University School of
Medicine in St. Louis. In 1983, she joined the faculty of Washington
University where she is an Associate Professor of Medicine.
Dr. Goldberg has been an active member of the NLA and an
effective member of the committees on which she has served. We
congratulate Dr. Goldberg on her achievement.
NLA Broadcasting from Above
The NLA has reached a multi-year agreement with ReachMD
(XMRadio 233) to provide weekly topic-focused education
programs. ReachMD launched this March on XM Satellite Radio
as a channel focused on providing programming for medical
professionals on a continuous basis. Information about ReachMD
can be found at www.reachmd.com. The first NLA program will
be launched in June 2007 and a minimum of 25 segments will be
offered the first year. This is an opportunity to not only discuss
relevant topics in lipidology but to also expand knowledge about
lipidologists and the role of the professionals working in the
specialty. Members are encouraged to present evidence-based
content and apply to be featured on a segment by visiting www.
lipid.org/xm Webpage or by contacting the NLA Communications
Director Daniel Sosnoski (dsosnoski@lipid.org). Schedules will
be announced on both the ReachMD and NLA websites when
available. ReachMD also plans to offer podcasts of these programs
and details on accessing podscasts will be determined this June.
Lipid Forum Message Boards Available
We set up a member message board back in 2005 on the lipid.org
website and yet only a handful of posts have been made since the
inception of this feature. The posts that are there are relevant and
could generate some interesting discussion. To locate the message
boards, go to www.lipid.org and click on the discussion tab on the
left-side navigation panel. Remember that you must be a member
and properly logged in to use this service.
Know Your Website Login information?
Users visiting the NLA at our website, www.lipid.org, may
occasionally be prompted for a username and password to access
14
special members-only content, manage their member record or to
take advantage of special discounts for meeting registrations. If you
have not already setup your Web account, you can do so quickly
and easily if we have a current e-mail address on file for you. Just
point your browser to our homepage at www.lipid.org, click on the
account link near the top left of the page and from there choose
“Setup your website account.” This is a two-step process. You will
enter your e-mail address and the system will send you a message
with a link where you can return to the site and establish a username
and password of your choice. If you do not receive the e-mail you
should check your e-mail settings or with your server administrator
to make sure e-mail from lipid.org isn’t being blocked as spam.
If you already have a website account and have forgotten your
username and/or password, our system will automatically send
them to you. As above, visit us at www.lipid.org, click on the
account button, and then choose “Login to your website account.”
Just beneath the login fields, enter your e-mail address to have the
system send your information directly to your inbox.
Of course, there may be circumstances where this process won’t
meet your needs. Perhaps your e-mail address has changed or
maybe we don’t have one on file for you. Maybe you just prefer to
deal with a real person. The NLA can help with that too. Just call
our office at 904-998-0854. Any staff member can quickly bring
your account up to date, giving you complete access to everything
the NLA website has to offer.
Once you’re up and running, please take advantage of our new
account management console which gives you a way to manage
your membership account online. Use this tool to keep us informed
of changes of address and contact preferences, keep track of your
NLA sponsored CME credit, pay dues online and much more.
ACCL Credentialing Update—Exam Dates
Announced
The ACCL has announced updates to its 2007–2008 schedule. To
view the updates, application and other information visit www.
lipidspecialist.org. Exams will be offered electronically at national
test centers in 2008 and at the following venues the remainder of
this year and the beginning of next year:
The Westin Savannah Harbor Golf Resort and Spa
One Resort Drive, Savannah, GA
Call 1-800-228-3000 by July, 2 2007 to secure a room rate of $160/
night. Ask for the NLA/ACCL discounted rate.
Application Deadline: Postmarked by July 5, 2007
1313 Nicollet Mall, Minneapolis, MN
Call 1-800-522-8856 by August 28, 2007 to secure a room rate of
$159/night. Ask for the NLA/ACCL discounted rate.
Application Deadline: Postmarked by August 30, 2007
Saturday, February 23, 2008
The Loews Hotel
1200 Market Street, Philadelphia, PA
Call 215-627-1200 by January 25, 2008 to secure a room rate of
$185/night. Ask for the NLA/ACCL discounted rate.
