Podcasts about national lipid association

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Erin D. Michos, MD, MHS Severe hypertriglyceridemia (sHTG) affects more than 3 million people, but it often flies under the clinical radar.1-3 When triglycerides are at or above a 500 mg/dL threshold, it's no longer just an isolated lab value—it's a level of hypertriglyceridemia where the clinical implications change, and where a more careful evaluation for underlying causes and risk becomes important.4 That's why Dr. Charles Turck sits down with Dr. Erin Michos to discuss what sHTG is, why it's so important to identify, and how we can effectively manage this condition to improve patients' overall health and reduce complication risk. Dr. Erin Michos is a Professor of Medicine, Director of Women's Cardiovascular Health, and Associate Director of Preventive Cardiology at Johns Hopkins University School of Medicine. References: Saadatagah S, Larouche M, Naderian M, et al. Recognition and management of persistent chylomicronemia: a joint expert clinical consensus by the National Lipid Association and the American Society for Preventive Cardiology. Am J Prev Cardiol. 2025;22:100978. doi:10.1016/j.ajpc.2025.100978 Sanchez RJ, Ge W, Wei W, Ponda MP, Rosenson RS. The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis. Lipids Health Dis. 2021;20(1):72. doi:10.1186/s12944-021-01488-8 Sikora Kessler A, Baum SJ, Kutrieb E, et al. Rates …

Over two decades ago, Lipoprotein(a)—or Lp(a)—was recognized as an emerging risk factor for cardiovascular disease. In this special edition of DOC Updates, Dr. Neil Skolnik explores our growing understanding of this cholesterol-carrying lipoprotein. This special episode is sponsored with support from Lilly. Please listen to the episodes by clicking on the podcast player below or by freely subscribing to DOC Updates via Apple Podcasts, Amazon Music, Spotify, or your preferred podcast platform. EPISODE NOTES Special Edition: Special Edition: Lp(a) & CV Risk In this special edition of DOC Updates, Neil Skolnik speaks with Dr. Michael Wilkinson, who goes over the history of Lp(a), the current guidelines, and the importance of screening. This special episode is sponsored with support from Lilly. Presented by: -Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health -Michael Wilkinson, MD, Associate Professor of Medicine at University of California San Diego Health, and Director of the advanced lipid treatment program at UC San Diego Health, Board of Directors of the National Lipid Association and Associate editor of the American Journal of Preventive Cardiology References: -The American Heart Association PREVENT Online Calculator -Lipoprotein(a) as a Pharmacological Target: Premises, Promises, and Prospects – Circulation 2025; 151:400-415 -2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation Volume 153, Issue 17, 28 April 2026; Pages e1154-e1276

Free course: Improve your metabolic healthGet our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠⁠https://levels.link/wnl⁠High cholesterol. Elevated ApoB. A positive CAC score. Now what?Most people quickly find themselves trapped between two extremes: simplistic advice to “cut saturated fat” and online influencers insisting cholesterol doesn't matter at all.In this episode of A Whole New Level, Mike Haney sits down with clinical research scientist Dr. Kevin Maki to cut through the confusion.Drawing on more than 35 years of cardiovascular research, Maki explains why heart disease risk is about much more than LDL cholesterol alone. He breaks down the roles of inflammation, blood sugar, family history, kidney function, and lipoproteins, while also making a clear case for something many people resist: LDL and ApoB still matter. A lot.The evidence increasingly suggests that when it comes to atherosclerosis, lower for longer is better. That has important implications for diet, statins, and how early we should intervene.Mike and Dr. Maki also tackle saturated fat, seed oils, red meat, industry-funded research, and how to separate evidence from online nutrition debates.

