Podcasts about national lipid association

CardioNerds co-founders Dr. Daniel Ambinder and Dr. Amit Goyal are joined by Dr. Spencer Weintraub, Chief Resident of Internal Medicine at Northwell Health, Dr. Michael Albosta, third-year Internal Medicine resident at the University of Miami, and Anna Biggins, Registered Dietitian Nutritionist at the Georgia Heart Institute. Expert commentary is provided by Dr. Zahid Ahmad, Associate Professor in the Division of Endocrinology at the University of Texas Southwestern. Together, they discuss a fascinating case involving a patient with a new diagnosis of hypertriglyceridemia. Episode audio was edited by CardioNerds Intern Student Dr. Pacey Wetstein. A woman in her 30s with type 2 diabetes, HIV, and polycystic ovarian syndrome presented with one day of sharp epigastric pain, non-bloody vomiting, and a new lower extremity rash. She was diagnosed with hypertriglyceridemia-induced pancreatitis, necessitating insulin infusion and plasmapheresis.   The CardioNerds discuss the pathophysiology of hypertriglyceridemia-induced pancreatitis, potential organic and iatrogenic causes, and the cardiovascular implications of triglyceride disorders. We explore differential diagnoses for cardiac and non-cardiac causes of epigastric pain, review acute and long-term management of hypertriglyceridemia, and discuss strategies for the management of the chylomicronemia syndrome, focusing on lifestyle changes and pharmacotherapy.  This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Hypertriglyceridemia Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. The acute management of hypertriglyceridemia-induced pancreatitis involves prompt recognition and initiation of therapy to lower triglyceride levels using either plasmapheresis or intravenous insulin infusion +/- heparin infusion. Insulin infusion is used more commonly, while plasmapheresis is preferred in pregnancy.   Medications such as fibrates and omega-3 fatty acids can be used to maintain long-term triglyceride reduction to prevent the recurrence of pancreatitis, especially in patients with persistent triglyceride elevation despite lifestyle modifications. Statins can be used in patients for ASCVD reduction in patients with a 10-year ASCVD risk > 5%, age > 40 years old, and diabetes or diabetes with end-organ damage or known atherosclerosis. Consider preferential use of icosapent ethyl as an omega-3 fatty acid for triglyceride lowering if the patients fit the populations that appeared to benefit in the REDUCE IT trial.   Apply targeted dietary interventions within the context of an overall healthy dietary pattern, such as a Mediterranean or DASH diet. Limit full-fat dairy, fatty meats, refined starches, added sugars, and alcohol. Encourage high-fiber vegetables, whole fruits, low-fat or fat-free dairy, plant proteins, lean poultry, and fish. Pay special attention to the cooking oils to ensure the patient is not using palm oil, coconut oil, or butter when cooking. Instead, use liquid non-tropical plant oils. Initiate a very low-fat diet (< 5% of total daily calories from fat) for 1-4 weeks when TG levels are > 750 mg/dL.  Recommend and encourage patients to exercise regularly, with a minimum goal of 150 minutes/week of moderate-intensity aerobic activity. If weight loss is required, aim for more than >225 - 250 minutes/week.   Develop patient-centered and multidisciplinary stra...

Send us a textIn this episode of Causes or Cures, Dr. Eeks sits down with Dr. Kevin Maki to dive into his systematic review on the impact of beef consumption on heart disease risk factors. Dr. Maki breaks down the complexities of defining red meat in research, highlighting the challenges and inconsistencies in dietary studies. He explains the key differences between processed and unprocessed meats, and the comparison groups used in these studies, offering a deep dive into the heart health risk factors that matter most. Tune in as Dr. Maki shares the interesting findings from his research, how they should shape our diets and dietary recommendations, and the innovative dietary interventions he believes could optimize heart health in the future. (Since they are currently dominating the news...,he also discusses interesting research about seed oils!)  If you're curious about the science behind beef, heart disease, and what dietary changes might make the biggest impact, this episode is for you. Dr. Maki is the President and Chief Science Officer of MB Clinical Research and Consulting, LLC, specializing in clinical studies on nutrition, metabolism, and chronic disease risk management. He holds adjunct faculty positions at DePaul University and Illinois Institute of Technology and is a Fellow of the National Lipid Association, The Obesity Society, and the American College of Nutrition. Dr. Maki has contributed to over 250 clinical trials and published more than 200 scientific works. With a Ph.D. in Epidemiology and an M.S. in Preventive Cardiovascular Health, he is an expert in cardiometabolic disease prevention and the science of genetics, lifestyle, and chronic disease risk. You can contact Dr. Eeks at bloomingwellness.com.Follow Eeks on Instagram here.Or Facebook here.Or X.On Youtube.Or TikTok.SUBSCRIBE to her monthly newsletter here.Support the show

Show notes: (2:21) Dr. Kedan's journey to becoming a leader in cardiology innovation (6:12) The broader applications of handheld ultrasound in patient care (15:15) The cholesterol debate: Is inflammation the bigger issue? (21:37) The role of ultrasound in preventive cardiology (27:31) The importance of balancing lifestyle changes with medical interventions (31:17) Factors predicting adverse events in cardiovascular health (36:49) How to find the right cardiologist and leveraging new technologies (38:56) The cholesterol vs. inflammation debate (43:18) Ultrasound vs. other imaging technologies (46:54) Key lifestyle tips for maintaining heart health (52:09) Where to find Dr. Kedan (54:57) Outro Who is Dr. Ilan Kedan?   Dr. Ilan Kedan is a distinguished cardiologist with a career marked by an unwavering commitment to patient care, academic excellence, and technological innovation. He embarked on his journey in medicine at Tulane University School of Medicine, where he honed his skills in cardiovascular health and patient-centered care.   Dr. Kedan's professional journey led him to Cedars Sinai Medical Group, where he cared for over 10,000 patients, fostering a culture of excellence and growth. During this time, he became a leader in the adoption of handheld ultrasonic cardiology technology, performing over 40,000 point-of-care ultrasound exams (POCUS).   Dr. Kedan's dedication to advancing patient care through technology earned him recognition as a Fellow of the American Society of Echocardiography and membership in esteemed organizations such as the National Lipid Association and the American College of Cardiology.   Beyond clinical practice, Dr. Kedan is deeply engaged in research, focusing on clinical cardiology, handheld ultrasound, and cardiometabolic disease. He has authored numerous publications on topics ranging from cardiac imaging to COVID-19, contributing to the advancement of cardiovascular medicine. Committed to shaping the next generation of medical professionals, Dr. Kedan mentors trainees and students, sharing his expertise and drive for excellence. Connect with Dr. Kedan: Website: https://www.cardiolucent.com/ Links and Resources: Peak Performance Life Peak Performance on Facebook Peak Performance on Instagram  

Today, I am excited to share the first class in a series of lipid masterclasses with the amazing Dr. Thomas Dayspring! Dr. Dayspring is certified in internal medicine and clinical epidemiology and is a fellow of the American College of Physicians and the National Lipid Association. He was previously the Educational Director of a nonprofit organization and has served as the Chief Academic Advisor for two major cardiovascular labs.  Due to the in-depth nature of my discussions with Dr. Dayspring over several sessions, each lasting nearly six hours, it seemed logical to present these masterclasses in segmented chunks to make them easier to understand. In our first class today, we dive into the fundamentals, exploring what lipids are and how lipids and fatty acids are classified. We cover the physiology and transportation of cholesterol and the role of apoptosis, apo-proteins, and apo-lipoproteins, unravel the differences between HDL, LDL, IDL, and VLDL, and explain how to calculate LDLs and triglycerides for assessing metabolic health. Dr. Dayspring also shares his preferences regarding lab values and the indicators that provide information to help him determine the early risk of cardiovascular disease. We get into some detailed aspects of physical chemistry in this episode, so I highlight the main clinical points throughout our conversation to make it more understandable. Be sure to join Dr. Dayspring and me for our next episode in the lipid masterclass series. IN THIS EPISODE YOU WILL LEARN: What are lipids, and why are they important? Dr. Dayspring explains what triglycerides are. How lipids get absorbed and transported throughout the body What lipoproteins are, and how they get classified How cholesterols get calculated The impact of triglycerides on cholesterol levels and cardiovascular health How high triglyceride levels can indicate early insulin resistance or increased ASCVD risk What is the role of HDL particles? How metabolic syndrome impacts cardiovascular health Bio: Thomas Dayspring MD is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. After practicing in New Jersey for 37 years, in 2012, he moved to Virginia. He served as an educational director for a nonprofit cardiovascular foundation and until mid-2019 as a Chief Academic Advisor for two major CV laboratories. Since then, he has served as a virtual cardiovascular / lipidology educator. Career-wise he has given over 4000 domestic (in all 50 states) and several international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women's cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. For several years he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association's Presidents Award for services to clinical lipidology and the 2023 Foundation of NLA Clinician/Educator Award. He has over 34K followers on his educational Twitter (X) feed (@Drlipid). He has Gold Heart Member status as a professional member of the American Heart Association and serves as a Social Media Ambassador for the European Atherosclerosis Society and the National Lipid Association. Connect with Cynthia Thurlow Follow on Twitter, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Thomas Dayspring Twitter (@DrLipid) LinkedIn

In this special episode titled “Lipids – Beyond Statins and LDL Cholesterol”, our host, Dr. Neil Skolnik will discuss with two expert guests the details of treatment for LDL-Cholesterol, Triglycerides, and other lipid risk markers.  This special episode is supported by an independent educational grant from Amarin. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health James Underberg, M.D. , Clinical Assistant Professor of Medicine at NYU School of Medicine and the NYU Center for Prevention of Cardiovascular Disease, Director of the Bellevue Hospital Lipid Clinic, and Past President of the National Lipid Association. Layla A. Abushamat, M.D., MPH, Assistant Professor, Department of Medicine in the Division of Atherosclerosis and Vascular Medicine, Baylor College of Medicine,  Houston, Texas   Selected references referred to the in the Podcast: 1.     Icosapent Ethyl: REDUCE-IT - N Engl J Med 2019; 380:11-22 2.     Omega-3 Fatty Acids: STRENGTH trial - JAMA. 2020;324(22):2268-2280 3.     Lipoprotein(a) Blood Levels and Cardiovascular Risk Reduction With Icosapent Ethyl. JACC. 2024 Apr, 83 (16) 1529–1539 4.     Icosapent ethyl following acute coronary syndrome. European Heart Journal 2024; 45:1173–1176 5.     Cardiovascular Disease and Risk Management: ADA Standards of Care in Diabetes—2024. Diabetes Care 2024;47(supp 1): S179–S218

CardioNerds Dan Ambinder and Dr. Devesh Rai join cardiology fellows and National Lipid Association lipid scholars Dr. Jelani Grant from Johns Hopkins University and Dr. Alexander Razavi from Emory University. They discuss a case involving a patient with familial hypercholesterolemia. Dr. Archna Bajaj from University of Pennsylvania provides expert commentary. Drs. Jelani Grant and Alexander Razavi drafted notes. CardioNerds Intern Pacey Wetstein engineered episode audio. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. A classic finding in patients with familial hypercholesterolemia is the presence of markedly elevated levels of total and low-density lipoprotein cholesterol (LDL-C) with an LDL-C concentration of 190 mg/dL or greater. However, severe hypercholesterolemia is not inevitably present, and many patients who carry this diagnosis may have lower LDL-C levels. This case history describes a young woman whose mother and brother met clinical and genetic criteria for heterozygous familial hypercholesterolemia but who had only a mild elevation in LDL-C, falling to 130 mg/dL after dietary intervention. Despite this finding, genetic testing revealed the presence of the same genetic variants as were noted in her mother and brother. In addition, a second genetic variant predisposing them to cholesterol gallstone formation was identified in all three family members. If genetic testing had not been performed, the diagnosis may have been missed or delayed, resulting in an increased risk for vascular complications associated with familial hypercholesterolemia. This case supports the value of genetic testing of family members of those with familial hypercholesterolemia, even when LDL-C levels are not severely elevated. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Exposing an Unusual Presentation of Familial Hypercholesterolemia – National Lipid Association Familial hypercholesterolemia (FH) is among the most common autosomal co-dominant genetic conditions (approximately 1:200 to 1:300 for HeFH, 1:160,000 to 1:300,000 for HoFH). Genetic testing has a role for all first-degree relatives when a family history of FH is strongly suggestive, regardless of LDL-C level. Heterogeneity in ASCVD risk among individuals with FH is derived from background polygenic risk, clinical risk factors (e.g., timing of lipid-lowering initiation and adjacent risk factors), as well as subclinical atherosclerosis burden. In clinical or genetically confirmed FH, an LDL-C goal of 55 mg/dL is recommended. Beyond statins, FDA-approved non-statin therapies for FH include ezetimibe, PCSK9 mAb, bempedoic acid, inclisiran, evolocumab (only HoFH), lomitapide (only HoFH), and LDL apheresis. Notes - Exposing an Unusual Presentation of Familial Hypercholesterolemia – National Lipid Association What are the diagnostic criteria for FH? Dutch Lipid Clinic Network1 Variables: family history, clinical history, physical exam, LDL-C level, DNA (LDLR, APOB, PCSK9) Simon-Broome1 Variables: total or LDL-C, physical exam, DNA (LDLR, APOB, PCSK9), family history Emphasis on clinical history and physical exam reduces sensitivity U.S. Make Early Diagnosis Prevent Early Death (MEDPED) 1 Only one of the three where no genetic testing is required, may work well in cascade screening Variables: age, total cholesterol, family relative (and degree) with FH Definite, probable, possible, unlikely Emphasis on clinical history and physical exam reduces sensitivity

CardioNerds Dan Ambinder and Dr. Devesh Rai join cardiology fellows and National Lipid Association lipid scholars Dr. Oby Ibe from Temple University and Dr. Elizabeth Epstein from Scripps Clinic. They discuss a case involving a patient with elevated Lp(a). Dr. Jessica Pena provides expert commentary. Drs. Oby Ibe and Elizabeth Epstein drafted notes. CardioNerds Intern Christiana Dangas engineered episode audio. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. This is a 63-year-old man with hypertension, hyperlipidemia, and active tobacco smoking who presented with acute dyspnea. He was tachycardic but otherwise initially hemodynamically stable. The physical exam demonstrated warm extremities with no murmurs or peripheral edema. Chest X-ray revealed diffuse pulmonary edema, and the ECG showed sinus tachycardia with T-wave inversions in the inferior leads. A bedside echocardiogram revealed a flail anterior mitral valve leaflet. The patient was taken for cardiac catheterization that revealed nonobstructive mid-RCA atheroma with a distal RCA occlusion, which was felt to reflect embolic occlusion from recanalized plaque. PCI was not performed. Right heart catheterization then demonstrated a low cardiac index as well as elevated PCWP and PA pressures. An intra-aortic balloon pump was placed at that time. A TEE was performed soon after which showed the posteromedial papillary muscle was ruptured with flail segments of the anterior mitral leaflet as well as severe posteriorly directed mitral regurgitation. The patient ultimately underwent a successful tissue mitral valve replacement and CABG. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Little (a), Big Deal – National Lipid Association You are never too young to see a preventive cardiologist! The field of preventive cardiology is shifting focus towards the identification of early upstream risk and intervention before the development of clinical ASCVD (1,5). Patients who have a strong family history of cardiovascular disease, a personal history of CVD at an early age, multiple risk factors, or genetic disorders such as familial hypercholesterolemia especially benefit from early cardiovascular risk assessment and reduction. Female-specific risk factors to incorporate into a young woman's cardiovascular risk assessment include polycystic ovarian syndrome, hormone contraceptive use, early menarche (age 5 pregnancies), early menopause (age

ในท่ามกลางกระแสการใช้เรื่องเล่าและหลักฐานงานวิจัยที่ไม่มีคุณภาพ เพื่อทำให้สารอาหารตัวใดตัวหนึ่งเป็นผู้ร้ายนั้น มีมานานตลอด 70 ปีที่ผ่านมา ตั้งแต่ไขมัน คาร์โบไฮเดรต โปรตีน โดยเฉพาะเมื่อมีการใช้แพลตฟอร์มโซเชียลมีเดียกันอย่างกว้างขวาง ทำให้การแพร่กระจายข้อมูลผิดๆเป็นไปได้ง่ายและรวดเร็ว หนึ่งในเรื่อง Top Hit ที่มีการแพร่กระจายข้อมูลกันอย่างผิดๆทางโซเชียลมีเดีย คือเรื่องอันตรายของน้ำมันพืช (กรดไขมันไม่อิ่มตัวเชิงซ้อนโดยเฉพาะ Linoleic Acid) ถึงแม้ว่าหน่วยงานสาธารณสุข ไม่ว่าจะเป็น American Heart Association, European Society of Cardiology, WHO, National Lipid Association จะออกคำแนะนำสนับสนุนการบริโภคน้ำมันพืชที่มีกรดไขมันไม่อิ่มตัวเชิงซ้อนโดยเฉพาะ Linoleic Acid เป็นส่วนประกอบ ก็ยังไม่สามารถทำลายมายาคติของความเชื่อที่ผิดๆนี้ได้ ในไลฟ์#79 พี่ปุ๋มจะพาน้องๆไปทำความเข้าใจถึงที่มาของการเผยแพร่ข้อมูลที่ผิดๆนี้และลงรายละเอียดถึงหลักฐานที่ไม่หนักแน่นซึ่งนำมาสนับสนุนว่าน้ำมันพืชอันตรายอันตรายต่อสุขภาพ อย่างเช่น Sydney Diet Heart Study, Minnesota Coronary Experiment, เปรียบเทียบกับหลักฐานงานวิจัยที่มีคุณภาพ ซึ่งสนับสนุนการบริโภคน้ำมันพืชพืชซึ่งมีกรดไขมันไม่อิ่มตัวเชิงซ้อนเป็นส่วนประกอบเพื่อสุขภาพโดยเฉพาะสุขภาพหัวใจ พบกันในไลฟ์#79 (ตอนที่ 1) วันจันทร์ที่ 1 ก.ค. เวลา 20.00 น. ค่ะ ❤️ #หาคำตอบสุขภาพจากงานวิจัยไม่ใช่จากเรื่องเล่า #FatOutHealthspans