Application Deadline: Postmarked by January 23, 2008
Friday, May 30 or Saturday May 31, 2008
The Westin Hotel
1900 5th Avenue, Seattle, WA
Application Deadline: Postmarked by April 25, 2008
Details on electronic testing will be available in the fall. For
additional information, please call Nicole Woodsmall, MSH, RD
(nwoodsmall@lipidspecialist.org) at 904-998-0356.
ABCL Exam Dates Announced—New Fall
Date Added
Those wishing to obtain Diplomate status in clinical lipidology now
have an additional testing opportunity available in the fall. There are
two testing dates offered for the remainer of 2007:
1313 Nicollet Mall, Minneapolis, MN
Call 1-800-522-8856 by August 28, 2007 to secure a room rate of
$159/night. Ask for the NLA/ABCL discounted rate.
Application Deadline: Postmarked by August 27, 2007
Friday, May 30 or Saturday May 31, 2008
The Westin Hotel
1900 5th Avenue, Seattle, WA
Application Deadline: Postmarked by April 25, 2008
For further details and information, visit www.lipidboard,org.
Program and who also successfully credential for the examination
will receive a $300 check from the NLA. Further, those passing the
exam will receive a 10-year exemption from annual membership
dues (up to a $900 value). The NLA will automatically track
participation by the ACCL applicants.
Dr. Havel to Address ABCL Diplomates
The American Board of Clinical Lipidology is holding its 2nd
Annual Convocation Ceremony to recognize the dedication and
achievement of the 50 physicians who successfully passed the
ABCL certifying exam to earn the distinction of Diplomate in 2006.
The ceremony will be conducted at the NLA/SWLA Scientific
Sessions in Scottsdale on Saturday, June 2, 2007 at the Hyatt Gainey
Ranch. This year’s guest speaker at the ceremony is Honorary
Diplomate Dr. Richard Havel, of the University of California at San
Francisco. During the ceremony, Diplomates are presented with
ABCL Diplomate cords to celebrate their achievement. Following
the ceremony, there is a reception and an opportunity to have
professional photographs taken.
NLA Course Catalog Debuts
Members receiving this Lipid Spin by mail should also receive a
copy of our education course catalogue. We plan to release revisions
every 6 months, but we always keep the NLA Website at www.
lipid.org updated with changes and new offerings. The new course
catalogue is a one-stop overview of all NLA educational offerings
and is intended to simplify and improve member access to our
rapidly growing curriculum.
JCL to Publish DALM Abstract Supplement
Even though the NLA’s Journal of Clinical Lipidology is still in
its first year of publication, it is already attracting notice. We are
pleased to announce that our journal has been chosen to host the
abstracts of the IAS-sponsored XVI International Symposium
on Drugs Affecting Lipid Metabolism (DALM 2007), to be held
October 4–7, 2007 in New York. This 5-day conference, presented
by the Giovanni Lorenzini Medical Foundation, is one of the
premier international conferences on lipid science and research.
Our supplement edition of the Journal of Clinical Lipidology will,
in presenting several hundred abstracts from the conference, offer
a comprehensive look at the shape and direction of the field of
lipidology today.
Dr. Kostis Leads Northeast Lipid Association
NLA Recognizes ACCL Participants
The NLA has recognized the desire of our allied health professional
membership to attain Certification as a Clinical Lipid Specialist and
wishes to extend two unique benefits for those completing the exam
process from May 2007–May 2008. Members who successfully
complete the NLA-SAP program or participate in the Masters
At the Third Annual NELA Scientific Forum held in Montreal,
Quebec in April 2007, leadership of the chapter changed as outgoing president David Capuzzi, MD, PhD turned over the reins to
John Kostis, MD, the new NELA president.
Dr. Kostis received his medical degree from the Medical School of
15
News & Notes from the National Office
the University of Salonica (first in academic standing 5 consecutive
years) and obtained a doctoral degree at the University of Athens.
He had his postgraduate education at the Brooklyn-Cumberland
Medical Center and the University of Pennsylvania where he also
served as an Assistant Professor of Medicine.