Most people think the cholesterol number on their lab report tells them whether their heart is at risk. But former National Lipid Association President Dr. Kevin Maki explains that LDL is just one piece of a much bigger picture and focusing on it alone can mean missing the markers that matter most.In this episode, Dr. Gabrielle Lyon sits down with Dr. Kevin Maki, former President of the National Lipid Association and co-editor-in-chief of the Journal of Clinical Lipidology, to discuss:Why ApoB and Lp(a) are better predictors of heart risk than LDL and why only about 2% of people ever get Lp(a) testedWhat a beef-vs-chicken feeding study revealed about red meat and cholesterol (the LDL results came back identical at 112 mg/dL)The evidence behind the seed oil debate, including why higher linoleic acid levels tracked with lower inflammation markers across a 2,000-person datasetWhy the balance of cholesterol-raising and cholesterol-lowering foods matters more than saturated fat aloneThe simple "ABCs" framework: A1c, blood pressure, cholesterol - for actually lowering long-term cardiovascular riskBy the end, you'll know which numbers actually predict heart risk, which tests to ask your doctor for, and how to cut through the conflicting noise around fat so you can make evidence-based decisions for the long haul.Thank you to our sponsors:OneSkin - Get 15% off at https://bit.ly/4tZnOpk with code DRLYONBodyHealth - Use the code LYON20 to get 20% off your first order https://bit.ly/48SJ7AC Amp - Visit https://bit.ly/3RcmqBz to get your AI-powered at-home gym for smarter, personalized training.Explore More from Dr. Gabrielle LyonPremium Podcast Subscription: Ad-free episodes, key takeaway summaries, exclusive Q&A, and behind-the-scenes content https://foreverstrong.supercast.comWeekly newsletter: Recipes, podcast updates, and practical weekly insights https://drgabriellelyon.com/sign-up/Apply to become a patient: Personalized care with Dr. Lyon's clinical team https://drgabriellelyon.com/new-patient-inquiry/Find Dr. Kevin Maki at:Midwest Biomedical Research: https://www.mbclinicalresearch.com/ LinkedIn: / kevin-c-maki-phd-497ba34 Connect with Dr. Gabrielle Lyon:Instagram: https://www.instagram.com/drgabriellelyon/TikTok: @drgabriellelyon X (Twitter): https://x.com/drgabriellelyonFacebook: https://www.facebook.com/doctorgabriellelyon Chapters00:00 - Introduction00:31 - Dr. Kevin Maki and the National Lipid Association01:04 - New dietary guidelines and the LDL confusion02:04 - What raises and lowers LDL cholesterol03:51 - Cholesterol levels from birth through puberty05:11 - The lipid panel kids should get before age 1106:42 - Lp(a): the test only 2% of people get08:18 - ApoB and the three risky particle types11:35 - Do we have evidence for "lower is better"?14:09 - The FLASH-GLICK risk factor framework17:10 - The 10% saturated fat guideline explained19:36 - Many dietary patterns can be healthy24:50 - Beef vs. chicken: identical LDL results27:10 - The balance of fatty acids that matters29:24 - Olive oil vs. corn oil feeding study31:00 - Lower for longer: 40-year risk reduction34:15 - Genetic cholesterol disorders and risk40:33 - The omega-3 index and why it matters49:10 - Are seed oils really driving inflammation?53:11 - How seed oils are processed and refined1:07:48 - Inherited beliefs and outdated nutrition science1:08:54 - Butter vs. cheese and high-fat dairy surprises1:14:48 - Exercise effects on HDL and triglycerides1:21:20 - The ABCs of reducing cardiovascular riskIf you found this episode valuable, share it with someone who would benefit from it.Disclaimers: This episode includes paid sponsorships.The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.

Heart disease is the number one killer of women. Not breast cancer. Heart disease. And the treatment guidelines just changed. The 2026 Dyslipidemia Guidelines are rewriting, assessing, and treating cardiovascular risk, with updates that are especially relevant for women in midlife and beyond. I have one of the most respected lipidologists in the country, Dr. Tom Dayspring, here to break it all down in plain English. With so much misinformation on social media from undereducated clinicians to influencers and statin haters, it's up to you to educate yourself through trusted sources. Dr. Dayspring is one of the most sought-after lipidologists and cardiovascular educators in the country and is a Fellow of both the American College of Physicians and the National Lipid Association, board-certified in internal medicine and clinical lipidology, and has delivered over 4,000 lectures across all 50 states on lipids, cardiovascular disease, vascular biology, and women's heart health. He has served as Chief Academic Advisor for major cardiovascular laboratories, authored lipid textbook chapters, and received the National Lipid Association's President's Award and their Clinician Educator Award — two of the highest honors in his field. He is a Gold Heart Member of the American Heart Association and a Social Media Ambassador for both the European Atherosclerosis Society and the National Lipid Association. Over 34,000 people follow his educational content on X at @DrLipid, and after this episode, you will understand exactly why. Medical Disclaimer: By listening to this podcast, you agree not to use this podcast as medical advice or to make any lifestyle changes to treat any medical condition in yourself or others. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any of my guests on my podcast. Stay connected with JFW: Watch on the YouTube channel: https://www.youtube.com/@jillfooswellness/videosFollow on Instagram: https://www.instagram.com/jillfooswellness/ Follow on Facebook: https://www.facebook.com/jillfooswellness Grab discounts on wellness products: https://www.jillfooswellness.com/health-products Enjoy 20% savings and free shipping at Fullscript for your favorite supplements by leading brands: https://us.fullscript.com/welcome/jillfooswellness Subscribe to the JFW newsletter at www.jillfooswellness.com and receive your FREE Guide on How To Create Your Menopause Health Equation Ebook. Schedule your complimentary 30-minute Zoom consultation here: https://calendly.com/jillfooswellness/30-minute-zoom-consultations Join Group Health Coaching here: https://www.jillfooswellness.com/group-coaching If you're a Chicago-area midlife woman, check out the Chicago Menopause Collective, a nonprofit dedicated to navigating menopause locally with experts: https://chicagomenopausecollective.org