I am thrilled to present the last class of our Lipid Masterclass series today with the esteemed Dr. Thomas Dayspring. Dr. Dayspring is board-certified in internal medicine and clinical lipidology and is a fellow of the American College of Physicians and the National Lipid Association.  Today, we round things out by diving into medications for lipid abnormalities and discussing lipid physiology, with Dr. Dayspring shedding light on insulin resistance and statins and cautioning against statin use for those predisposed to diabetes or insulin resistance. He also explains why LDL particle size is not worth testing and discusses ways to identify specific laboratory abnormalities.  Be sure to stay tuned for the AMA session to follow, where Dr. Dayspring will answer listeners' questions.  It has been a privilege engaging with Dr. Dayspring throughout this masterclass series. I know you will have learned a lot from it! IN THIS EPISODE YOU WILL LEARN: · The lack of research and consistency in addressing the needs of women in various stages of life · Dr. Dayspring discusses the use of bile acid sequestrants for lowering LDL cholesterol · Dr. Dayspring discusses the history of bile acid sequestrant use, explaining why their use is limited · How bempedoic acid and statins lower LDL cholesterol · Potential contraindications for bempedoic acid · The benefits and risks of using fibrates to reduce heart attacks · Dr. Dayspring explains why fibrates work best for genetic hypertriglyceridemia · Why reducing ApoB is essential for atherosclerosis patients, especially for high-risk patients · Dr. Dayspring explains why small LDL particles are dangerous · The ideal ApoB level for those who have no heart disease and are not diabetic  Bio: Thomas Dayspring MD is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. After practicing in New Jersey for 37 years, in 2012, he moved to Virginia to serve as an educational director for a nonprofit cardiovascular foundation until mid-2019 as a Chief Academic Advisor for two major CV laboratories. Since then, he has served as a virtual cardiovascular/lipidology educator. Career-wise, he has given over 4000 domestic (in all 50 states) and several international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women's cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. For several years, he was an Associate Editor of the Journal of Clinical Lipidology. He received the 2011 National Lipid Association's Presidents Award for services to clinical lipidology and the 2023 Foundation of NLA Clinician/Educator Award. He has over 34K followers on his educational Twitter (X) feed (@Drlipid). He has Gold Heart Member status as a professional member of the American Heart Association, and he serves as a Social Media Ambassador for the European Atherosclerosis Society and the National Lipid Association. Connect with Cynthia Thurlow Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Thomas Dayspring On Twitter (@DrLipid) On LinkedIn

I am excited to share our fourth class in our informative Lipid Masterclass series today, with the esteemed Dr. Thomas Dayspring. Dr. Dayspring is certified in internal medicine and clinical lipidology and is a distinguished fellow of the American College of Physicians and the National Lipid Association. He brings a wealth of expertise to our discussion today. In this class, we dive into lipid and lipoprotein dynamics during the menopausal transition, exploring the impact of estrogen on gut health and its effects on laboratory findings. We look at the differences between hyper absorbers and hyper synthesizers, sharing clinical insights on routine lipid panels that can let you know if you are one of those individuals. We talk about Boston Heart Testing, highlighting the impact of specific biomarkers on brain health lipids and lipoproteins, and we get into the staggering differences between the half-lives of peripheral cholesterol and brain cholesterol. We discuss lipid permeability across the blood-brain barrier, highlighting those at risk for brain health concerns as they age, and we reveal strategies for managing lipid abnormalities. We also focus on LP(a), an ApoB lipoprotein with potent atherogenic and thrombotic properties, and its implications regarding calcific aortic stenosis.  I am sure you will find this enlightening conversation with Dr. Dayspring invaluable. There is one more class yet to come in this masterclass series. Be sure to listen in! IN THIS EPISODE YOU WILL LEARN: How cholesterol absorption in the gut increases in perimenopausal women How hyper cholesterol absorbers tend to have elevated HDL cholesterol The impact of phytosterols on cholesterol absorption When should hyperabsorbers consider treatment? What research has shown regarding the differing effects of estrogen on brain health for older versus younger menopausal women What happens if a statin crosses the blood-brain barrier? How cholesterol synthesis relates to cognitive impairment  The importance of understanding LP-PLA2 test results How Lp(a) levels in women tend to fluctuate, particularly during menopause Should women with heart disease consider hormone replacement therapy?   Bio: Thomas Dayspring MD is a Fellow of the American College of Physicians and the National Lipid Association certified in internal medicine and clinical lipidology. After practicing in New Jersey for 37 years, in 2012, he moved to Virginia to serve as an educational director for a nonprofit cardiovascular foundation until mid-2019 as a Chief Academic Advisor for two major CV laboratories. Since then, he has served as a virtual cardiovascular / lipidology educator. Career-wise, he has given over 4000 domestic (in all 50 states) and several international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women's cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. For several years, he was an Associate Editor of the Journal of Clinical Lipidology. He received the 2011 National Lipid Association's Presidents Award for services to clinical lipidology and the 2023 Foundation of NLA Clinician/Educator Award. He has over 34K followers on his educational Twitter (X) feed (@Drlipid). He has Gold Heart Member status as a professional member of the American Heart Association, and he serves as a Social Media Ambassador for the European Atherosclerosis Society and the National Lipid Association. Connect with Cynthia Thurlow Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Thomas Dayspring On Twitter (@DrLipid) On LinkedIn

Dr. Thomas Dayspring joins me again today for the third class in our Lipid Masterclass Series. Dr. Dayspring brings a wealth of expertise as a certified specialist in internal medicine and clinical lipidology, holding fellowships with the American College of Physicians and the National Lipid Association. This hour-long class is devoted to women's health and abnormal lipids. We continue with our conversation about ApoB, discussing ways to look at other lipid abnormalities related to abnormal ApoBs and talking about our ideal lab values and lifestyle modifications, briefly touching on my lipid journey and the medication I have been taking for the past six months. We examine diagnostics and their limitations, getting into CACs, coronary artery calcification scoring, CIMT, the labs we need to look at, the role of Lp(a), and how it affects our heart. We look into the changes women experience from losing estrogen in menopause, clues women can use to predict future cardiovascular risk, how estrogen helps clear LDL from the body, and the changes occurring with menopause, including higher ApoBs. We also dive into risks women face for cardiovascular disease, the impact of the Women's Health Initiative study, and absorption and synthesis challenges with cholesterol. Stay tuned for more! IN THIS EPISODE YOU WILL LEARN: Why ApoB testing for inherited lipoprotein disorders is essential  Why hypo beta lipoproteins (HDL) are critical for maintaining good health The benefits of a holistic approach to treating high cholesterol The three stages of prevention for atherosclerosis How Lp(a) impacts heart health The importance of assessing early heart function through Lp(a) testing How your pregnancy history can help in predicting your risk for cardiovascular disease Why should women be more concerned about cardiovascular disease than breast cancer? How the Women's Health Initiative led gynecologists to be more cautious about prescribing HRT How genetically mediated cholesterol abnormalities can impact our ability to absorb and synthesize cholesterol   Bio: Thomas Dayspring MD is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. After practicing in New Jersey for 37 years, in 2012, he moved to Virginia to serve as an educational director for a nonprofit cardiovascular foundation until mid-2019 as a Chief Academic Advisor for two major CV laboratories. Since then, he has served as a virtual cardiovascular / lipidology educator. Career-wise he has given over 4000 domestic (in all 50 states) and several international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women's cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. For several years, he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association's Presidents Award for services to clinical lipidology and the 2023 Foundation of NLA Clinician/Educator Award. He has over 34K followers on his educational Twitter (X) feed (@Drlipid). He has Gold Heart Member status as a professional member of the American Heart Association, and he serves as a Social Media Ambassador for the European Atherosclerosis Society and the National Lipid Association. Connect with Cynthia Thurlow Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Thomas Dayspring On Twitter (@DrLipid) LinkedIn

Dr. Thomas Dayspring is certified in internal medicine and clinical lipidology. He is a fellow of the American College of Physicians and the National Lipid Association. He joins me today for the second class in our series of Lipid Masterclasses.   In today's class, Dr. Dayspring shares valuable insights on cardiovascular health and lipid management. We dive into the complexities of cardiovascular disease, focusing on lipoproteins, atherogenesis progression, and its implications on myocardial infarctions (heart attacks). He explains the mechanisms of ApoB invasion into arterial walls and discusses the critical importance of finding competent healthcare providers, particularly for women navigating the perimenopausal to menopausal transition. He also gets into the limitations of bikini medicine, and we tackle pertinent issues surrounding hormone replacement therapy, including potential side effects and clinical observations.  Dr. Dayspring has a wealth of information to share today, and we have several additional masterclasses coming up to follow this class. Be sure to tune in for those episodes. IN THIS EPISODE YOU WILL LEARN: How lipids get transported, and how energy gets produced in the body How the liver prevents fatty liver tissue from building up Dr. Dayspring explains the process of lipolysis   What is the role of LDL particles in atherosclerosis? How the buildup of plaque in arteries can lead to blockages, causing heart attacks or strokes if left untreated Why high cholesterol needs to get diagnosed and treated as early as possible  The importance of HDL cholesterol in immunity and oncogenesis Why ApoB is essential for lipid panel analysis Why women need comprehensive medical care, especially during menopause Connect with Cynthia Thurlow Follow on Twitter, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Thomas Dayspring Twitter (@DrLipid) LinkedIn

Today, I am excited to share the first class in a series of lipid masterclasses with the amazing Dr. Thomas Dayspring! Dr. Dayspring is certified in internal medicine and clinical epidemiology and is a fellow of the American College of Physicians and the National Lipid Association. He was previously the Educational Director of a nonprofit organization and has served as the Chief Academic Advisor for two major cardiovascular labs.  Due to the in-depth nature of my discussions with Dr. Dayspring over several sessions, each lasting nearly six hours, it seemed logical to present these masterclasses in segmented chunks to make them easier to understand. In our first class today, we dive into the fundamentals, exploring what lipids are and how lipids and fatty acids are classified. We cover the physiology and transportation of cholesterol and the role of apoptosis, apo-proteins, and apo-lipoproteins, unravel the differences between HDL, LDL, IDL, and VLDL, and explain how to calculate LDLs and triglycerides for assessing metabolic health. Dr. Dayspring also shares his preferences regarding lab values and the indicators that provide information to help him determine the early risk of cardiovascular disease. We get into some detailed aspects of physical chemistry in this episode, so I highlight the main clinical points throughout our conversation to make it more understandable. Be sure to join Dr. Dayspring and me for our next episode in the lipid masterclass series. IN THIS EPISODE YOU WILL LEARN: What are lipids, and why are they important? Dr. Dayspring explains what triglycerides are. How lipids get absorbed and transported throughout the body What lipoproteins are, and how they get classified How cholesterols get calculated The impact of triglycerides on cholesterol levels and cardiovascular health How high triglyceride levels can indicate early insulin resistance or increased ASCVD risk What is the role of HDL particles? How metabolic syndrome impacts cardiovascular health Bio: Thomas Dayspring MD is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. After practicing in New Jersey for 37 years, in 2012, he moved to Virginia. He served as an educational director for a nonprofit cardiovascular foundation and until mid-2019 as a Chief Academic Advisor for two major CV laboratories. Since then, he has served as a virtual cardiovascular / lipidology educator. Career-wise he has given over 4000 domestic (in all 50 states) and several international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women's cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. For several years he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association's Presidents Award for services to clinical lipidology and the 2023 Foundation of NLA Clinician/Educator Award. He has over 34K followers on his educational Twitter (X) feed (@Drlipid). He has Gold Heart Member status as a professional member of the American Heart Association and serves as a Social Media Ambassador for the European Atherosclerosis Society and the National Lipid Association. Connect with Cynthia Thurlow Follow on Twitter, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Dr. Thomas Dayspring Twitter (@DrLipid) LinkedIn Books written by Gary Taubes

Many doctors made the transition from traditional medicine to a more holistic form of medicine – whether you name it functional medicine, integrative medicine, alternative medicine, holistic medicine, or antiaging medicine – all these new terms describe a new form of medicine, where we look at the web of relationships that make up human health, be it nutrition, stress, movement, sleep, toxicity, hormone balance, gut microbiome, sugar metabolism, or other metabolic and genetic factors.Please take a listen to Dr. Carlos Jorge, who left his traditional practice, and heralded a more enlightened way of practicing medicine by addressing all these factors, and now has a successful membership-based practice in Charlotte, NC. About Dr, Carlos Jorge: Dr. Jorge is a co-founder of Companion Health, PLLC an innovative private membership longevity functional medicine and primary care center in Charlotte, NC. (Companion Health is changing healthcare one client at a time by taking a deep medicine approach to all clients.) He is also the chief medical officer of Healthcoin Exchange, a disruptive technology solutions company that is developing platforms to offer alternative payments, engagement, and clinician interactions for consumers. Dr. Jorge is triple board certified in family medicine, functional and regenerative medicine, and clinical lipidology. Dr. Jorge is the former Medical Director of Presbyterian Novant Heart and Wellness and Corporate Medicine located in Charlotte, North Carolina. (He was also the Co-Chair of the Presbyterian Novant Heart and Wellness Committee.) He is an active member of various groups and boards including the A4M/MMI, National Lipid Association, American Medical Association, American Academy of Family Practice, North Carolina Academy of Family Physicians. He is a previous clinical advisor to the Cleveland Heart Lab at the Cleveland Clinic. Dr. Jorge originates from the Dominican Republic where he attended medical school and graduated Cum Laude from the National University Pedro Henriquez Urena (UNPHU) in 1999. He completed his residency in 2002 at the Northwestern University affiliated family practice program at St. Joseph Hospital in Chicago, where he also served as chief resident. To Connect With Dr. Carlos Jorge:https://www.companionhealthnc.com/our-team/dr-carlos-jorge/To Connect With Dr. Joy Kong:http://drjoykong.com/Watch Video Episodes on YouTube:https://www.youtube.com/channel/UCZj1GQBWFM5sRAL0iQfcMAQFollow Dr. Joy Kong on Social Media:https://www.instagram.com/dr_joy_kong/https://www.facebook.com/stemcelldrjoyhttps://www.linkedin.com/in/joy-kong-md-4b8627123/For more information about anti-aging regenerative medicine treatment visit:https://uplyftcenter.com

The following question refers to Section 4.9 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSD fellow Dr. Patrick Azcarate, and then by expert faculty Dr. Melissa Tracy. Dr. Tracy is a preventive cardiologist, former Director of the Echocardiography Lab, Director of Cardiac Rehabilitation, and solid organ transplant cardiologist at Rush University. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #35 In patients with a low risk of cardiovascular disease, which of the following is true?AAspirin does not affect the risk of ischemic strokeBAspirin increases the risk of fatal bleeding.CAspirin reduces the risk of non-fatal MI.DAspirin reduces cardiovascular mortality Answer #35 ExplanationIn 2019, an updated meta-analysis of aspirin for primary prevention of cardiovascular events found that patients with a low risk of CVD taking aspirin did not have a reduction in all-cause or cardiovascular mortality. There was a lower risk of non-fatal MI (RR 0.82) and ischemic stroke (RR 0.87). However, aspirin was also associated with a  higher risk of major bleeding (RR 1.50), intracranial bleeding (RR 1.32), and major GI bleeding (RR 1.52). There was no difference in the risk of fatal bleeding (RR 1.09).Accordingly, the ESC does not recommend antiplatelet therapy in individuals with low/moderate CV risk due to the increased risk of major bleeding (Class III, LOE A).Although aspirin should not be given routinely to patients without established ASCVD, we cannot exclude that in some patients at high or very high CVD risk, the benefits may outweigh the risks.Main TakeawayIn patients with low/moderate risk of CVD, aspirin for primary prevention is not recommended due to the higher risk of bleeding. For those at higher risk of CVD, low-dose aspirin may be considered for prevention in the absence of contraindications.Guideline Loc.Section 4.9.1, Page 3291 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