He has published six books, over 300 papers and chapters and over
250 abstracts. He has lectured by invitation at over 150 medical
schools and international meetings in the U.S. and in over 40
countries in North and South America, Europe, Asia and Africa
(over 400 lectures). Among his many accomplishments, he serves
as Associate Editor of Cardiology, is on the editorial boards of other
scientific journals and held leadership positions in the American
College of Cardiology, American Heart Association and American
Society of Hypertension. The NLA welcomes Dr. Kostis to his new
position and wishes him an enjoyable and productive term.
2007 Triglyceride Awareness Campaign
Last year we received an unrestricted educational grant from
Abbott Laboratories to explore patient and physician knowlege
of cholesterol and triglycerides. The NLA Consumer Affairs
Committee, headed by Dr. Jerome Cohen, oversaw the development
of a survey and then helped to interpret its findings. Information
about this effort and details about the findings are available at www.
lipid.org on the Press Page section of the Website.
Southeast Lipid Association Presents at
COSEHC and FAFP
As the NLA and its chapters grow in prominence, our members are
increasingly in demand as speakers. At the recent Consortium for
Southeastern Hypertension Control (COSEHC) meeting, Dr. Daniel
Wise, Dr. Ronald Goldberg, Dr. Thomas Barringer, and Dr. William
Cromwell gave featured presentations.
As a similar example of our members peforming valuable
interactions with other organizations, Dr. Edward Shahady acted
as a local liaison to the Florida Academy of Family Physicians and
arranged for Dr. Dean Bramlet to speak on primary care issues and
lipids to the Florida audience at their recent meeting. The NLA
supports such efforts to bring insights from our field to primary care
settings.
New Lorenzini Foundation International
Research Prize
The Giovanni Lorenzini Medical Science Foundation has announced
the the International Prize “Premio Benessere Stresa” for research
and innovation related to well-being. The topic of the first award is
focused on “Women’s Wellbeing and Health in Midlife: Prevention
and Care,” and will be awarded to international researchers or
clinicians who have published, or submitted for publication,
experimental or clinical papers regarding prevention and treatment
related to the well-being and health of women in their midlife years.
Following from the success of the survey, which was widely
reported and cited by numerous other organizations, the NLA
proposed a physician and patient education outreach campaign to
promote the findings of the survey and improve patient/physician
communication. Our proposal was accepted and the outreach effort
should begin soon. Look here and on our Website for details as we
make progress. The effort will include radio, magazine and special
publications in addition to a patient awareness Website and desktop
information kit.
Masters Summit on the Role of the Digestive
Tract in Lipid Metabolism
The success of the NLA-sponsored Masters Summit on HDL
inspired us to hold a second Masters Summit event, and thanks to
support by Daiichi Sankyo, Merck/Schering-Plough, and Unilever
Inc., we are now able to offer a high-level conference on Digestive
Tract Lipid Modifying Therapies. We expect some 300–400
attendees at this half-day symposium to be held Saturday, November
3, 2007 prior to the Scientific Sessions of the American Heart
Association in Orlando, Florida. Announcements and registration
information wll be available soon.
For information about this award and how to apply for it, visit our
Website at www.lipid.org, or contact the Lorenzini Foundation
directly at stresaprize@lorenzinifoundation.org.
New NLA Self-Study Module Available
The first NLA Self-Study Module on the Management of
Cardiovascular Risk Associated with Visceral Adiposity and the
Role of the Endocannabinoid System will be mailed to all active
members in May. This CME activity provides an educational
syllabus and self-assessment questions to test your knowledge on
this current topic. The NLA sponsors a series of Complex Lipid
Management Self-Study and Self-Assessment Modules for its
members free of charge, each offering up to 5 hours of CME credit.
Journal of Clinical Lipidology
The NLA Journal of Clinical Lipidology invites member
submissions of clinical articles, reviews, case reports
and more. Submit your articles online.
www.lipidjournal.com
16
Practical Pearls continued from page 11
Lipid Luminations continued from page 12
insist that everyone’s LDL-C should be less than 100 or 70 mg/dL.
Risk scoring should be performed to ensure that patients are being
treated appropriately.
no evidence for a deleterious effect of torcetrapib on atheroma
volume to explain the increased number of CVD events in the
ILLUMINATE trial. It is possible that the increase in blood
pressure associated with torcetrapib or other off-target vascular
effects may have interfered with a beneficial effect of the drug
on atheroma volume, and intravascular ultrasonagraphy studies
have shown a relationship between blood pressure and atheroma
progression. On the other hand the absence of a change in
atheroma volume despite the impressive increase in HDL-C,
raises serious questions about the validity of CETP inhibition as
an anti-atherogenic strategy and beyond this on the generalized
concept that raising HDL will reduce CVD. For the present,
pharmacotherapeutic measures targeted at HDL-C raising,
should be restricted to the use of agents that have been shown to
have a beneficial effect on cardiovascular outcomes.
I suspect that some of the more important reasons why physicians
and mid-level providers do not take the time to calculate Framingham
risk trends are because they lack familiarity with the calculation and
assume it is time-consuming. After one has done the calculation on a
spreadhseet or input the data into a risk calculator (say your PDA or
computer), the calculation can typically be done in 10–20 seconds or
less. A medical assistant or a member of nursing staff can also input
the data to ease workflow. Providing patients with a quantitative
measure of risk can facilitate the institution of appropriate lifestyle and
pharmacologic interventions. If a patient sees that their cardiovascular
system is at significantly higher risk for a CHD-related event than
they would have ever assumed, it could be the wake up call that leads
to significant change and a willingness to initiate treatment, encourage
regular follow-up, and the acceptance of responsibility to maintain
health and prevent disease.
Reference
1.
Nissen SE, Tardif JC, Nicholls SJ, et al, ILLUSTRATE Investigators.
Effect of torcetrapib on the progression of coronary atherosclerosis. N
Engl J Med. 2007;356:1304-16.
References
1.
Executive Summary of The Third Report of The National Cholesterol
Education Program (NCEP) Expert Panel on Detection, Evaluation, And
Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).
Jama. 2001;285(19):2486-2497.
2.
Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials
for the National Cholesterol Education Program Adult Treatment Panel III
guidelines. Circulation. 2004;110(2):227-39
AC C L
The Accreditation Council
for Clinical Lipidology
Certification as a Clinical Lipid Specialist
The Accreditation Council for Clinical Lipidology (ACCL) is an independent
certifying organization that has developed standards and an examination in the field
of Clinical Lipidology for the growing number of allied healthcare professionals who
manage and treat patients with lipid or other related disorders.
The examination is designed to comprehensively evaluate the knowledge and experience
of a wide range of medical professionals. As a prerequisite, candidates must successfully credential to sit for the
examination. The specific criteria and the associated fees can be found at www.lipidspecialist.org. Those who
successfully complete this examination will be awarded the designation of “Clinical Lipid Specialist.”
2007 ACCL Examination Dates
Summer Examination
The Westin Hotel
Savannah, GA
Application Deadline: July 5, 2007
Fall Examination
The Millennium Hotel
Minneapolis, MN
Application Deadline: August 30, 2007
For eligibility requirements and an application, go to www.lipidspecialist.org or call 904.998.0356
17
Scenes from NELA 2007
The Northeast Lipid Association held its Third Annual Scientific
Forum in Montreal, Quebec, April 13–15. This was the first
international venue for a meeting of an NLA chapter and it drew
an impressive gathering of NELA members.
THE
Lipid Spin
Editors
Ronald B. Goldberg, MD
Professor of Medicine,
University of Miami School of Medicine
Director, Lipid Disorders Center
Associate Director, Diabetes Research Institute
Miami, FL
Maria F. Lopes-Virella, MD, PhD
Professor of Medicine and Pathology
Medical University of South Carolina
Ralph H. Johnson Medical Center
Charleston, SC
Co-editors
Lynn Cofer, MSN, RN, FAHA
Clinical Director,
Midwest Heart Specialists Lipid Clinic
Naperville, IL
Outgoing President David Capuzzi, MD, PhD, presents the NLA
Distinguished Achievement Award to W. Virgil Brown, MD.