The following question refers to Section 4.7 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Shivani Reddy, answered first by NP Carol Patrick, and then by expert faculty Dr. Eileen Handberg.Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President Elect for the PCNA.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #34 Ms. BW presents after her best friend was diagnosed with hypertension and is interested in measuring her own blood pressure. According to the ESC Guidelines, what BP screening approach is recommended for making a diagnosis of hypertension? ARepeated measurements in one visitBA single measurement in a single visitCRepeated measurements in more than one visit  DReported patient history  Answer #34 Explanation The correct answer is C – Repeated measurements in more than one visit.It is recommended to base the diagnosis of hypertension on repeated office BP measurements on more than one visit except when hypertension is severe (e.g., Grade 3—defined as SBP > 180 and/ or DBP >110mmHg—and especially in high-risk patients) (Class I, LOE C). In addition to recommending repeat measurements across visits, the guidelines provide a number of considerations for appropriately measuring blood pressure, such as taking measurements when seated in a quiet environment for 5 minutes and measuring in both arms at the first visit and using the higher-level value arm for visits thereafter (see Table 14 on page 3283).Additionally, home blood pressure monitoring is recommended as an alternative to repeated office measurements. Blood pressure measurements are taken with a semiautomated, validated cuff for 3 consecutive days – and 6-7 days being preferred – in the morning and at night, averaged over that period. Notably, home blood pressure thresholds for the diagnosis of hypertension are lower than for that of in-office measurements, with a daytime systolic of 135mmHg or diastolic of 85mmHg given as the level at which hypertension is diagnosed, as opposed to 140mmHg and 90mmHg for systolic and diastolic levels, respectively, given for in-office diagnosis.Main TakeawayWith the exception of those with severely elevated blood pressures, the diagnosis of hypertension requires repeated measurements across multiple office visits.Guideline Loc.Sections 4.7.1 and 4.7.2, Table 13 and 14, Figure 14 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

[CE contact hours--see below.] : Guests Kathy Byrne, MSN, CRNP, CCRN.,and Lisa Maher, DNP, ARNP, FNP-BC, FPCNA, describe the most common genetic dyslipidemia--elevated lipoprotein (a), or Lp(a). The discussion includes testing for Lp(a)--especially for family members, and others who may be at risk. Resources for patients and HCPs are also part of the conversation.CE LINK:https://pcna.net/online-course/ce-podcast-lpa-closer-to-home-than-you-think PCNA Lp(a) patient education sheet: https://pcna.net/clinical-resources/patient-handouts/lipoproteina-patient-tools-and-handouts/ National Lipid Association: https://www.lipid.org/ Family Heart Foundation: https://familyheart.org/ European Atherosclerosis Society Lp(a) Consensus Statement: https://eas-society.org/page/lipoproteina-consensus-2022/ 2018 AHA/ACC multi-society guidelines: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625American Heart Association: https://www.heart.org/ See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Host: Mary Katherine Cheeley, PharmD, BCPS, CLS, FNLA Guest: Alan S. Brown, MD, FACC, FAHA, FNLA Both clinical trials for lowering Lp(a) had patients with established atherosclerotic cardiovascular disease (ASCVD). Join in for a further discussion on important updates presented at the 2023 National Lipid Association Meeting with Dr. Mary Katherine Cheeley and fellow ReachMD host, Dr. Alan Brown, Past President of the National Lipid Association.

The following question refers to Section 5.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by MGH medicine resident Dr. Christian Faaborg-Andersen, answered first by Dr. Patrick Azcarate, and then by expert faculty Dr. Laurence Sperling. Dr. Laurence Sperling is the Katz Professor in Preventive Cardiology at the Emory University School of Medicine and Founder of Preventive Cardiology at the Emory Clinic. Dr. Sperling was a member of the writing group for the 2018 Cholesterol Guidelines, serves as Co-Chair for the ACC's Cardiometabolic and Diabetes working group, and is Co-Chair of the WHF Roadmap for Cardiovascular Prevention in Diabetes. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #29 What percentage of the European population currently meets the recommended physical activity guidelines (150 minutes moderate-intensity activity weekly or 75 minutes vigorous-intensity activity weekly)?A75% Answer #29 ExplanationThe correct answer is A:

Dr. David Carmouche, MD is Senior Vice President of Omnichannel Care at Walmart, where he leads the fleet of Walmart Health centers, Walmart Health Virtual Care, Walmart's work to address Social Determinants of Health, and all new omnichannel healthcare offerings ( https://www.walmarthealth.com/ ). He joined Walmart in 2021, bringing a unique combination of provider, payer, and integrated delivery network experience - serving as a physician, an executive for an insurance company, and as a leader in a regional health system. Dr. Carmouche joined Walmart from Ochsner Health, the largest nonprofit academic healthcare system in the Gulf South, where he served as EVP, Value-based Care and Network Operations; President, Ochsner Health Network; and Executive Director, Ochsner Accountable Care Network. Prior to joining Ochsner Health, Dr. Carmouche was Chief Medical Officer and Executive Vice President of External Operations for Blue Cross and Blue Shield of Louisiana, where he introduced the company's first value-based care contracts. As the first lipidologist in Louisiana and a Fellow of the National Lipid Association, he practiced preventative cardiology in Baton Rouge through 2012, where he built a large, multidisciplinary internal medicine and preventive cardiology practice as Director of the Center for Cardiovascular Disease Prevention at the Baton Rouge Clinic. He also championed an Epic electronic medical record (EMR) single instance implementation across three entities. Dr. Carmouche attended Tulane University where he studied biology, and LSU Medical School in New Orleans. Board-certified in Internal Medicine, he completed his residency at the University of Alabama at Birmingham where he later served as Chief Resident. He serves as President of the Board of the Consortium for Southeastern Healthcare Quality, and he serves on the advisory board at Stellar Health. He is a board observer and advisor for a New Orleans-based startup, Ready, and he serves nationally as a board member for the National Association of Accountable Care Organizations. Support the show

The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern Dr. Maryam Barkhordarian, answered first by medicine resident CardioNerds Academy House Chief Dr. Ahmed Ghoneem, and then by expert faculty Dr. Kim Williams.Dr. Williams is Chief of the Division of Cardiology and is Professor of Medicine and Cardiology at Rush University Medical Center. He has served as President of ASNC, Chairman of the Board of the Association of Black Cardiologists (ABC, 2008-2010), and President of the American College of Cardiology (ACC, 2015-2016). The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #27 Mr. O is a 48-year-old man with a past medical history significant for obesity (BMI is 42kg/m2), hypertension, type 2 diabetes mellitus, and hypercholesterolemia. His calculated ASCVD risk score today is 18.8%. You counsel him on the importance of weight loss in the context of CVD risk reduction. Which of the following weight loss recommendations is appropriate?AMaintaining a weight loss of at least 25% from baseline is required to influence blood pressure, cholesterol, and glycemic control. BHypocaloric diets lead to short term weight loss, but a healthy diet should be maintained over time to reduce CVD risk.CLiraglutide can be used to induce weight loss, as an alternative to diet and exercise.DBariatric surgery is effective for weight loss but has no ASCVD risk reduction benefit. Answer #27 Explanation The correct answer is B. Energy restriction is the cornerstone of management of obesity. All the different types of hypocaloric diets achieve similar short-term weight loss, but these effects tend to diminish by 12 months. It is a class I recommendation to maintain a healthy diet over time to achieve CVD risk reduction. The Mediterranean diet is an example of a diet that can have persistent CV benefit beyond the 12 months. Choice A is incorrect because maintaining even a moderate weight loss of 5 – 10% from baseline has favorable effects on risk factors including blood pressure, cholesterol, and glycemic control, as well as on premature all-cause mortality. Choice C is incorrect because medications approved as aids to weight loss (such as liraglutide, orlistat and naltrexone/bupropion) may be used in addition to lifestyle measures to achieve weight loss and maintenance; they are not alternatives to a healthy lifestyle. Meta-analysis of medication-assisted weight loss found favorable effects on BP, glycemic control, and ASCVD mortality. Choice D is incorrect because patients undergoing bariatric surgery had over 50% lower risks of total ASCVD and cancer mortality compared with people of similar weight who did not have surgery. Bariatric surgery should be considered for obese high-risk individuals when lifestyle change does not result in maintained weight loss (Class IIa). The ACC/AHA guidelines focused primarily on lifestyle interventions for obesity and had no specific recommendations for bariatric surgery or medication-assisted weight loss. Main Takeaway Weight reduction (even as low as 5-10% from baseline) and long-term maintenance of a healthy diet are recommended to improve the CVD risk profile of overweight and obese people. Medication and/or bariatric surgery may have a useful adjunctive role in some patients. Guideline Loc. Section 4.3.3 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!

Stroke Busters is a podcast presented by the Institute for Stroke and Cerebrovascular Disease at UTHealth Houston in Houston, TX. The purpose of this podcast is to bring you the latest news and discussion in stroke care, research, community, and academia. Today's guest is Dr. Patrick Key, a non-invasive board-certified clinical cardiologist with clinical interests in clinical lipidology, preventive cardiology and non-invasive cardiovascular imaging. His Ph.D. research focuses on the metabolism of high-density lipoproteins (aka good cholesterol). He has an active research program in molecular imaging of atherosclerosis and targeted drug delivery using novel nanoparticles and intravascular devices. He is a member of the National Lipid Association and is up to date with the contemporary management of various lipid disorders. He runs a Level 2 Lipid Clinic and Preventive Cardiology Clinic at the UT Professional Building.  Dr. Kee joined us for Stroke Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Jerome Jeevarajan to answer some more questions, so that we can share more of his insight and research. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

The following question refers to Sections 3.3 and 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern student Dr. Adriana Mares, answered first by Brigham & Women's medicine resident & Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Allison Bailey. Dr. Bailey is an advanced heart failure and transplant cardiologist at Centennial Heart. She is the editor-in-chief of the American College of Cardiology's Extended Learning (ACCEL) editorial board and was a member of the writing group for the 2018 American Lipid Guidelines.  The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #26 Ms. Priya Clampsia is a 58-year-old never-smoker with a history of hypertension. Her BMI is 29 kg/m2. She also mentions having pre-eclampsia during her pregnancy many years ago. She describes a predominately sedentary lifestyle and works as a receptionist. You see her in the clinic to discuss routine preventive care. Her most recent lipid panel results were LDL of 101 mg/dL, HDL of 45 mg/dL, and triglycerides of 190 mg/dL. What additional step will provide valuable information regarding her CVD risk profile? A Send additional lab workup including C-reactive protein and lipoprotein (a) B Measure her waist circumference C Assess her work stress D Ask her about history of preterm birth E B, C, and D Answer #26 Explanation The correct answer is E – measuring her waist circumference, assessing her occupational stress, and obtaining history about adverse pregnancy outcomes including preterm birth all add valuable information for CVD risk stratification. BMI is easily measured and can be used to define categories of body weight. However, body fat stores in visceral tissue carry higher risk than subcutaneous fat and therefore, waist circumference can be a simple way to measure global and abdominal fat. When waist circumference is ≥102 cm in men and ≥88 cm in women, weight reduction is advised. While these WHO thresholds are widely accepted in Europe, it is important to note that different cut-offs may be appropriate in different ethnic groups. Work stress is important to ascertain as well because there is preliminary evidence of the detrimental impact of worse stress on ASCVD health, independent of conventional risk factors and their treatment. Work stress is determined by job strain (i.e., the combination of high demands and low control at work) and effort-reward imbalance. Pre-eclampsia is associated with increase in CVD risk by factor of 1.5-2.7 compared with all women. Both preterm (RR 1.6) and still birth (RR 1.5) are also associated with a moderate increase in CVD risk. Taking a thorough pregnancy history is important in determining future cardiovascular risk in women. The ESC guidelines give a Class IIb (LOE B) recommendation that in women with history of premature or stillbirth, periodic screening for hypertension and DM may be considered. Of note, the 2018 ACC/AHA guidelines include preeclampsia and premature menopause (occurring at age

The following question refers to Section 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Hirsh Elhence, answered first by Mayo Clinic Fellow Dr. Teodora Donisan, and then by expert faculty Dr. Eugene Yang.Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and chair of the ACC Prevention of CVD Section.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #25 Please choose the CORRECT statement from the ones below.ACAC scoring can be considered to improve ASCVD risk classification around treatment decision thresholds.BPatients with type 1 or type 2 diabetes are considered very high CV risk, regardless of comorbidities and other risk factors.CCKD does not increase the cardiovascular risk in the absence of other risk factors.DMen and women older than 65 years old are at high cardiovascular risk. Answer #25 ExplanationOption A is correct. Coronary artery calcium (CAC) scoring can reclassify CVD risk upwards and downwards in addition to conventional risk factors and may thus be considered in men and women with calculated risks around decision thresholds (Class IIb, Level B). If CAC is detected, its extent should be compared with what would be expected for a patient of the same sex and age. CAC scoring does not provide direct information on total plaque burden or stenosis severity and can be low or even zero in middle-aged patients with soft non-calcified plaque.Option B is false. Not all patients with diabetes are very high risk by default.·       Moderate risk: well controlled diabetes, 75 years-old and men > 65 years-old are usually at high 10-year CVD risk.·       Only between the ages of 55 – 75 years in women and 40 – 65 years in men does the 10-year CVD risk vary around commonly used thresholds for intervention. Of note:·       In younger, apparently healthy patients, we also discuss lifetime CVD risk estimates since 10-year risk assessments often underestimate risk.

The following question refers to Section 6.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Eugenia Gianos.Dr. Gianos specializes in preventive cardiology, lipidology, cardiovascular imaging, and women's heart disease; she is the director of Women s Heart Health at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #23 An asymptomatic 55-year-old man with no past medical history presents to clinic after having a cardiac CT as part of an executive physical. His coronary artery calcium (CAC) score was 200 and the coronary CTA demonstrated isolated 70% stenosis of the left circumflex coronary artery. He is asymptomatic and able to jog 2 miles daily without limitation. He was recently started on aspirin 81 mg daily and atorvastatin 40 mg daily by his primary care provider. His LDL is 50 mg/dL, HbA1c is 6.0%. His BP is 108/70. What would you recommend?AStop aspirin 81 mg daily as he has not had an ASCVD event or revascularizationBCardiac catheterization and stent placement in the left circumflexCIncrease atorvastatin to 80 mg dailyDStress testENo change in management Answer #23 Answer choicesAStop aspirin 81 mg daily as he has not had an ASCVD event or revascularizationBCardiac catheterization and stent placement in the left circumflexCIncrease atorvastatin to 80 mg dailyDStress testENo change in managementExplanationThe correct answer is E – no change in management.Though the patient has not had an ASCVD event or revascularization, low-dose aspirin may be considered with definite evidence of CAD on imaging (Class IIb, LOE C).He is asymptomatic and does not have high risk anatomy on CT (i.e., proximal LAD, left main disease, multivessel disease), so percutaneous coronary intervention or stress testing are not indicated.His LDL is well controlled, so increasing atorvastatin would not be appropriate at this time.Main TakeawayAspirin 75-100 md daily may be considered in the absence of MI or revascularization when there is definitive evidence of CAD on imaging (Class IIb, LOE C).Guideline Loc.Section 6.1 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

The following question refers to Section 4.6 of the 2021 ESC CV Prevention Guidelines. The question is asked by Student Dr. Shivani Reddy, answered first by Johns Hopkins Cardiology Fellow Dr. Rick Ferraro, and then by expert faculty Dr. Eileen Handberg. Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President for the PCNA. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #22 Mr. HC is a 50-year-old man presenting for a routine clinic visit. He is not sure the last time he had a lipid panel drawn, and would like one today, but ate lunch just prior to your appointment – a delicious plate of 50% fruits and vegetables, 25% lean meats, and 25% whole grains as you had previously recommended. True or False: Mr. HC should return another day to obtain a fasting lipid panel. TRUE FALSE Answer #22 Answer choices TRUE FALSE Explanation  This statement is False. A non-fasting lipid panel is appropriate for risk stratification and lipid evaluation in most patients per the ESC guidelines. While no level of evidence in provided in the ESC guidelines, this recommendation is consistent with AHA/ACC cholesterol guidelines, which have also largely moved away from fasting lipid panels for most patients and give a Class 1 (LOE B) recommendation to obtaining a fasting or nonfasting plasma lipid profile for ASCVD estimation and baseline LDL-C in adults 20 years of age or older. The ESC recommendation is based upon large trials showing that results of fasting and non-fasting panels are largely similar. This is similar to the AHA/ACC guidelines, which note non-fasting and fasting LDL-C change minimal over time following a normal meal, while HDL-C and tryiglycerides appear to have similar prognostic significance with cardiovascular outcomes in fasting or nonfasting states. A fasting lipid panel should be considered in those with hypertriglyceridemia, metabolic syndrome, and diabetes mellitus, as consumption of food or drink can have direct and immediate effects on TG and blood glucose values. Main Takeaway A non-fasting lipid panel is appropriate for the majority of patients undergoing lipid evaluation and cardiovascular risk stratification.  Guideline Loc. Section 4.6.1 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