Peter P. Toth, MD, PhD, FAAFP, FICA, FAHA, FACC
Director of Preventive Cardiology
Sterling Rock Falls Clinic, Ltd
Sterling, IL
Clinical Associate Professor
Southern Illinois University School of Medicine
Springfield, IL
NLA Staff Editor
Daniel Sosnoski
NLA Executive Director
Christopher R. Seymour, MBA
John Kostis, MD,
addresses the
assembly in his
new role as NELA
President.
The Lipid Spin is published quarterly by the National Lipid Association
8833 Perimeter Park Blvd. #301 • Jacksonville, FL 32216
Phone: 904-998-0854 • Fax: 904-998-0855
Copyright © 2007 by the National Lipid Association. All rights reserved.
Visit us on the web at: www.lipid.org
Save the Date
May 29-June 1, 2008
2008 Scientific Sessions
Seattle
18
ABCL Recognizes Clinical Lipidology Diplomates
In 2006 the American Board of Clinical Lipidology officially awarded Diplomate status to the following physicians who qualified for this
distinction. The Diplomates will be honored at the ABCL Convocation Ceremony to be held at the NLA 2007 Annual Scientific Sessions at the Hyatt
Regency Scottsdale Resort at Gainey Ranch on Saturday, June 2, 2007. The National Lipid Association congratulates these dedicated professionals.
Nicola Abate, MD
Dallas, TX
John C. Dormois, MD
Tampa, FL
Walter D. Kohut, MD
Greensboro, NC
John R. Nelson, MD
Fresno, CA
Richard A. Sokol, MD
Norfolk, VA
Yoel R. Vivas, MD
Pittsburgh, PA
Rajaratnam Abraham, MD
Fall River, MA
George W. Douglass, MD
Charleston, SC
Jeffrey H. Kuch, MD
Largo, FL
Ahmed F. Okba, MD
Moline, IL
David B. Southren, MD
Valley Cottage, NY
Steven W. von Elten, MD
Warrenton, VA
C. David Akin, MD
Independence, MO
Ralph J. Duda, MD
Springfield, MO
Mariananda Kumar, MD
Lecanto, FL
Mark W. Oldendorf, MD
Rensselaer, NY
Andrew D. Sumner, MD
Hummelstown, PA
Karol Watson, MD
Los Angles, CA
Hisham A. Alrefai, MD
Scottsburg, IN
Honey East, MD
Jackson, MS
Dharamjit N. Kumar, MD
Jamaica, NY
Trevor J. Orchard, MD,
M.Med.Sci.
Pittsburgh, PA
Joseph Tannous, MD
Aurora, MN
Thomas R. White, MD
Cherryville, NC
Moutasim H. Al-Shaer, MD
Davenport, IA
Jeff L. Eggart, MD
Surfside Beach, SC
Richard L. Kunis, MD
Pittsford, NY
Kimberly Tibbs, MD
Colorado Springs, CO
Mary B. Wiles, MD
Blairsville, GA
Joseph R. Arulandu, MD
Laporte, IN
Scott Eisenberg, DO
Marlboro, NJ
Peter M. Lehmann, MD
Poulsbo, WA
Douglas L. Trenkle, DO
Ellsworth, ME
Robert D. Williams, MD
Franklin, NC
Christie Ballantyne, MD
Houston, TX
Andrea J. Frank, DO
Kenilworth, NJ
Ann M. Liebeskind, MD
Neenah, WI
Mohammad A. Tulimat, MD
Sterling Heights, MI
Gordon L. Wolfe, MD
Portland, OR
Sarang Baman, MD
Franklin, WI
Howard D. Frauwirth, MD
New York, NY
Bradford C. Lipman, MD
Atlanta, GA
Ernesto Ang Uy, MD
Lakeland, FL
John C. Wood, MD
Signal Mountain, TN
Mark A. Bartz, MD
Greenwood, SC
John G. Frownfelter, MD
Southfield, MI
Jonathan S. Lown, MD
Smithtown, NY
Michael P. Varveris, MD
Naples, FL
Hasan Zakariyya, MD, MBBS
Fulton, NY
Krishna R. Bhaghayath, MD
Nashua, NH
Joseph P. Giancaspro, MD
Westerly, RI
R. Clarke Maiocco, MD
Littleton, CO
Carmelo V. Venero, MD
North Haven, CT
Allan Zelinger, MD
Oak Lawn, IL
Thomas C. Blevins, MD
Austin, TX
Ronald Goldberg, MD
Miami, FL
Chadi H. Mansour, MD
Sterling Heights, MI
Maureen Rafferty, MD
Park Ridge, IL
Jose V. Venero, MD
Palm Bay, FL
Paul E. Ziajka, MD, PhD
Winter Park, FL
Adolphus S. Bonar, MD
Waxhaw, NC
Edward M. Goldenberg, MD
Wilmington, DE
William B. Martin, MD
Lawrenceville, GA
Sabyasachi Bose, MBBS, MRCP
(UK)
Saskatoon, Canada
Rob Greenfield, MD
Newport Beach, CA
Khaled A. Reheem, MD
Munster, IN
Patrick F. Mathias, MD
Kissimmee, FL
Thomas B. Repas, DO
New Holstein, WI
Theodore Mazzone, MD
Chicago, IL
Nicholas P. Ricculli, DO
Chester, NJ
B. Alan Bottenberg, DO
Carson City, NV
Howard A. Brand, MD
Stony Brook, NY
Clinton D. Brown, MD
Brooklyn, NY
Robert J. Buynak, MD
Valparaiso, IN
Brian Chesnie, MD
Newport Beach, CA
(D.H.) Dellie H. Clark, MD
West Monroe, LA
Michael E. Cobble, MD
Sandy, UT
Steven M. Curland, MD
Norwich, CT
Julio C. Delgado, MD
Selma, AL
Margo Denke, MD
Kerrville, TX
Martha D. Dickens, MD
Madison, MS
Avinash C. Gupta, MD
Lakewood, NJ
Rodolfo W. Guzman, MD
Bronx, NY
Alan Helmbold, DO
Senoia, GA
John A. Hoekstra, MD, PhD
Richmond, VA
Glenn R. Huth, MD
Appleton, WI
Ramakrishnan Iyer, MBBS
Charleston, WV
Frank J. Johnson, MD
Bluefield, VA
Steven R. Jones, MD
Virginia Beach, VA
Salman Khan, MD
Chester, VA
Amit Khera, MD
Dallas, TX
Jane E. Kienle, MD
Gulfport, FL
John A. Osborne, MD, PhD
Grapevine, TX
Robert L. Panther, MD
Oconomowoc, WI
Ramesh N. Patel, MD
Joliet, IL
Jane K. Pearson, MD
Madison, WI
Daniel F. Phillips, MD
Pensacola, FL
Stacey J. Porterfield, DO
Colorado Springs, CO
Donald L. McAlexander, MD James W. Roberts, MD
Concord, NC
Charlotte, NC
Patrick McBride, MD
Madison, WI
Robert Rosenson, MD
Chicago, IL
Patrick J. McCullough. MD
Cincinnati, OH
Gary E. Schaffel, MD
Lake Forest, IL
Chris S. McElroy, MD
Martinez, GA
Jeffrey C. Schultz, MD
Baltimore, MD
David G. Meyers, MD, MPH Simone M. Scumpia, MD
Fairway, KS
Austin, TX
Michael Miller, MD
Baltimore, MD
Barry Seidman, MD
Delray Beach, FL
Jeanette A. Moleski, DO
Hudson, OH
Charlie Shaeffer, MD
Rancho Mirage, CA
Terrance J. Moran, MD
Monterey, CA
Edward J. Shahady, MD
Fernandina Beach, FL
Richard L. Mueller, MD
New York, NY
Bridget P. Sinnott, MD
Chicago, IL
Vincent P. Murphy, MD
Beaumont, TX
Daniel E. Soffer, MD
Swarthmore, PA
American Board of Clinical Lipidology
2006 Honorary Diplomates
Elizabeth Barrett-Connor, MD
La Jolla, CA
John Brunzell, MD
Seattle, WA
William Castelli, MD
Framingham, MA
Jean Davignon, MD
Montreal, Quebec, Canada
William Hazzard, MD
Seattle, WA
Donald Hunninghake, MD
Carlsbad, CA
John Kane, MD
San Francisco, CA
Robert Knopp, MD
Seattle, WA
Ronald Krauss, MD
Oakland, CA
John LaRosa, MD
Brooklyn, NY
19
National Lipid Association Educational Activities & Meetings Calendar
Name and Time of Activity
Online: September 2006 – September 2007