The following question refers to Section 4.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by medicine resident Dr. Ahmed Ghoneem, and then by expert faculty Dr. Noreen Nazir. Dr. Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #21 Ms. J is a 57-year-old woman with a past medical history of myocardial infarction resulting in ischemic cardiomyopathy, heart failure with reduced ejection fraction, and major depressive disorder who presents today for follow-up. She reports feeling extremely overwhelmed lately due to multiple life stressors. She is on appropriate cardiovascular GDMT agents and is not prescribed any medications for her mood disorder. True or false: in addition to psychotherapy for stress management, it is appropriate to consider Ms. J for anti-depressant SSRI pharmacotherapy at this time to improve cardiovascular outcomes. A True B False Answer #21 Explanation The correct answer is FALSE. An ESC class 3 recommendation states that SSRIs, SNRIs, and tricyclic antidepressants are not recommended in patients with heart failure and major depression; this is based on data suggesting potential lack of SSRI efficacy for reducing depression or cardiovascular events, as well as safety data indicating an association between SSRI use and increased risk of CV events and all-cause as well as cardiovascular mortality among HF patients. Mental health disorders are associated with worse outcomes in patients with ASCVD and appropriate treatment effectively reduces stress symptoms and improves quality of life. Nonpharmacologic modalities of treatment (exercise therapy, psychotherapy, collaborative care) should be considered before pharmacotherapy to improve cardiovascular outcomes in patients with heart failure. Of note, the ESC suggests SSRI treatment be considered for patients with coronary heart disease (without HF) and moderate-to-severe major depression based on data that SSRI treatment is associated with lower rates of CHD readmission (RR 0.63), all-cause mortality (RR 0.56), and the composite endpoint of all-cause mortality/MI/PCI (HR 0.69) vs. no treatment. This is a class 2a recommendation. ESC also gives a class 2a recommendation to consider referral to psychotherapeutic stress management for individuals with stress and ASCVD to improve CV outcomes and reduce stress symptoms. The ACC/AHA guidelines do not provide focused recommendations regarding mental health considerations in patients with elevated cardiovascular risk. Main Takeaway It is important to consider mental health treatment in patients with ASCVD as mental disorders are associated with increased CVD risk and poor patient prognosis, and data support that mental health interventions can improve overall and CVD outcomes, as well as improve quality of life. Guideline Loc. Section 4.4 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

“We're clearly over-nourished, under-muscled, under-slept, and overstressed. All of those things dramatically impact our state of health," says Peter Attia, M.D. Peter, a Stanford, John Hopkins, and NIH-trained physician, joins us to discuss how we can actually eradicate cardiovascular disease, plus: - Peter's personal connection to healthspan & heart health (~00:58) - The four horsemen that lead to death (~03:25) - What's driving chronic disease? (~06:37) - What is ApoB & why is it important? (~11:26) - Does exercise play a role in lowering ApoB? (~17:37) - How pharmaceuticals can lower ApoB (~18:35) - Why aren't we talking about these heart disease treatments? (~22:36) - The best lab tests to measure cardiovascular health (~31:39) - The best lifestyle modifications for heart health (~36:36) - Labs you should demand at the doctor (~39:01) - Peter's personal nutrition philosophy (~43:34) - How to eat more protein every day (~46:48) - Why exercise is the ultimate elixir (~53:09) - What we still don't know about cardiovascular health (~01:00:52) - The power of grip strength for longevity (~01:03:24) - How Peter views the future of well-being (~01:06:10) Order a copy of my new book The Joy Of Well-Being at thejoyofwellbeing.com!  Referenced in the episode: - Peter's book, Outlive. - Peter's podcast, The Drive. - Research on PCSK9 inhibitors, Ezetimibe, and Bempedoic Acid. - National Lipid Association member finder. - SPRINT trial on blood pressure. - STOP-Bang questionnaire. - A study on exercise & mortality risk. - mbg Podcast episode #466, with Don Layman, Ph.D. - Maui Nui Venison Snacks & UCAN granola. - Sign up for The Long Game.  We hope you enjoy this episode, and feel free to watch the full video on YouTube! Whether it's an article or podcast, we want to know what we can do to help here at mindbodygreen. Let us know at: podcast@mindbodygreen.com.

The following question refers to Section 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Adriana Mares, answered first by Brigham & Women's medicine intern & Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Michael Wesley Milks. Dr. Milks is a staff cardiologist and assistant professor of clinical medicine at the Ohio State University Wexner Medical Center where he serves as the Director of Cardiac Rehabilitation and an associate program director of the cardiovascular fellowship. He specializes in preventive cardiology and is a member of the American College of Cardiology's Cardiovascular Disease Prevention Leadership Council. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #20 Ms. Ruma Toid is a 65-year-old African American woman who presents to your clinic in Ohio for routine follow up. She has a history of rheumatoid arthritis, hypertension, obesity, and sleep apnea. Her medications include methotrexate and atenolol. Her blood pressure in the office is 120/80 mmHg, heart rate 68 bpm, and oxygen saturation 99% on room air. Recent lipid testing revealed total cholesterol 165 mg/dL, HDL 42 mg/dL, and LDL 118 mg/dL. She was recently advised to talk to her doctor about taking a statin due to her risk factors but in the past has heard negative things about those medications and would like your advice on next steps. Her calculated ASCVD risk score based on the Pooled Cohort Equation is 7%. Which of the following choices would be the next step?AShe is at borderline risk for ASCVD events. A statin is not indicated at this time.BDue to her history of rheumatoid arthritis, her calculated ASCVD risk should be multiplied by 1.5, yielding an ASCVD risk of 10.5% placing her in the intermediate risk category. Moderate intensity statin would be indicated.CWhen other risk factors are present, rheumatoid arthritis is no longer an enhancing risk factor.DStatins are contraindicated when taking methotrexate. Answer #20 ExplanationThe correct answer is B. Due to her history of rheumatoid arthritis, her calculated ASCVD risk should be multiplied by 1.5, yielding an ASCVD risk of 10.5% placing her in the intermediate risk category. Moderate intensity statin would be indicated. Due to her history of rheumatoid arthritis, her calculated ASCVD risk should be multiplied by 1.5, yielding an ASCVD risk of 10.5% placing her in the intermediate risk category. Moderate intensity statin would be indicated. The ESC gives a Class IIa (LOE B) indication to multiply the calculated total CVD risk by a factor of 1.5 in adults with rheumatoid arthritis due to the observed 50% increased CVD risk in patients with rheumatoid arthritis. This 50% increase in CVD risk attributed to RA is present beyond traditional risk factors, making answer choice C wrong. Answer A is incorrect because when borderline risk is calculated, one should still look for risk enhancers that could potentially increase ASCVD risk before final determination of statin indication. Answer choice D is false as there is no contraindication to take both methotrexate and statins together. Note that it is appropriate to use the pool cohort equations and American risk thresholds for this patient since she is in America where the PCE was validated (versus using SCORE2 risk model which would be more appropriate for European populations).Main TakeawayInflammatory conditions including rheumatoid arthritis and inflammatory bowel disease increase a person's risk for ASCVD events. Specifically for rheumatoid arthritis, there is a Class IIa indication to multiply the calculated risk score by 1.5 to account for rheumatoid arthritis as a risk enhancer.

The following question refers to Section 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern, student Dr. Hirsh Elhence, answered first by Ohio State University Cardiology Fellow Dr. Alli Bigeh, and then by expert faculty Dr. Eugene Yang. Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and current chair of the ACC Prevention of CVD Section.  The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #19 True or False: A 70-year-old male has an estimated 10-year ASCVD risk (using SCORE2-OP) of 7.5% which confers a very high CVD risk and necessitates treatment with a statin.  TRUE  FALSE  Answer #19 Explanation   FALSE – CVD risk thresholds for risk factor treatment are higher in apparently healthy people 70 years and older in order to prevent overtreatment in the elderly. A 10-year CVD risk ≥15% is considered “very high risk” for individuals ≥70 years of age (compared to a ≥7.5% cut-off for “very high risk” in younger patients 70 years of age, a 10-year CVD risk of 7.5 to 70 years of age, a 10-year CVD risk of

Welcome to the NACE Journal Club, where each month we discuss some of the most important recent articles to come out in the medical literature.  This month Dr. Skolnik and guests will be discussing:Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients The New England Journal of Medicine March 4, 2023Dr. James Underberg who is a Clinical Assistant Professor of Medicinein the Division of General Internal Medicine at NYU Medical School, a boardcertified lipidologist and a Past president of the National Lipid Association. Non-occupational physical activity and risk of cardiovascular disease, cancer, and mortality outcomes: a dose–response meta-analysis of large prospective studies - British Journal of Sports MedicineDr. Bill Callahan who is a Associate Director in the family medicineresidency program at Jefferson Health – Abington.Lecanemab in Early Alzheimer's Disease - New England Journal of MedicineDr. Meera Shah who is an Associate Director in the family medicine residency program at Jefferson Health – Abington and director of the geriatric curriculumTwo-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort studyDr. Byce Eng who is a second year resident in the family medicine residency program at Jefferson Health – Abington.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

A recent meta-analysis (Bytyçi 2022) determined that the prevalence of statin intolerance is around 9%. Given the high rate of statin discontinuation in this group, intolerance should be identified and addressed to better support those who require lipid-lowering to reduce their cardiovascular risk.   Today's podcast will touch on this recent meta-analysis before focusing on the National Lipid Association's new scientific statement on statin intolerance outlining key considerations and practical tips to systematically approach your suspected intolerant patients.    References discussed in this episode: Bytyçi, I. et al. Prevalence of statin intolerance: a meta-analysis. Eur Heart J (2022) doi:10.1093/eurheartj/ehac015 Cheeley, M. K. et al. NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient. J Clin Lipidol 16, 361–375 Jacobson, T. A. et al. The STatin Adverse Treatment Experience Survey: Experience of patients reporting side effects of statin therapy. J Clin Lipidol 13, 415–424 (2019)  

Co-Host's Gerardo and Barbara discuss the benefits of eating a Healthy Latino Diet. So many of our cultural foods in the Latino Diet are really good for you, here is the advice from the National Lipid Association:Eat Lots of VegetablesEat Plant-Based or Lean ProteinChoose Healthy FatsChoose Fiber-Rich Whole Grains and TubersChoose a Variety of FruitsEat Low-Fat Dairy FoodsUse Spices for Flavor Instead of Salt 

CardioNerds Tommy Das (Program Director of the CardioNerds Academy and cardiology fellow at Cleveland Clinic), Rick Ferraro (cardiology fellow at the Johns Hopkins Hospital), and Dr. Aliza Hussain (cardiology fellow at Baylor College Medicine) take a deep dive on the REDUCE-IT trial with Dr. Peter Toth, director of preventive cardiology at the CGH medical center in Sterling, Illinois, clinical professor in family and community medicine at the University of Illinois School of Medicine, and past president of the National Lipid Association and the American Board of Clinical Lipidology.  Special introduction to CardioNerds Clinical Trialist Dr. Jeff Wang (Emory University). Audio editing by CardioNerds academy intern, Shivani Reddy. This episode is part of the CardioNerds Lipids Series which is a comprehensive series lead by co-chairs Dr. Rick Ferraro and Dr. Tommy Das and is developed in collaboration with the American Society For Preventive Cardiology (ASPC). Relevant disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardiovascular Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - REDUCE-IT The Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) trial was a large randomized controlled trial that showed a significant reduction in atherosclerotic cardiovascular disease (ASCVD) events with use of icosapent ethyl ester in secondary prevention patients and high risk primary prevention patients with diabetes and residual elevated triglycerides between 135 to 499 mg/dL on top of maximally tolerated statin therapy1. Despite the use of high intensity statin therapy, considerable residual risk for future atherosclerotic cardiovascular disease exists in patients with ASCVD.Elevated triglycerides (TGs) are an important marker of increased residual ASCVD risk2.There are two primary types of Omega-3 fish oils: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omege-3 fish oils have been shown to lower triglyceride levels.Low-dose combination EPA and DHA has not exhibited incremental cardiovascular benefit in either primary prevention and secondary prevention patients on top of statin therapy3-5.REDUCE-IT showed the use of high dose EPA in patients with either ASCVD or DM and one additional risk factor, and relatively well-controlled LDL-C levels on maximally tolerated statin therapy and residual hypertriglyceridemia (TG 135-499 mg/dL) results in significant reductions in cardiovascular events over a median follow-up period of 4.9 years1. Show notes - REDUCE-IT Multiple epidemiologic and Mendelian randomization studies have established elevated triglyceride (TG) levels as an important risk factor for atherosclerotic cardiovascular events6-8. However previous clinical trials using TG-lowering medication such as niacin, fibrates and low dose omega-3 fish oil have not shown to reduce cardiovascular events when added to statin therapy in patients with or without ASCVD,9,10.The JELIS trial first demonstrated a significant reduction in cardiovascular events when 1.8g daily of eicosapentaenoic acid (EPA) was added to low-intensity statin therapy in patients with ASCVD and hypercholesterolemia, However, the trial was limited due to open label design without placebo, use of low doses of background statin therapy, and geographic/demographic limitations to participants in Japan11.In a large international multicenter randomized controlled trial, the Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) randomized 8,179 patients with established atherosclerotic heart disease or diabetes and an additional risk factor, on maximally tolerated statin therapy, to 4 gm/day of icosapent ethyl (a highly purified and stable EPA ethyl ester) or miner...

The following question refers to Section 6.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSD cardiology fellow Dr. Harpreet Bhatia, and then by expert faculty Dr. Eugenia Gianos.Dr. Gianos specializes in preventive cardiology, lipidology, cardiovascular imaging, and women's heart disease; she is the director of the Women's Heart Program at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #10 Ms. DW is a 67-year-old woman with a history of coronary artery disease and prior percutaneous coronary intervention in 2019 with a drug-eluting stent to the proximal left anterior descending artery. They have transitioned to your clinic from a previous provider, and their LDL is 134 mg/dL. What would be the ESC recommended goal LDL-C level for this patient? A.

The following question refers to Section 4.6 of the  2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Shivani Reddy, answered first by NP Carol Patrick, and then by expert faculty Dr. Eileen Handberg. Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President Elect for the PCNA. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #10 Ms. DW is a 67-year-old woman with a history of coronary artery disease and prior percutaneous coronary intervention in 2019 with a drug-eluting stent to the proximal left anterior descending artery. They have transitioned to your clinic from a previous provider, and their LDL is 134 mg/dL. What would be the ESC recommended goal LDL-C level for this patient?  A.

The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by pharmacy resident Dr. Anushka Tandon, and then by expert faculty Dr. Noreen Nazir. Dr. Noreen Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #9 Mr. A is a 28-year-old man who works as an accountant in what he describes as a “desk job” setting. He shares that life got “a little off-track” for him in 2020 between the COVID-19 pandemic and a knee injury. His 2022 New Years' resolution is to improve his overall cardiovascular and physical health. He has hypertension and a family history of premature ASCVD in his father, who died of a heart attack at age 50. Prior to his knee injury, he went to the gym 3 days a week for 1 hour at a time, split between running on the treadmill and weightlifting. He has not returned to the gym since his injury and has been largely sedentary, although he is trying to incorporate a 20-minute daily walk into his routine. Which of the following exercise-related recommendations is most appropriate? A. A target of 75-150 minutes of vigorous-intensity or 150-300 minutes of moderate-intensity aerobic physical exercise weekly is recommended to reduce all-cause mortality, CV mortality, and morbidity. B. Bouts of exercise less than 30 minutes are not associated with favorable health outcomes. C. Exercise efforts should be focused on aerobic activity, since only this type of activity is associated with mortality and morbidity benefits. D. Light-intensity aerobic activity like walking is expected to have limited health benefits for persons with predominantly sedentary behavior at baseline. Answer #9 The correct answer is A. There is an inverse relationship between moderate-to-vigorous physical activity and CV morbidity/mortality, all-cause mortality, and incidence of type 2 diabetes, with additional benefits accrued for exercise beyond the minimum suggested levels. The recommendation to “strive for at least 150-300 min/week of moderate-intensity, or 75-150 min/week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof” is a Class 1 recommendation per the 2021 ESC guidelines, and a very similar recommendation (at least 75 minutes of vigorous-intensity or 150 minutes of moderate-intensity activity) is also Class 1 recommendation per 2019 ACC/AHA primary prevention guidelines. Both the ESC and ACC/AHA provide examples of activities grouped by absolute intensity (the amount of energy expended per minute of activity), but the ESC guidelines also offer suggestions for measuring the relative intensity of an activity (maximum/peak associated effort) in Table 7, which allows for a more individualized, customizable approach to setting activity goals. Importantly, individuals who are unable to meet minimum weekly activity recommendations should still be encouraged to stay as active as their abilities and health conditions allow to optimize cardiovascular and overall health. Choice B is incorrect, as data suggests physical activity episodes of any duration, including

This question refers to Sections 3.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern, student Dr. Hirsh Elhence, answered first by internal medicine resident at Beaumont Hospital and soon to be Mayo Clinic cardiology fellow and Dr. Teodora Donisan and then by expert faculty Dr. Eugene Yang. Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and current chair of the ACC Prevention of CVD Section. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #8 Please read the following patient vignettes and choose the FALSE statement. A. A 39-year-old man who comes for a regular physical, has normal vitals and weight, denies any significant past medical or family history – does not need systematic cardiovascular disease (CVD) assessment. B. A 39-year-old woman who comes for a regular physical, has normal vitals and weight, and has a history of radical hysterectomy (no other significant past medical or family history) – could benefit from systematic or opportunistic CVD assessment. C. A 39-year-old woman who comes for a regular physical, has normal vitals except for a BMI of 27 kg/m2 and a family history of hypertension – requires a systematic global CVD assessment. D. A 39-year-old man who comes for a regular physical, has normal vitals and weight, and has a personal history of type I diabetes – requires a systematic global CVD assessment. Answer #8 Option A is an accurate statement, as systematic CVD risk assessment is not recommended in men < 40 years-old and women < 50 years-old, if they have no known cardiovascular (CV) risk factors. (Class III, level C) Option B is an accurate statement, as this patient had a radical hysterectomy, which means the ovaries have been removed as well and she is considered postmenopausal. Systematic or opportunistic CV risk assessment can be considered in men > 40 years-old and women > 50 years-old or postmenopausal, even in the absence of known ASCVD risk factors. (Class IIb, level C) Option C is a false statement and thus the correct answer, as the recommendations for global screening in this patient are not as strong and would require shared decision making. Opportunistic screening of blood pressure can be considered in her, as she is at risk for developing hypertension. Blood pressure screening should be considered in adults at risk for the development of hypertension, such as those who are overweight or with a known family history of hypertension. (Class IIa, level B) Option D is an accurate statement, as systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor (i.e., family history of premature CVD, familial hyperlipidemia, CVD risk factors such as smoking, arterial hypertension, DM, raised lipid level, obesity, or comorbidities increasing CVD risk). (Class I, level C) Additional learning points: Do you know the difference between opportunistic and systematic CVD screening? Opportunistic screening refers to screening without a predefined strategy when the patient presents for different reasons. This is an effective and recommended way to screen for ASCVD risk factors, although it is unclear if it leads to benefits in clinical outcomes. Systematic screening can be done following a clear strategy formally evaluating either the general population or targeted subpopulations (i.e., type 2 diabetics or patients with significant family history of CVD). Systematic screening results in improvements in risk factors but has no proven effect on CVD outcomes. Main Takeaway

The following question refers to Section 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Adriana Mares, answered first by early career preventive cardiologist Dr. Dipika Gopal, and then by expert faculty Dr. Michael Wesley Milks. Dr. Milks is a staff cardiologist and assistant professor of clinical medicine at the Ohio State University Wexner Medical Center where he serves as the Director of Cardiac Rehabilitation and an associate program director of the cardiovascular fellowship. He specializes in preventive cardiology and is a member of the American College of Cardiology's Cardiovascular Disease Prevention Leadership Council. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #7 While you are on holiday break visiting your family, your aunt pulls you aside during the family gathering to ask a few questions about your 70-year-old uncle. He has hypertension, hyperlipidemia, type 2 diabetes mellitus, and moderate chronic obstructive pulmonary disease. His medications include Fluticasone/Salmeterol, Tiotropium, Albuterol, Lisinopril, Simvastatin, and Metformin. She is very concerned about his risk for heart disease as he has never had his “heart checked out.” She asks if the presence of COPD increases his chance of having heart disease. Which of the following statements would best answer her question? A. Systemic inflammation and oxidative stress caused by COPD promote vascular remodeling and a paradoxical ‘anticoagulant' state affecting all vasculature types. B. Although chronic COPD is associated with increased cardiovascular events, individual exacerbations have no impact on risk of cardiovascular events. C. Patients with mild-moderate COPD are 8-10x more likely to die from atherosclerotic cardiovascular disease than respiratory failure. D. Cardiovascular mortality increases proportionally with an increase in forced expiratory volume in 1 second (FEV1) Answer #7 The correct answer is C. Patients with mild-moderate COPD are 8-10x more likely to die from atherosclerotic cardiovascular disease than respiratory failure. Patients with COPD have a 2-3-fold increased risk of CV events compared to age-matched controls even when adjusted for tobacco smoking, a shared risk factor. This can be partly explained by other common risk factors including aging, hypertension, hyperlipidemia, and low physical activity. Interestingly, CVD mortality increases proportionally with a decrease (rather than increase) in FEV1, making answer choice D wrong (28% increase CVD mortality for every 10% decrease in FEV1). Additionally, COPD exacerbations and related infections are associated with a 4x increase in CVD events, making answer choice B incorrect. COPD has several effects on the vasculature which creates a ‘procoagulant' not ‘anticoagulant' effect on all vascular beds. This is associated with increased risk of cognitive impairment due to cerebral microvascular damage as well as increased risk of ischemic and hemorrhagic stroke. Main Takeaway The presence of COPD (even mild to moderate) has a significant impact on the incidence of non-fatal coronary events, stroke, and cardiovascular mortality mediated by inherent disease process and progression, risk factors (smoking, aging, hypertension, and hyperlipidemia), and systemic inflammation altering vasculature creating a ‘procoagulant' effect. The ESC gives a Class I indication (LOE C) to investigate for ASCVD and ASCVD risk factors in patients with COPD. Guideline Location 3.4.5, Page 3264. CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

In this episode, host Dr Laurence Sperling speaks with Katherine Wilemon, founder of the FH Foundation. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/958283). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals. Resources The Agenda for Familial Hypercholesterolemia: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/10.1161/CIR.0000000000000297?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Familial Hypercholesterolemia Foundation https://thefhfoundation.org/ Cascade Registry https://thefhfoundation.org/fh-research/registry Finding missed cases of familial hypercholesterolemia in health systems using machine learning https://www.nature.com/articles/s41746-019-0101-5 Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2020/08/27/13/28/genetic-testing-in-dyslipidemia Genetic Testing for Managing Dyslipidemia https://www.acc.org/Latest-in-Cardiology/Articles/2020/11/13/20/26/Genetic-Testing-for-Managing-Dyslipidemia

After graduating from Boston University School of Medicine, Dr. Harkin attended Columbia University for Internal Medicine residency and New York University for Cardiology fellowship. ⁣⁣Upon completion of her Cardiology fellowship, including serving as a chief fellow, she remained on at NYU as an Assistant Attending. In her role as a private practice cardiologist in Manhattan, she helped countless patients treat and prevent heart disease. ⁣⁣She is a fellow of the American College of Cardiology (FACC Cardiology), as well as a member of the National Lipid Association certifying her as a cholesterol specialist doctor and American Society for Preventive Cardiology.⁣⁣Dr. Harkin recently moved to San Francisco with her family and founded Whole Heart Cardiology, with the mission of providing patient centered cardiac care, evidence-based nutritional guidance, and personalized lifestyle plans for her patients in a modern setting. She takes pride in helping patients achieve their goals, feel better, and THRIVE!

Listen Now Preventing adult heart attacks in early childhood? Don Wilson, M.D., explains why it's absolutely within REACH. Children with high cholesterol, especially those who have a genetic cause, such as familial hypercholesterolemia, also know as fH, are at a higher risk for developing premature heart disease, such as heart attack or stroke as they become adults. At the forefront of developing guidelines for lowering this risk, Dr. Wilson details how the Risk Evaluation to Achieve Cardiovascular Heath, or REACH, clinic at Cook Children's is putting those guidelines to work and changing the outcomes for these in the future, and saving the lives of parents today. Meet the speaker Dr. Don Wilson Related InformationRisk Evaluation to Achieve Cardiovascular Health (REACH) Clinic Diabetes Program Endocrinology Program They're Active, Eat Healthy, and Have High Cholesterol-Why? Harper's Story Kids at Risk of Smoke Exposure in Smoke-Free Areas? A Simple Blood Test Could Save Your Child's Life The Unique Risks of Being a Woman with Diabetes Number of Children and Adolescents Who are Obese 10 Times Higher than 40 Years Ago Transcript: 00:00:03 Host: Hello, and welcome to Cook Children's Doc Talk. Today we're talking with Dr. Don Wilson about genetic dyslipidemia, and cardiovascular disease. But first, here's just a little about Dr. Wilson. He is board certified in pediatrics, pediatric endocrinology and clinical lipidology. He is the founder and currently the medical director of Cook Children's REACH program, one of the first cardiovascular risk assessment clinics for children and adolescents in the nation. Dr. Wilson is a fellow of the National Lipid Association and an associate editor for The Journal of Clinical Lipidology and a member of the

On this episode, Dr. Tom Dayspring and Faraz Khan discuss the basics of lipids that you need to know about: 1. What are lipids and lipoproteins? 2. Why is cholesterol very good for you - and very bad for you - but here is how to know which one you have? 3. How to review your lipid numbers after your next blood test - plus 1-2 secret tests you MUST start getting from now on. Get the full show notes here: https://antiaginghacks.net/podcast/lipids-cholesterol-apob-hdl-ldl/ Thomas Dayspring is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. After practicing in NJ for almost 40 years, he moved to VA and served as an educational director for a nonprofit cardiovascular foundation and later as a Chief Academic Advisor for two major Cardiovascular labs until mid-2019. Currently he is a cardiovascular educational research assistant & clinical lipidologist at Attia Medical. Career-wise he has given over 4000 domestic and international lectures, including over 600 CME programs. Until 2019 he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association's Presidents Award for services to clinical lipidology. He is very active on twitter and has well over 15K followers (@DrLipid)

Dr. Eugenia Gianos is the director of Women s Heart Health at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health. As a clinical cardiologist with expertise in preventive cardiology, lipidology, imaging, and women s heart disease, she sees patients with various cardiovascular diseases. She has a specific interest in those with a genetic predisposition or heart disease at a young age, lipid disorders, complex coronary disease, and uncontrolled risk factors for heart disease. After earning an undergraduate degree in psychiatry from Barnard College at Columbia, Dr. Gianos earned her medical degree from New York Medical College. She completed her internship and residency in internal medicine and her fellowship in cardiology at Northwell s Long Island Jewish Medical Center. Dr. Gianos holds board certification in internal medicine, cardiovascular disease, echocardiography, and nuclear cardiology and she is certified in lipidology through the National Lipid Association. We cover a range of different topics relating to heart health and in particular, how women can lower their risks of heart disease. If you or someone you know has suffered from heart disease, this is the episode for you. You can find Dr. Gianos on: Instagram @dochearthealth Twitter @EugeniaGianos

In this episode, OMA Chief Science Officer, Harold Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC interviews Sarah Hallberg, DO, MS, ACSM-CEP, FOMA, FNLA, to discuss a recent report from the National Lipid Association about managing body weight with the ketogenic diet. Topics covered include: updates in the data related to the impact of the ketogenic diet on LDL cholesterol, what factors can lead to cholesterol absorption in the intestines, and when to recommend evaluation for beta-Sitosterolemia and treat with ezetimibe. In our article review podcasts, we have carefully selected recent articles included in the latest version of the Obesity Medicine Association (OMA) Obesity Algorithm, which is a comprehensive review of obesity medicine that can be found at obesitymedicine.org. We then discuss this new science with obesity experts. Episode Guests Harold Bays, MD, FOMA, FTOS, FACC, FNLA, FASPC Sarah Hallberg, DO, MS, ACSM-CEP, FOMA, FNLA Resources Mentioned Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force

Janet is Program Manager and lead dietitian of the Heart Health program. She holds a certificate in training in Childhood and Adolescent Weight Management (in addition to adult) and is a Fellow of the National Lipid Association (clinical lipidology). Janet has been a practicing dietitian for nearly 20 years, with 14 of those in her current role. She completed her master’s in science degree and dietetic internship at Boston University and has enjoyed working with families on healthy habits ever since. Featured on Episode 14 is Jermel's good friend, Janet Carter. Jermel met Janet on a CCSD/MUSC/DAE collaboration called Options a couple years ago. Janet and Jermel remained friends after the project. She also participated in our nutrition segment for DAE TV! For DAE TV, Janet’s main focus was to educate student-athletes about proper foods to eat pre and post workouts, certain diets to consider to gain and/or lose weight, tactics to gain muscle, and foods not to eat if you are sick or injured during that time period. In my conversations with athletes and coaches everyone stresses the importance of DIET, NUTRITION and SLEEPING. Sometimes, we see kids eating McDonalds, Skittles and drinking sodas pre and post games. Athletes should be more intentional about health as well as talent. Your talent needs you to be healthy so it can perform! The DAE Foundation message is to bring quality information to STUDENT-ATHLETES, PARENTS of student athletes and THE COMMUNITY that supports them both. There is a wealth of knowledge being shared in our interviews, the stories are from former COLLEGIATE PLAYERS, PROFESSIONAL PLAYERS, COLLEGIATE COACHES, SPORT AGENTS and this list goes on…