CME Newsletter: Statin Safety – NLA Recommendations for the Primary Care Community
CME Newsletter: Diabetes & Dyslipidemia: Reports from the ADA Scientific Sessions
Sponsored by Albert Einstein College of Medicine
NLA Sponsored/
Endorsed/Other
Contact and Registration
Information
Sponsored – CME
Online Activity
www.nlacme.com/statinsafety
Endorsed – CME, CE
Online Activity
www.NLACME.com
Webcast: New Perspectives on Real World Management of Dyslipidemia in Diabetes : Cases Endorsed – CME, CE
Online activity
and Controversies
www.NLACME.com
Sponsored by Albert Einstein College of Medicine
Online: November 2006 – November 2007
CME Newsletter: Lipid Management Today
Online: January 2007 – January 2008
Webcast: Why Your Patients Are Not Getting to Goal – Steps You Can Use to Improve
Dyslipidemia Treatment Outcomes
Sponsored – CME, CE
Online activity
www.nlacme.com/lipidmanagementtoday
Endorsed – AOA, CME
Online Activity
www.NLACME.com
Online: March 2007 – March 2008
Meeting Highlights: Presentations from the 2006 NLA Scientific Meetings
Online Activity
www.NLACME.com
June 21-23, 2007
2nd International Symposium on Integrated Biomarkers in Cardiovascular Diseases
Berlin, Germany
Other
Live meeting
Web: www.lorenzinifoundation.org
Live Meeting
www.lipid.org/education/lmtc
Sponsored – CME
Live Meeting
www.lipid.org/education/masters
Examination
www.lipidspecialist.org
Live Meeting
E-mail: nwoodsmall.lipid.org
www.lipid.org
Live Meeting
E-mail: ssheridan@lipid.org
Ph:904.998.0854
www.lipid.org
Sponsored – CME
Live Meeting
Web: www.lipid.org/education/masters
Sponsored by American Osteopathic Association
Sponsored by The Giovanni Lorenzini Medical Foundation
August 2-3, 2007
NLA Lipid Management Training Course
The Westin Hotel, Savannah, GA
August 2-3, 2007
NLA Masters in Lipidology Board Review Course
The Westin Hotel, Savannah,GA
August 3, 2007
ACCL Non-Physician Certification Exam
August 5, 2007
NLA Nutrition Counseling Workshop
August 3-5, 2007
Southeast Lipid Association Annual Scientific Forum
September 27-28, 2007
NLA Masters in Lipidology Board Review Course
The Millennium Hotel, Minneapolis, MN
NLA Lipid Management Training Course
September 28, 2007
ABCL Physician Certification Exam
September 28, 2007
ACCL Non-Physician Certification Exam
Midwest Lipid Association 4th Annual Scientific Forum
October 4-7, 2007
Drugs Affecting Lipid Metabolism
Hilton New York, New York City, NY
November 3, 2007
NLA Masters Summit – Digestive Tract Lipid Modifying Therapies
Orlando, FL
November 4-7, 2007
American Heart Association 2007 Scientific Sessions
Orlando, FL
20
Live Meeting
Web: www.lipid.org/education/lmtc
Examination
Web: www.lipidboard.org
Examination
Web: www.lipidspecialist.org
Live Meeting
Email: ssheridan@lipid.org
Ph:904.998.0854
Web: www.lipid.org
Other
Live meeting
Web: www.lorenzinifoundation.org/
dalm2007.html
Live Meeting
www.lpid.org
Other
www.scientificsessions.org

the Lipid Spin (Summer 2007)

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