Los exámenes moleculares pueden reducir las cirugías innecesarias de tiroides en un 50% o mas Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U que se unió a Palm Beach Diabetes y Endocrine Specialists desde en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de  la Escuela de Medicina de   la Universidad de Zulia, en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami. Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami. Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos. Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association. En esta entrevista hablamos sobre esta temas: ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico La mayoría de los nódulos son benigno, estos se pueden presentar hasta en más del 70% de la población ¿Qué tests puede realizar un médico para evaluar el nódulo? Ningún test es 100% seguro Ultrasonido – qué están buscando en general Que es aguja  fina y el proceso general de la biopsia Tests moleculares ¿Qué tipos de resultados se pueden obtener de la citología y qué significan? La mayoria de ojo finas son benigno Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer Los arco iris – 3,4,5 – indeterminate categoria Systema BETHESDA ¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? – Tests moleculares Que son todas los tests moleculares?  Y son las mismas? Dr. Casanova prefiere usar test de Afirma, este es por que MAS INFORMACIÓN Listen to Doctor Thyroid here!American Thyroid Association (español)Dr. Paul CasanovaAfirmaLa prueba de la expresión génica de Afirma puede reducir cirugías innecesarias del cáncer de tiroides Ninguna Biopsia es 100% Exacta, Los Marcadores Moleculares Son Los Mejores   Dr. Casanova:  ...Utilicemos, precisamente, marcadores moleculares, para definir y clarificar qué personas, definitivamente, se benefician de ir a cirugía y cuáles son aquellas que, basado en el resultado molecular, pueden permanecer sin cirugía y con observación a través del ultrasonido.   ...En Colombia, México, Brasil y en Chile lo están realizando; también el test puede solicitarse para poder ser realizado en cualquier momento. Hay compañías que ya tienen la licencia para enviar el paquete que se requiere para tomar la muestra por el patólogo que lo está realizando en cada uno de los paises de Latinoamerica.   ...Si, en la mayoría de estos nódulos indeterminados, sobretodo de las categorías III y IV, es posible que hasta un 60 % de los pacientes no tenga cáncer y vayan a una cirugía innecesaria. La cirugía innecesaria no solamente implica el hecho de retirar un órgano tan noble como el tiroides (que tiene una función única y es particularmente difícil, inclusive para los endocrinólogos una vez que la persona va a cirugía, manejarlo), sino que también tiene que tomar en cuenta que una persona que va a cirugía se expone a otros riesgos: el tiroides es uno de los órganos que tiene además, en la parte posterior, otras glándulas como las paratiroides que controlan el calcio; está cerca de nervios que, básicamente, comprometen la voz del paciente. Es una cirugía; dependiendo de la edad del paciente, los riesgos de cirugía pueden ser menos o más altos...   ...En el futuro estos análisis moleculares van a cambiar totalmente la manera en que nosotros vamos a clasificar, finalmente, los nódulos. Estos análisis moleculares están avanzando a pasos gigantes. Esperamos, además, que va a ser un beneficio para clarificar el diagnóstico de los pacientes que, a futuro, también nos guíe acerca de cómo tratar, si se da la situación a las personas con cáncer, de una manera más adecuada...   Philip James, presentador: Hoy estamos con el Doctor Paul Casanova. El hizo sus estudios en la Universidad de Miami y también en Venezuela. El está trabajando en el Palm Beach Diabetes and Endocrine Specialist y es un miembro de la American Thyroid Association.    Doctor Casanova, Bienvenido.    Dr. Casanova:  Muchas gracias, Philip, por la invitación.Y a todos aquellos que te escuchan: hoy, precisamente, vamos a hablar un poco más alrededor del tema de la evaluación de nódulos tiroideos. Ha sido un viaje a través del tiempo y a través de los últimos años; ahora tenemos mucho más que compartir con las personas que te escuchan. Philip James, presentador: Si, el tema de hoy es: Nódulos Indeterminados. Hablaremos más sobre este tema.   Pero, acerca de su experiencia valorando los nódulos, lo cual ha hecho por muchos años... Por favor ¿puede compartir algo de su experiencia anterior?   Dr. Casanova: Si, mi experiencia ha comenzado hace más de, aproximadamente, siete años (en el 2010). Tuve la oportunidad de tomar los primeros tests, que fueron utilizados, precisamente, para el diagnóstico de nódulos indeterminados y malignos, que fueron, en aquel momento, presentados por la Universidad de Pittsburgh, por el Doctor Yuri Nikiforov. Esos tests (que no estaban disponibles para el público) nos permitieron entrar en conocimiento de una de las mutaciones más frecuentes que se ven en nódulos malignos y tratar de probar si eso tenía cierta utilidad para los pacientes en términos de asegurar el diagnóstico o darle alguna explicación adicional a los cirujanos. Más adelante, otra serie de tests moleculares han salido en los últimos 7 años y estos tests moleculares han sido, básicamente, probados a través de diferentes estudios. Y eso es lo que he utilizado a través de estos últimos años y he visto los resultados a través [de ello], y el beneficio para mis pacientes, particularmente aquellos que tienen un diagnóstico de nódulos indeterminados.   Philip James, presentador:  Entonces, en el tema de nódulos, ¿cuántas personas en el mundo tienen un nódulo de tiroides?   Dr. Casanova: Eso es un elemento variable en cada población. En términos generales, aquí en los Estados Unidos por ejemplo, podría decirse que después de la edad de 40 años, más del 50 % de las mujeres pueden tener nódulos tiroideos; es, de hecho, el tumor endocrino más común que tenemos presente en la actualidad. Pero el hecho de ser común no quiere decir que todo nódulo tiroideo es maligno; de hecho, la gran mayoría de estos nódulos son de naturaleza benigna.    En términos generales podemos decir que, en Los Estados Unidos, unos 450 mil casos de biopsia de tiroides se han hecho en los últimos años y, a pesar de esa cantidad de biopsias, la gran mayoría de ellas no tiene ningún tipo de malignidad; es por ello que ahora hay un énfasis en tratar de mejorar cada uno de los recursos que tenemos para evitar, precisamente, que personas vayan a cirugía, y tratar de no hacer un exceso de cirugías innecesarias en esta población.   Philip James, presentador: Y para aquellos que están escuchando esta entrevista y posiblemente están pensando: “¿Cómo sabemos si tenemos un nódulo de tiroides?” Dr. Casanova: Si. En términos generales, la primera observación que tiene la persona es ir al médico. Estos nódulos de tiroides, aun cuando es una minoría, pueden ser detectados por su médico. Nódulos de más de 2.5 cm pueden ser palpables a través del examen físico del cuello; el examen físico del cuello, si usted lo solicita, su médico general, su ginecólogo puede realizarlo.    Aun cuando esta es una de las formas de poder diagnosticar nódulos, la mayoría de los nódulos que nosotros vemos son diagnosticados porque la persona va a estudios diferentes. Por ejemplo: la persona va y se va a hacer un ultrasonido de las arterias carótidas y alguien le dicen: “Mira, tienes algo en el tiroides”; la persona va a hacerse un estudio del pecho y le dicen: “tienes algo en el tiroides”. Y eso es algo también muy común; la mayoría de los nódulos tiroideos no son diagnosticados necesariamente por palpación, solo aquellos que son grandes y están superficiales.    Los nódulos tiroideos en algunas ocasiones, si hay síntomas (si la persona tiene problemas para tragar; la persona tiene de pronto problemas para respirar; o en algunas ocasiones, con historia familiar en el pasado de que los padres o sus hermanos tienen nódulos; o la persona tienen historial de cáncer de tiroides; o fue expuesto a radiación), lo óptimo sería que la persona solicitara al menos hacerse un ultrasonido del cuello que incluya el tiroides.   Philip James, presentador: Doctor Casanova, entonces si un paciente tiene un nódulo de tiroides, ¿hay algún examen en particular para saber con certeza si es cáncer o no?   Dr. Casanova: Una vez que la persona se hace el ultrasonido y se ha hecho una evaluación propia de la historia del paciente, el ultrasonido como tal no es, completamente, una herramienta para nosotros decirle al paciente si tiene o no tiene algo maligno. El ultrasonido nos guía para, precisamente, seleccionar qué casos requieren, lo que es el tema de tu pregunta y es, hacer una biopsia de aguja fina dirigida por ultrasonido para obtener una muestra de citopatología. El diagnóstico de malignidad requiere, y está basado en, la obtención de material dentro de los nódulos que son sospechosos, y ser analizados entonces por un patólogo [el cual] nos indica si existe la certeza de si es malignidad, o no.   Philip James, presentador: Pero, ¿podemos saber, con cierto porcentaje de certeza, si es cáncer?   Dr. Casanova:  No. Lastimosamente ningún test, ni siquiera la citopatología, es 100% seguro; uno obtiene a través de la citopatología, un análisis a través de, aproximadamente, 6 tipos de diagnóstico. Los diagnósticos que podemos obtener a través de la muestra citopatologica, inclusive cuando es benigno, pudiera todavía tener un porcentaje mínimo de un 6 a un 7% de malignidad. Y esto es importante que la gente lo entienda porque muchas veces, a pesar de que recibe diagnóstico de benignidad, después de una biopsia de tiroides todavía requiere que el nódulo sea observado a través del tiempo para ver si se comporta como debe hacerlo un nódulo benigno. Si ese nódulo se comporta de una manera diferente, entonces requiere otra vez evaluacion.   Pero, en términos generales, es lo mejor que tenemos en este momento: la citopatología sigue siendo el estándar para diagnostico, y ahora estamos agregando, precisamente, el análisis molecular, que va a incrementar nuestra certeza y la información que le vamos a dar, entonces, a los pacientes. Philip James, presentador:  En ocasiones anteriores, usted ha hablado sobre un arcoiris o “rainbow”, sobre qué ocurre después de este examen, ¿puede compartir más detalles sobre eso? Dr. Casanova:  Exacto. En la actualidad, desde 1909, los patólogos han llegado a un acuerdo para tener un lenguaje común, y ese lenguaje común lo podemos, precisamente, tomar como referencia a un arco iris de diagnósticos que van en 6 diferentes categorías:  la categoría número I es que de la persona, por razones diversas, no se obtuvo suficiente material y no hay un diagnóstico preciso; no existe el suficiente grupo de células para definir si es algo bueno o algo malo; las categorías que van del II al VI son precisamente ese arcoiris: la categoría 2 es la categoría buena, benigna; la categoría 6 es la categoría maligna. Ello nos da una definición para tomar decisiones quirúrgicas.   Sin embargo, debido a las categorías particulares del tiroides, hay otras tres características entre la buena y la mala (entre la benigna y la maligna) con las que, básicamente, el citopatólogo o la persona que está leyendo la lámina o la muestra de la biopsia de tejido [tiroideo], puede, totalmente, tomar una decisión adecuada. Esas categorías, que son la III, IV, V, son categorías que nosotros la llamamos globalmente como Nódulos Con Una Citopatología Indeterminada.    Si esa categoría, que va del III al V se acercaba más a la parte benigna, el porcentaje de personas (en el pasado, cuando no teníamos ciertas herramientas como los análisis y marcadores moleculares), todas estas personas iban a cirugía. Las personas que iban a cirugía en la categoría III tenían un porcentaje de malignidad entre un 15 y un 30%, esto se incrementaba en la categoría IV de un 30 a un 40%, y en la categoría V era un 70% de riesgo de malignidad.   Por eso, porque esa característica indeterminada está presente particularmente en las categorías III y IV ([y de ahí] el riesgo de ir a una cirugía innecesaria, sin propósito, porque iban a hacer un diagnóstico al final benigno), ahora los endocrinólogos, los otorrinolaringólogos y los patólogos, utilizamos marcadores moleculares para definir y clarificar qué personas, definitivamente, se benefician de ir a cirugía y cuáles son aquellas que, basados en el resultado molecular, pueden permanecer sin cirugía y con observación a través del ultrasonido.   Lo que estamos buscando con estos análisis moleculares es igualar el riesgo que una persona tendría si es diagnosticado ese nódulo como benigno. Como yo lo dije y comenté anteriormente: un nódulo benigno no significa 100 % seguridad de que no pueda ser algo malo, pero nos puede dar hasta un 94 % de seguridad de que uno está a salvo de tener cáncer de tiroides. Si nosotros tenemos un test que (en estas categorías III y IV, que son indeterminadas), nos permita igualar ese riesgo de llevar esos nódulos al mismo porcentaje de seguridad de observación, estamos ayudando al paciente a evitar cirugía innecesaria y, además de eso, le evitamos costos al sistema de salud pública.    Philip James, presentador: Entonces, sobre este tema de las categorías III y IV...    Dr. Casanova: El Bethesda III y IV, exacto.   Philip James, presentador: ¿Qué podemos hacer para obtener más información sobre este tema de las categorías III y IV?   Dr. Casanova:  Si. La parte de lo que son las categorías III y IV, que son, para los patólogos, categorías del Sistema de Bethesda.    Para las personas que van [a consulta], en un momento dado su médico toma la decisión de hacer una biopsia por aguja fina, requiere que la persona solicite que al mismo tiempo tomen la muestra para el análisis molecular. Los análisis moleculares que nosotros tratamos de recomendar a las personas son análisis moleculares que pregunten o traten de definir, si este nódulo es realmente benigno. Hay dos tipos de análisis moleculares: unos que son de confirmación de si “¿tú eres un nódulo malo?”, pero hay otros análisis que se basan, básicamente, en descartar que son malos; en este caso, confirmar la benignidad.   Es el médico que está realizando la biopsia el que tiene la oportunidad, al hacer el mismo pase de agujas que utilizamos para la citopatología, de tomar una muestra del test molecular y guardarlo al momento en espera del resultado final de la citopatología o del reporte. Si el reporte de la patología viene con categorías III o IV (que son indeterminados), en ese momento ya la persona tiene la muestra y puede ser enviada para el análisis y la clarificación, para evitar entonces la decisión final, en este caso, de ir a cirugia sin ningún otro tipo de ayuda. Y lo que hacemos con el análisis molecular, en este caso, es ayudar a la persona a tomar la decisión clínica correcta. Eso es lo que hacemos con este nuevo tipo de análisis moleculares.   Philip James, presentador: Para terminar. Cuando un paciente va por primera vez y el nódulo es indeterminado, ¿necesita volver otra vez para otra punción con aguja fina?, o ¿se pueden usar los resultados de la primera?   Dr. Casanova: Si la persona que está haciendo la biopsia toma la previsión de tomar la muestra (porque estas son muestra en las que están separadas la biopsia de la citopatología), de tomar la muestra y colocarla en el tubo (es un tubo especial; muchos de estos estudios moleculares requieren de un tubo especial), la persona no requiere repetir la biopsia.   En otras ocasiones, (porque en categoría III, la Asociación Americana de Tiroides lo recomienda), tiene 3 posibilidades: o ir a cirugía; o repetir la biopsia; o hacer observación. El repetir la biopsia: si la persona no pudo tomar la muestra molecular en ese momento, se toma la muestra y se clarifica (pero todavía en este punto no ha ido a cirugía). Nosotros recomendamos de nuevo, que la persona, cuando vaya a hacerse una biopsia, le pregunte a la persona que la está haciendo si va, al mismo tiempo de tomar la muestra para citopatología, a guardar una muestra para el análisis molecular, y así evitar hacer dos veces un procedimiento que, por supuesto, produce molestias. En términos generales, volver a repetir lo mismo otra vez [genera] un costo adicional para el paciente    Philip James, presentador: Y ¿esto es común para los médicos en general?, ¿ellos están usando el examen molecular?   Doctor casanova: La mayoría de los médicos que hacen biopsia (la gran mayoría) están ya familiarizados con estos tests moleculares. De hecho (...) Aquí particularmente, en Los Estados Unidos, el test ha sido aprobado, inclusive para su utilización en el sistema de Medicare; es decir, que ha sido reconocido como un elemento que tiene un costo-beneficio. Muchos de los seguros (de nuevo, aquí en los Estados Unidos) tienen cobertura de los más importantes tests moleculares. En términos generales, si hay algún problema con una persona, por ejemplo en Los Estados Unidos (o alrededor del mundo), las asociaciones de tiroides de cada continente tienen listas donde ellos le informan a las personas, si el médico hace biopsias con test molecular. La Asociación Americana de Tiroides [American Thyroid Association] tiene esa facilidad para los pacientes aquí en Los Estados Unidos, pero sé también que otras asociaciones de tiroides alrededor del mundo también le permiten a las personas, a través del internet, buscar quién es el médico que está haciendo biopsias utilizando este test molecular.   Philip James, presentador: Y actualmente, por ejemplo, en América Latina ¿también está disponible el exámen molecular?    Dr. Casanova: Si, el test está disponible en América Latina. Básicamente hay países que ya lo están realizando. [Tengo] conocimiento de que en Colombia, México, Brasil, en Chile lo están realizando. También, el test, puede solicitarse para ser realizado en cualquier momento y hay compañías que ya tienen la licencia para enviar el paquete que se requiere para tomar la muestra por el patólogo que lo está realizando en cada uno de los países de Latinoamérica.   Philip James, presentador: ¿Hay alguna empresa que ofrezca estos exámenes moleculares?, y si hay más de una, ¿cuáles son?   Dr. Casanova:  Ahorita tenemos 4 grandes grupos o compañías que están haciendo este test y cada una de ellas tiene su nivel de estudios que soportan, precisamente, este tipo de test molecular.    Está la compañía Veracyte que tiene un test que se llama Afirma. El Afirma viene en dos variantes: ellos tienen lo que se llaman un GC y actualmente están haciendo un test que van a introducir (más avanzado) que se llama GSC. Está otra compañía que está basada en la Universidad de Pittsburgh, la cual, en conjunto con un grupo de patólogos que se llaman CVL (Clinical Virology Laboratory) que están radicados en Nueva York, ellos hacen la muestra [prueba] que se conoce como ThyroSeq v2.    Está el grupo que se conoce como el Rosetta y, por supuesto, está también el otro grupo que hace el test molecular, y tienen dos tipos de test al mismo tiempo que se llaman ThyGeNEXT™ y ThyraMIR®. En Latinoamérica, en mi entender, el test que está siendo utilizado y que está licenciado en muchos de los países, es el que proviene del grupo Veracyte: Afirma.   Hay intenciones, de todos estos grupos, de trabajar [a lo largo] de Latinoamérica y, evidentemente, al contactar directamente a esos grupos en Los Estados Unidos, el patólogo o la persona que está interesada en utilizar esos test en sus prácticas a nivel de Latinoamérica, podría hacer [algún tipo de] acuerdo con estas compañías.   Philip James, presentador :  Y usted ¿cuál es el exámen está usando y por qué?   Dr. Casanova: Yo, en estos momentos estoy utilizando, fundamentalmente, un test de la compañía Veracyte: Afirma. Es el más avanzado, se llama Afirma GSC. La razón para utilizar éste test es, precisamente, porque en nuestra experiencia particular, la gran mayoría de los nódulos tiene un bajo riesgo de malignidad. Este test está basado en la lectura de ARN mensajero.    Y para ponerle [un ejemplo], a los pacientes y a las personas que nos escuchan, sobre “qué es lo que hace cada uno de los tests (?)”, es semejante a que: “usted tiene una persona que es su hija, la hija llega con su novio, y usted al ver novio [se lleva] una primera impresión”; el nódulo viene a ser el novio. Si el nódulo se observa, y se ve como que parece que no es bueno, la pregunta que uno hace no es “si usted es un mal muchacho”, es “si usted en verdad es un buen muchacho para mi hija”. El test o los tests que, precisamente, descartan que es malignidad son tests que tratan de responder esta pregunta que es: “¿Eres tú un nódulo benigno?” Los tests como Afirma, como Rosetta, están diseñados para responder esa pregunta.   Ahora, si una persona tiene un nódulo que es altamente sospechoso de cáncer, [ahí] es cuando nosotros (o mi persona) aplica tests como ThyroSeq v2, o los test, en este caso, del Thyroid Oncogene. Pero los tests moleculares basados en ADN, (que es lo que, algunas veces los cirujanos tratan de contestarse) son solamente aplicables, de manera cierta, a aquellos nódulos que son realmente sospechosos de malignidad.    La información que yo tengo [sobre] este test que te estoy comentando, el Afirma GSC, (...) la he podido corroborar personalmente. Muchos de estos casos, que han sido sospechosos a través del test molecular, van a cirugía y se corrobora que la información del test es precisamente la que nos informa el análisis molecular. Pero también el test me ha dado la oportunidad de evitar cirugías en pacientes y tener el orgullo de poder haber salvado de una cirugía innecesaria a más del 50 % de los pacientes que, en un momento dado tenían estos [nódulos] indeterminados.   Philip James, presentador: Esto es muy importante porque, anteriormente y hoy en día, hay muchas cirugías en las que se está extirpando la tiroides aunque no se sabe si es cáncer o no, pero el doctor dice: “Vamos a quitar su tiroides, no sabemos si es cáncer, pero…” ¿Cuántas veces no tienen cáncer?, ¿una de cada dos o cuantas?   Dr. Casanova: Si, en la mayoría de estos nódulos indeterminados, sobretodo de las categorías III y IV, es posible que hasta un 60 % de los pacientes no tenga cáncer y vayan a una cirugía innecesaria. La cirugía innecesaria no solamente implica el hecho de retirar un órgano tan noble como el tiroides (que tiene una función única y es particularmente difícil, inclusive para los endocrinólogos una vez que la persona va a cirugía, manejarlo), sino que también tiene que tomar en cuenta que una persona que va a cirugía se expone a otros riesgos: el tiroides es uno de los órganos que tiene además, en la parte posterior, otras glándulas como las paratiroides que controlan el calcio; está cerca de nervios que, básicamente, comprometen la voz del paciente. Es una cirugía; dependiendo de la edad del paciente, los riesgos de cirugía pueden ser menos o más altos.   De tal manera que la óptica que tienen, y de hecho ese es el propósito que tienen las asociaciones alrededor del mundo y particularmente la Asociación Americana del Tiroides, es minimizar el potencial de dañar o de sobretratar a la mayoría de los pacientes con un riesgo bajo de mortalidad y de enfermedad.   Los nódulos tiroideos son, solo una mínima parte, malignos; la mayoría son benignos, pero en este caso deben tomarse las previsiones para que cuando tengamos la respuesta a través de la citología, o a través del análisis molecular, sea la adecuada para evitar cirugías innecesarias.   Philip James, presentador:  Si yo soy un paciente y el resultado de mi punción con aguja fina (FNA) fue “nódulo indeterminado” ¿cómo sé si mi médico está utilizando el test para nódulo indeterminado?    Dr. Casanova: Bueno, básicamente porque el reporte lo indica. Cuando la persona recibe un reporte, además de la parte indeterminada, recibe una hoja adicional con la explicación del test molecular que fue seleccionado por su médico. En el caso de los test Afirma, el ThyroSeq de Rosetta o de otros tests moleculares, (en este caso) ellos informan directamente, además de la respuesta de la citopatología, le informan a la persona que un test molecular ha sido realizado.   Si el test molecular no está reflejado en el reporte, es importante que la persona (dependiendo de la categoría que tiene, ya sea III o IV) tenga la opción antes de hacer cirugía de, inclusive, poder realizar de nuevo el test molecular. Lo correcto es hacer todo en un solo paso. [Se trata de] tomar la previsión de que esto puede ocurrir. A a pesar de que no ocurre en todos los pacientes (solo entre un 15 a un 30%, dependiendo del lugar del mundo donde esté, puede ser indeterminado), y si existe esa posibilidad, y la posibilidad de ese diagnóstico es potencialmente de ir a una cirugía innecesaria, es importante que antes, al momento de la biopsia, solicite a su médico: “Por favor, envíeme a un doctor que haga este test al mismo tiempo, para poder tener tranquilidad”.    Philip James, presentador:  Doctor Casanova, gracias.   Antes de irnos, ¿hay alguna otra información que quiera compartir con las personas que están escuchando sobre este tema?    Dr. Casanova: Si, yo en lo particular, recomiendo a las personas que, siempre que evalúen los nódulos tiroideos, tomen en cuenta que a pesar que es una patología que es muy frecuente en nuestra población, siguen siendo (la mayoría de ellos) benignos. Siempre vayan con la óptica de que en los diagnósticos de nódulos tiroideos existen un alto porcentaje que usted vaya a salir con una respuesta que lo va a poner contento. Pero, si se tomó la decisión (dependiendo de su historia familiar o de su historia de exposición; y de las características del nódulo; y de los exámenes que se realizan preliminarmente) de que se necesita una biopsia, prepárese para que todas las respuestas sean respondidas en una sola ocasión. Eso indica, hacer la biopsia guiada por ultrasonido, tomar y enviar la muestra a un patólogo reconocido y, además, que al mismo tiempo que le hayan tomado la muestra citopatológica, guarden la muestra molecular.   En el futuro estos análisis moleculares van a cambiar totalmente la manera en que nosotros vamos a clasificar, finalmente, los nódulos. Estos análisis moleculares están avanzando a pasos agigantados. Esperamos, además, que va a ser un beneficio para clarificar el diagnóstico de los pacientes que, a futuro, también nos guíe acerca de cómo tratar, si se da la situación a las personas con cáncer, de una manera más adecuada   Así que, manténganse conectados con estos podcasts, que son siempre muy interesantes, y a futuro, probablemente escucharán, más allá del capitulo 60, muchos más de estos análisis.   Philip James, presentador: Este es el fin del episodio número 59. Yo soy Philip James. Si quiere escuchar más entrevistas con otros médicos, acerca del tema de tiroides, cáncer de tiroides  e hipotiroidismo, puede visitar la página web doctiroides.com.

Caroline deRichmond, CRNP, a nurse practioner & clinical lipid specialist with Geisinger Cardiology & is a regional board meember of the National Lipid Association and WILK's Mark Davis discuss heart health and cholesterol issues in studio with Frank Andrews. See omnystudio.com/listener for privacy information.

While we are in an incredibly exciting time when it comes to preventing and reversing disease, issues such as misleading scientific research, imperfect policy, corporate financial interests, and other biases often act as roadblocks to enhancing the health of our population and our planet. Yet, when we recently reflected on a number of conversations from The Doctor’s Farmacy, we couldn’t help but hear a common and hopeful message. In this mini-episode, we revisit four conversations Dr. Hyman has had with guests on this podcast, each with a common refrain: Progress is being made and it’s happening fast! Michael Pollan is the author of the New York Times bestsellers Cooked, Food Rules, In Defense of Food, The Omnivore’s Dilemma, The Botany of Desire, and his latest book How to Change Your Mind, which is all about the new science of psychedelics. A longtime contributor to the New York Times Magazine, he also teaches writing at Harvard and the University of California, Berkeley where he is the John S. and James L. Knight Professor of Science Journalism. In 2010, Time magazine named him one of the one hundred most influential people in the world.Dr. Hallberg is a Medical Director at Virta Health and a Fellow of the Aspen Institute’s Health Innovator Fellowship and a member of the Aspen Global Leadership Network. She is also the Medical Director and founder of the Medically Supervised Weight Loss Program at Indiana University Health Arnett and an adjunct Professor of Clinical Medicine at the Indiana University School of Medicine. Dr. Hallberg is serving as Chair of the Board of Directors and Chair of the Scientific Advisory Council for The Nutrition Coalition. Dr. Hallberg is a diplomate of the American Board of Internal Medicine, American Board of Obesity Medicine, and The American Board of Clinical Lipidology and is a Registered Exercise Physiologist by the ACSM. She is also a Fellow of the Obesity Medicine Association and The National Lipid Association.David Wallace-Wells is the deputy editor of New York magazine and the author of the international bestseller The Uninhabitable Earth: Life After Warming, published in February 2019, which the New York Times called both “brilliant” and “the most terrifying book I have ever read.”Dr. Sonia Angell is a former Deputy Commissioner at the New York City Department of Health and Mental Hygiene (DOHMH), where she oversaw the Division of Prevention and Primary Care. Dr. Angell is a practicing physician, board certified in internal medicine, and on faculty at the College of Physicians and Surgeons of Columbia University and New York Presbyterian Hospital.Tune into Dr. Hyman’s full length conversation with Michael Pollan: https://DrMarkHyman.lnk.to/MichaelPollanTune into Dr. Hyman’s full length conversation with Dr. Sarah Hallberg: https://DrMarkHyman.lnk.to/DrSarahHallbergTune into Dr. Hyman’s full length conversation with David Wallace-Wells: https://DrMarkHyman.lnk.to/DavidWallaceWellsTune into Dr. Hyman’s full length conversation with Dr. Sonia Angell: https://DrMarkHyman.lnk.to/DrSoniaAngell See acast.com/privacy for privacy and opt-out information.

Joining Dr. Gregg Sherman  for this episode is Dr. James Underberg for a discussion about the impact of Hyperlipidemia management on Cardiovascular Risk Reduction. Click here to access NACE on-demand CME/CE courses on cardiovascular diseaseDr. Underberg is a Clinical Assistant Professor of Medicine at NYU Medical School & NYU Center for CV Prevention, Director of the Bellevue Hospital Lipid Clinic and Past President of the National Lipid Association. We very excited to spend a few minutes with Dr. Underberg to discuss current clinical guidelines, his insights about the evolving state of lipid management, and the impact of Hyperlipidemia management on Cardiovascular Risk Reduction.This activity is supported by educational funding provided by Amgen.This activity is not certified for CME/CE credit.

Guest: R. Preston Mason, PhD Guest: Michael Miller, MD, FACC, FAHA, FNLA Guest: Margo Minissian, PhD, ACNP Guest: James A. Underberg, MD, MS, FACP, FNLA Host: Sergio Fazio, MD, PhD The curriculum will include highlights from the National Lipid Association symposium presented in a multi-part, structured activity that is engaging and interactive.

Guest: R. Preston Mason, PhD Guest: Michael Miller, MD, FACC, FAHA, FNLA Guest: Margo Minissian, PhD, ACNP Guest: James A. Underberg, MD, MS, FACP, FNLA Host: Sergio Fazio, MD, PhD The curriculum will include highlights from the National Lipid Association symposium presented in a multi-part, structured activity that is engaging and interactive.

Fran Emmolo Gamella is a young mother of two living with Familial Hypercholesterolemia. She was diagnosed with FH in her mid-20s but it wasn’t until she had a heart attack at age 31 that she became really serious about her medical care. Her six-year-old daughter has also been diagnosed with FH. Fran works as a Medical Assistant in a primary care practice setting and is passionate about raising awareness for FH. LDL of >190— definitely get it checked out! Story Reference Points: Fran’s diagnosis with FH in her mid-20s… and her 6yo daughter’s diagnosis @ 1:52 So…. what is FH? @ 7:49 23andme and FH testing @ 11:28 Misperceptions of what it “looks like” to have high cholesterol @ 13:55 Fran on being a non-compliant or “bad” patient @ 16:55 Fran’s heart attack… and her denial of the symptoms @ 18:30 Adjusting to what it takes to live a healthy life with FH @ 22:40 Challenges of insurance coverage @ 25:34 Links and Resources The FH Foundation Connect with the FH Foundation on Social Media: The FH Foundation on Twitter: @TheFHFoundation The FH Foundation on Instagram: @fhfoundation The FH Foundation on Facebook Grey Genetics News Corner blog post: Familial Hypercholesterolemia: Screening, diagnosis and management of pediatric and adult patients. National Lipid Association. 2011. Grey Genetics News Corner blog post: What can 23andMe results tell you about your cholesterol-related risks? Listen to a previous Patient Stories Podcast with Colleen McCready: Familial Hypercholesterolemia: The Symptomless Sickness Check out other Patient Stories podcast episodes. Read other Patient Stories on the Grey Genetics Patient Stories Page Do you want to support Patient Stories? You can now make a donation online! Want to support Patient Stories in a non-monetary way? Leave us a review on iTunes, or share your favorite episodes on Social Media. Patient Stories on Twitter: @GreyGeneticsPod Patient Stories on Instagram: @patientstoriespodcast Are you looking for genetic counseling? Patient Stories is sponsored by Grey Genetics, an independent telehealth genetic counseling and consulting company. Book an appointment with a genetic counselor specialized in your area of concern. Choose from our growing Network of Genetic Counselors. All genetic counseling appointments take place over secure, HIPAA-compliant video-conferencing or by phone. To see a list of genetic counselors who specialize in cardiovascular genetics, visit https://greygenetics.as.me/cardiovascular

The American Heart Association / American College of Cardiology (AHA/ACC) Task Force recently published the 2018 Guideline on the Management of Blood Cholesterol. The guidelines writing committee had representation from 12 organizations, including the National Lipid Association, American Diabetes Association, and the American Pharmacists Association — all of whom endorsed the guidelines. The previous guidelines (published in 2013) were intended to answer some specific clinical questions and significantly changed our approach to treatment. The 2018 guidelines provide a more comprehensive set of recommendations, akin to the (older) National Heart, Lung, and Blood Institute Adult Treatment Panel (ATP) III guidelines last published in 2002! Guest Authors:  Dawn Fuke, Pharm.D., BCPS, and Zach Conroy, PharmD, BCACP Music by Good Talk

Dr. Sarah Hallberg is a diabetes expert, who is here to change the way we treat diabetes. Her number one weapon for reversing type 2 diabetes: a ketogenic diet.Dr. Hallberg is a Medical Director at Virta Health and a Fellow of the Aspen Institute’s Health Innovator Fellowship and a member of the Aspen Global Leadership Network. She is also the Medical Director and founder of the Medically Supervised Weight Loss Program at Indiana University Health Arnett and an adjunct Professor of Clinical Medicine at the Indiana University School of Medicine. Dr. Hallberg is serving as Chair of the Board of Directors and Chair of the Scientific Advisory Council for The Nutrition Coalition. Dr. Hallberg is a diplomate of the American Board of Internal Medicine, American Board of Obesity Medicine, and The American Board of Clinical Lipidology and is a Registered Exercise Physiologist by the ACSM. She is also a Fellow of the Obesity Medicine Association and The National Lipid Association.In this episode, Dr. Hallberg shares the benefits of a high fat, or ketogenic, diet. You may have heard that a ketogenic diet can be beneficial for your health—that it promotes weight loss, longevity, and enhanced cognitive function—and wondered if the hype is true. Tune into this week’s episode to find out. See acast.com/privacy for privacy and opt-out information.

In this podcast, John Marchica speaks with the CEO and Co-Founder of Teleplus Healthcare, Dr. Suzanne Shugg Teleplus is a medical information technology company that combines comprehensive telemedicine and tele-educational services with the leading treatment technology, focusing on the areas of Sleep Apnea, Congestive Heart Failure, Obesity, Chronic Care, and COPD. Teleplus has an exclusive global partnership with the University of Pennsylvania called the UPENN Sleep Disorder Certificate program that distributes sleep disorder education. Here are some of the interview highlights: What do telehealth and telemedicine mean, and what are their differences? The advantages of bringing telehealth for managing chronic care and rural health. The motivations behind the creation of the telehealth company and its continued success. Speaker Bios Suzanne Shugg, DNP, has over 20 years of experience in multiple healthcare sectors. She has developed a new, innovative health insurance company, implemented and expanded preventive cardiovascular clinics, assisted in the management of hospital systems, and remains a hands-on health care provider. Suzanne continues to teach all aspects of Adult Medicine and Future Technology in Medicine at Rutgers University, where her program is ranked 7th in the U.S. She was elected as a Fellow of the National Lipid Association, one of the highest and most prestigious rankings in the organization. Suzanne currently heads a preventive clinic at a partner of the largest hospital system in New Jersey, Saint Barnabas Medical Center and New Jersey Cardiology Associates. She has served across the United States as a consultant for telemedicine, starting independent telemedicine clinics both in and out of hospitals. She has been published in numerous peer-reviewed journals, sits on multiple medical boards and is a highly sought-after speaker in the field of preventive cardiology and telemedicine. John Marchica is a veteran health care strategist and CEO of Darwin Research Group. He was the founder and CEO of FaxWatch, a leading business intelligence and medical education company and two-time member of the Inc. 500 list of America's fastest growing companies. John is the author of The Accountable Organization and has advised senior management on strategy and organizational change for more than a decade. John earned his B.A. in economics from Knox College, an MBA and M.A. in public policy from The University of Chicago, and completed his Ph.D. coursework and doctoral exams in clinical epidemiology and health economics at The Dartmouth Institute for Health Policy and Clinical Practice. He is a faculty associate in the W.P. Carey School of Business and the College of Health Solutions at Arizona State University. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Dr. Paul Y. Casanova-Romero, M.D., M.P.H., F.A.C.P., F.A.C.E, E.C.N.U, que se unió a Palm Beach Diabetes y Endocrine Specialists en 2012, recibió su grado médico con honores (Summa Cum Laude) y Doctor en Ciencias Médicas (DMSc), de la Universidad de Zulia, la Escuela de Medicina en Venezuela. Posteriormente se unió a la facultad de su Alma Mater y en 1998, el Grupo de Investigación del Programa de Prevención de la Diabetes (D.P.P.) en el Instituto de Investigación de la Diabetes-Universidad de Miami. Completó su posgrado en Medicina Interna y Endocrinología (Jackson Memorial Hospital) y estudios de postgrado en Salud Pública (M.P.H.) con el Premio de Mérito Académico en la Universidad de Miami. Un consultor privado endocrinólogo y orador nacional desde 2006, el Dr. Paul Y. Casanova-Romero de investigación extensa sobre la prevención de la diabetes, trastornos de la tiroides, síndrome metabólico y otros trastornos endocrinos han sido ampliamente publicadas. Sigue colaborando en estudios de investigación en Estados Unidos y Latinoamérica, el más reciente en pruebas moleculares de tiroides. El Dr. Casanova-Romero está certificado por la Junta en Medicina Interna, así como en Endocrinología, Diabetes y Metabolismo. Es miembro del Colegio Americano de Endocrinología (F.A.C.E.) y miembro del Colegio Americano de Médicos (F.A.C.P.). Actualmente es profesor voluntario de medicina en la Universidad de Miami. Dr. Paul Y. Casanova-Romero se especializa en el tratamiento de la enfermedad de la tiroides incluyendo nódulos tiroideos, hipotiroidismo, hipertiroidismo y cáncer de tiroides, enfermedad paratiroidea, diabetes, pre-diabetes, trastornos lipídicos y otros trastornos endocrinos. Él ha estado usando la prueba molecular para la caracterización de los nódulos de la tiroides desde 2010. Él ha satisfecho con éxito los requisitos para la certificación endocrina en el ultrasonido del cuello (ECNU) para realizar la biopsia internamente guiada por ultrasonido de la aspiración de la aguja fina de nódulos de tiroides, de la paratiroides, nodos. Es miembro del panel de membresía de la American Thyroid Association, miembro activo de la Endocrine Society, la Asociación Americana de Endocrinólogos Clínicos, la American Diabetes Association, el American College of Physicians y la National Lipid Association. En esta entrevista hablamos sobre esta temas: ¿Cómo se identifican los nódulos y por qué ocurren? autoexamen o en la oficina del médico La mayoría de los nódulos son benignos pero ocurren porque en mas de 70% de la población ¿Qué tests puede realizar un médico para evaluar el nódulo? Ninguna test es 100% Ultrasonido - qué están buscando en general Que es ojo fina y el proceso general Tests moleculares ¿Qué tipos de resultados se pueden obtener de la citología y qué significan? La mayoria de ojo finas son benigno Maligno o sospechoso de malignidad, todavía tiene la posibilidad de no ser cáncer Los arco iris - 3,4,5 - indeterminate categoria  Systema BETHESDA ¿Qué tests adicionales se pueden realizar para resolver los nódulos indeterminados? - Tests moleculares Que son todas los tests moleculares?  Y son las mismas? Dr. Casanova prefiere usar test de Afirma, este es por que MAS INFORMACIÓN Dr. Paul Casanova American Thyroid Association (español) La prueba de la expresión génica de Afirma puede reducir cirugías innecesarias del cáncer de tiroides Afirma

Thank you for listening to the Healthy Wealthy and Smart Podcast! In this episode I welcome Dr. Suzanne Shugg. Her mission is to change health care for the better by using insurance solutions, telemedicine and preventive care. Sounds familiar right? These are themes that come up regularly on social media and in discussions with fellow PTs and healthcare practitioners. In this episode we discuss: - How Endeavor Plus is shaking up the insurance market - Why and how insurance companies function - The steps telemedicine is taking to change the healthcare market - What it is like to be the only woman in the C-Suite - and much more!   More about Dr. Shugg: Dr. Suzanne Shugg’s mission is to change health care for the better by using insurance solutions, telemedicine and preventive care.   She currently runs a preventive Cardiology clinical treating metabolic and lipid disorders at NJ Cardiology Associates while teaching full time as a professor in the School of nursing at Rutgers, University. She also is the Co founder of Teleplus HealthCare, a telemedicine company that works to improve care and medical outcomes in cardiovascular and chronic care. Finally, she is the director of wellness at a new insurance and technology solution, Endeavor Plus. This solution has been designed to improve the health care choices and management for both the patients and providers while helping small businesses and hospitals save money. Dr. Suzanne Shugg received her Doctor of Nursing Practice at what is now Rutgers in 2010. She has specialized in Preventive Cardiology and clinical lipidology. Prior to that she has practiced in general cardiology and in primary care as a nurse practitioner. She has been published in the Journal of Clinical Lipidology “Low-density lipoprotein particle number predicts coronary artery calcification in asymptomatic adults at intermediate risk of cardiovascular disease”. She has published in the Federal Nurse Practitioner for, “Health Information Technology Presents New Opportunities for Advanced Practice Nurses”. Finally she has recently published in the NP Women’s Health Care Journal for, “Pregnancy’s effects on cardiovascular health: A woman’s first “cardiac stress test”. She has also written medical guidelines for Prevention of Cardiovascular disease and Cardiac Rehab. She has also written a guideline for professional’s treatment of LPa. In 2010 she became a Clinical Lipid Specialist accredited by the National Lipid Association and shortly thereafter was nominated as a fellow. She has given various lectures on Women’s Cardiac Health, Prevention of Cardiovascular Diseases, Nutrition and Supplements, as well as advanced lipid testing.  In addition, she was a consultant to set up a Preventive Cardiovascular Clinic at Oklahoma Heart She sits on various editorial and preventive medicine boards and in   her spare time she has done medical missions. When Suzanne is not working she enjoys being outside; running, kayaking, biking, scuba diving and hiking with her two dogs, Dudley and Maggie.  

Host: Alan S. Brown, MD, FACC, FAHA, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Robert Kloner, Vice President of Translation at Huntington Medical Research Institutes and Professor of Medicine in the Cardiovascular Division of Keck School of Medicine at the University of Southern California. Dr. Kloner discusses the cardiovascular risk factors associated with erectile dysfunction, safety and efficacy of erectile disfunction drugs, and benefits vs risks of supplementing with testosterone.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Robert Kloner, Vice President of Translation at Huntington Medical Research Institutes and Professor of Medicine in the Cardiovascular Division of Keck School of Medicine at the University of Southern California. Dr. Kloner discusses the cardiovascular risk factors associated with erectile dysfunction, safety and efficacy of erectile disfunction drugs, and benefits vs risks of supplementing with testosterone.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Robert Kloner, Vice President of Translation at Huntington Medical Research Institutes and Professor of Medicine in the Cardiovascular Division of Keck School of Medicine at the University of Southern California. Dr. Kloner discusses the cardiovascular risk factors associated with erectile dysfunction, safety and efficacy of erectile disfunction drugs, and benefits vs risks of supplementing with testosterone.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Robert Kloner, Vice President of Translation at Huntington Medical Research Institutes and Professor of Medicine in the Cardiovascular Division of Keck School of Medicine at the University of Southern California. Dr. Kloner discusses the cardiovascular risk factors associated with erectile dysfunction, safety and efficacy of erectile disfunction drugs, and benefits vs risks of supplementing with testosterone.

Host: Alan S. Brown, MD, FACC, FAHA, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Rhoda Cooper-DeHoff. Dr. Cooper-DeHoff is an Associate Professor in the Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine of the Colleges of Pharmacy and Medicine at the University of Florida. She is also Associate Director of the Center for Pharmacogenomics at this institution. Dr. Cooper-DeHoff discusses the rise of pharmacometabolomics, genomic testing, and pharmacogenetic testing in lipidology, with particular emphasis on predictive mapping for statin responses.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Rhoda Cooper-DeHoff. Dr. Cooper-DeHoff is an Associate Professor in the Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine of the Colleges of Pharmacy and Medicine at the University of Florida. She is also Associate Director of the Center for Pharmacogenomics at this institution. Dr. Cooper-DeHoff discusses the rise of pharmacometabolomics, genomic testing, and pharmacogenetic testing in lipidology, with particular emphasis on predictive mapping for statin responses.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Rhoda Cooper-DeHoff. Dr. Cooper-DeHoff is an Associate Professor in the Department of Pharmacotherapy and Translational Research and Division of Cardiovascular Medicine of the Colleges of Pharmacy and Medicine at the University of Florida. She is also Associate Director of the Center for Pharmacogenomics at this institution. Dr. Cooper-DeHoff discusses the rise of pharmacometabolomics, genomic testing, and pharmacogenetic testing in lipidology, with particular emphasis on predictive mapping for statin responses.

Host: Alan S. Brown, MD, FACC, FAHA, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dave Dixon, PharmD, Clinical Pharmacist and Associate Professor of Pharmacology at Virginia Commonwealth University School of Pharmacy. Dr. Dixon is also a Board Certified Pharmacotherapy Specialist, Clinical Lipid Specialist, and Fellow of the National Lipid Association. He serves as a Regional Representative for the Southeast Chapter of NLA and on the Journal of Clinical Lipidology Editorial Board. Dr. Dixon discusses guidelines for treating hypertriglyceridemia, effective therapies for reducing triglyceride levels, and emerging lipid-lowering therapies in development.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dave Dixon, PharmD, Clinical Pharmacist and Associate Professor of Pharmacology at Virginia Commonwealth University School of Pharmacy. Dr. Dixon is also a Board Certified Pharmacotherapy Specialist, Clinical Lipid Specialist, and Fellow of the National Lipid Association. He serves as a Regional Representative for the Southeast Chapter of NLA and on the Journal of Clinical Lipidology Editorial Board. Dr. Dixon discusses guidelines for treating hypertriglyceridemia, effective therapies for reducing triglyceride levels, and emerging lipid-lowering therapies in development.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dave Dixon, PharmD, Clinical Pharmacist and Associate Professor of Pharmacology at Virginia Commonwealth University School of Pharmacy. Dr. Dixon is also a Board Certified Pharmacotherapy Specialist, Clinical Lipid Specialist, and Fellow of the National Lipid Association. He serves as a Regional Representative for the Southeast Chapter of NLA and on the Journal of Clinical Lipidology Editorial Board. Dr. Dixon discusses guidelines for treating hypertriglyceridemia, effective therapies for reducing triglyceride levels, and emerging lipid-lowering therapies in development.

Host: Alan S. Brown, MD, FACC, FAHA, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Eugenia Gianos. Dr. Gianos is an assistant professor in the Department of Medicine and co-clinical director of the Center for the Prevention of Cardiovascular Disease at the NYU School of Medicine. Dr. Gianos discusses the effectiveness, potential side effects, and patient outcomes with PCSK9 antibodies for management of dyslipidemia.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Eugenia Gianos. Dr. Gianos is an assistant professor in the Department of Medicine and co-clinical director of the Center for the Prevention of Cardiovascular Disease at the NYU School of Medicine. Dr. Gianos discusses the effectiveness, potential side effects, and patient outcomes with PCSK9 antibodies for management of dyslipidemia.

Host: Alan S. Brown, MD, FNLA Live from the Clinical Lipid Update of the National Lipid Association in Amelia Island, FL, host Dr. Alan Brown welcomes Dr. Eugenia Gianos. Dr. Gianos is an assistant professor in the Department of Medicine and co-clinical director of the Center for the Prevention of Cardiovascular Disease at the NYU School of Medicine. Dr. Gianos discusses the effectiveness, potential side effects, and patient outcomes with PCSK9 antibodies for management of dyslipidemia.

Summary: In this episode our guest is Master Lipidologist, Dr. Peter Howard Jones from Baylor College of Medicine and the National Lipid Association. My guest host is Dr. Paul Williams, Clinician Educator extraordinaire from Philadelphia. We explore everything you’ll ever want to know about cholesterol and lipids. Are statins still king when it comes to cholesterol lowering? Should we be rushing to use PCSK9 inhibitors? Should we throw away older drugs like fibrates? Are nonpharmacologic therapies like niacin and fish oil worthwhile? Join us for this extensive conversation.   Disclosures: Dr. Jones is the Chief Science Officer at the National Lipid Association. He has served as a scientific advisor to Merck, Amgen and Sanofi.   Learning objectives: 1. Identify each individual's risk for cardiovascular disease and counsel them on benefits of therapy. 2. Learn to lower atherogenic lipids by any means necessary and understand the effects of the common lipid lowering drugs 3. Effectively counsel patients on benefits of lipid lowering drugs to promote patient buy in and adherence.   Clinical Pearls 1. Omega 3 fatty acids at 1,000 mg daily or more is useful for prevention of sudden death in post ACS patients. 2. Omega 3 fatty acids at dose of 4,000 mg per day is needed to lower triglycerides. Indicated if TG remain above 500 on first line therapy. 3. Hypertriglyceridemia with level above 500 on optimal statin dose, then consider addition of fibrate and/or omega-3 fatty acids. Uncertain clinical benefit in patient with moderate elevation (200-300) of triglycerides. 4. Statin intolerance can be overcome in most patients using the following methods: a. Same statin at lower dose b. Different statin c. Use of rosuvastatin or atorvastatin 3 times weekly 5. Statins are safe to take for at least 20 years and probably longer (this data is still being collected, but will be available in the future) 6. Withdrawal of statins at the end of life is not harmful and may be beneficial.   Links from the Show:   Studies that used fibrates for preventions of CV events: Helsinki Heart Study for primary prevention NEJM 1987 VA HIT Study for secondary prevention NEJM 1999   Withdrawal of statins at the end of life http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618294/   Expert Consensus on use of Non-Statin Drugs http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/03/30/11/58/2016-acc-expert-consensus-decision-pathway-on-the-role-of-nonstatin   National Lipid Association recommendations for patient-centered management of dyslipidemia https://www.lipid.org/sites/default/files/Recommendations-Part-1.pdf   Recommended websites National Lipid Association The Heart.org (Medscape) Journal of Clinical Lipidology

Host: Alan S. Brown, MD, FNLA Guest: Joyce Ross Host Dr. Alan Brown welcomes Joyce Ross, nurse practitioner and President of the National Lipid Association. Joyce is a consultative education specialist in Cardiovascular Risk Intervention with the University of Pennsylvania Health System. She is the first Nurse Practitioner elected as President of the NLA. Ms. Ross introduces her goals for the upcoming year, including novel efforts on behalf of the NLA to help combat America's obesity epidemic.

Host: Alan S. Brown, MD, FACC, FAHA, FNLA Guest: Joyce Ross, MSN, CRNP, CS, CLS, FNLA, FPCNA Host Dr. Alan Brown welcomes Joyce Ross, MSN, CRNP, FNLA, President-Elect of the National Lipid Association. Joyce serves as a consultative education specialist in cardiovascular risk intervention with the University of Pennsylvania Health System. Their discussion focuses on lipid management to reduce atherosclerotic cardiovascular disease (ASCVD) risk in elderly patient populations. Thhis interview was recorded live at the National Lipid Association in San Diego, California for the 2016 Spring Clinical Lipid Update.

Host: Alan S. Brown, MD, FNLA Guest: Joyce Ross, MSN, CRNP, CS, CLS, FNLA, FPCNA Host Dr. Alan Brown welcomes Joyce Ross, MSN, CRNP, FNLA, President-Elect of the National Lipid Association. Joyce serves as a consultative education specialist in cardiovascular risk intervention with the University of Pennsylvania Health System. Their discussion focuses on lipid management to reduce atherosclerotic cardiovascular disease (ASCVD) risk in elderly patient populations. Thhis interview was recorded live at the National Lipid Association in San Diego, California for the 2016 Spring Clinical Lipid Update.

Host: Alan S. Brown, MD, FNLA Guest: Joyce Ross, MSN, CRNP, CS, CLS, FNLA, FPCNA Host Dr. Alan Brown welcomes Joyce Ross, MSN, CRNP, FNLA, President-Elect of the National Lipid Association. Joyce serves as a consultative education specialist in cardiovascular risk intervention with the University of Pennsylvania Health System. Their discussion focuses on lipid management to reduce atherosclerotic cardiovascular disease (ASCVD) risk in elderly patient populations. Thhis interview was recorded live at the National Lipid Association in San Diego, California for the 2016 Spring Clinical Lipid Update.

Host: Alan S. Brown, MD, FNLA Guest: Joyce Ross, MSN, CRNP, CS, CLS, FNLA, FPCNA Host Dr. Alan Brown welcomes Joyce Ross, MSN, CRNP, FNLA, President-Elect of the National Lipid Association. Joyce serves as a consultative education specialist in cardiovascular risk intervention with the University of Pennsylvania Health System. Their discussion focuses on lipid management to reduce atherosclerotic cardiovascular disease (ASCVD) risk in elderly patient populations. Thhis interview was recorded live at the National Lipid Association in San Diego, California for the 2016 Spring Clinical Lipid Update.

Host: Alan S. Brown, MD, FNLA Guest: Joyce Ross, MSN, CRNP, CS, CLS, FNLA, FPCNA One of the most recurrent questions that cardiologists and lipidologists face in daily practice is how to best approach the elderly patient with dyslipidemia. Joining Dr. Alan Brown for special considerations in this population and guideline-based recommendations for management is Joyce Ross, certified registered nurse practitioner, clinical lipid specialist, and President-Elect of the National Lipid Association. Supported by an Educational Grant from AstraZeneca.

Guest: Kevin C. Maki, PhD, FNLA, CLS Guest: Carl Orringer, MD, FACC, FNLA Guest: Harold Bays, MD, FNLA Host: Alan S. Brown, MD, FNLA Guest: Matthew Ito, PharmD, FNLA Host Dr. Alan Brown is joined by an expert panel to discuss the NLA's latest draft document that will serve as recommendations to clinicians for the management of patients with dyslipidemia. The National Lipid Association's goal was to harmonize guidelines among what has been presented in the past by the ATP panel, the American College of Cardiology/American Heart Association Guidelines, and those also released in 2013 by the International Atherosclerosis Society. The NLA reaffirms the importance of understanding targets of treatment and goals for patients. Our expert panelists: Harold Bays, MD, FNLA - Medical Director and President of Louisville Metabolic and Atherosclerosis Research Center; co-author of the National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia and co-author of the American Society of Bariatric Physicians Obesity Algorithm Matthew Ito, PharmD, FNLA - Professor of Pharmacy Practice and Director of the Cardiovascular Pharmacodynamics Laboratory at Oregon State University/Oregon Health & Science University; member of the National Lipid Association Expert Panel on the Diagnosis and Treatment of Familial Hypercholesterolemia and the Recommendations for Patient-Centered Management of Dyslipidemia Carl E. Orringer, MD, FACC, FNLA - Associate Professor of Medicine, Cardiology Division at the University of Miami Medical Center; Editorial reviewer ...