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.  Given 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 segments 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 transport of cholesterol and the roles of apoptosis, apo-proteins, and apo-lipoproteins; we unravel the differences between HDL, LDL, IDL, and VLDL; and we explain how to calculate LDL and triglycerides to assess metabolic health. Dr. Dayspring also shares his preferences regarding lab values and indicators that help him assess the early risk of cardiovascular disease. We cover some detailed aspects of physical chemistry in this episode, so I highlight the main clinical points throughout our conversation to make it easier to follow. 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, he moved to Virginia in 2012. 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 X, Instagram & LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Join other like-minded women in a supportive, nurturing community (The Midlife Pause/Cynthia Thurlow)  Cynthia's Menopause Gut Book is on presale now! Cynthia's Intermittent Fasting Transformation Book The Midlife Pause supplement line Connect with Dr. Thomas Dayspring ⁠Twitter⁠ (@DrLipid) ⁠LinkedIn⁠ ⁠Books written by Gary Taubes⁠ 

We are discussing perspective changes in neurology genetics with the crossover of the APOE gene in neuro and cardio as well as telehealth for neurology predictive testing. Segment 1: Is it time for a paradigm shift? Inclusion of APOE  on genetic dyslipidemia panels.   Emily Brown is a certified genetic counselor at the Center for Inherited Heart Disease at Johns Hopkins Hospital. She graduated from the University of Maryland Genetic Counseling Program in 2014 and has practiced in cardiology for the past 10 years. Her main areas of interest include dyslipidemias, and she is a member of the National Lipid Association.   Hannah Ison is a cardiovascular genetic counselor at the Stanford Center for Inherited Cardiovascular Disease. She received her Master's in Medical and Molecular Genetics from Indiana University in 2018, and returned home to California to begin her career. Her primary clinical interest includes working with patients who have inherited lipid conditions in both the adult and pediatric setting. A large part of her role has been focused on developing a Pediatric Lipid Clinic at the Stanford Children's Hospital, allowing her to care for patients across the generations. Hannah was the co-chair of the Dyslipidemia Working Group through the cardiovascular SIG from 2020-2024 where she worked with members to develop dyslipidemia resources. In addition to her work in the lipid space, she also provides inpatient and outpatient genetic counseling to patients with isolated congenital heart disease, and enjoys participating in various research opportunities.    In this segment we discuss: - APOE's relevance in both Alzheimer's and cardiovascular disease - Counseling strategies for APOE alleles (ε2, ε3, and ε4), including penetrance, lifestyle modification, and exploration of risk for conditions and symptoms external to Alzheimer's - Case studies highlighting APOE's diagnostic, variant, and treatment insights - The need for standardization, education, and reframing of APOE testing in practice Segment 2: Patient-reported outcomes for remote and in-person visits for genetic counseling in adult neurology.   Rachel A. Paul, MS, CGC and Laynie Dratch, ScM, CGC are board-certified genetic counselors who specialize in adult neurogenetics and work with the Penn Neurogenetics Therapy Center team in Philadelphia, PA (https://www.linkedin.com/company/penn-neurogenetics-therapy-center).   Rachel provides clinical and research genetic counseling services for the Division of Movement Disorders at the University of Pennsylvania. Her research interests include genetic screening for clinical trials access, remote/telemedicine genetic services, and motivations/barriers for genetics utilization. She graduated cum laude from Temple University in Philadelphia, previously worked as a genetic counseling assistant (GCA) for the Penn neurogenetics program, and completed her training with the Arcadia University (now University of Pennsylvania) Genetic Counseling Program.   Laynie's clinical focus includes frontotemporal degeneration (FTD) spectrum disorders, amyotrophic lateral sclerosis (ALS), and other neurodegenerative conditions. Her research interests include the lived experiences of at-risk individuals, predictive genetic testing considerations, and genetic counseling access and service delivery. She graduated summa cum laude from Colgate University with a BA in neuroscience and a minor in psychology, and completed her genetic counseling masters training at the Johns Hopkins University and the National Institutes of Health.   In this segment we discuss: - How COVID-19 pushed neurogenetics counseling from in-person to telehealth. - Why patient satisfaction stayed high across both formats, with video outperforming phone. - What drives visit preferences—travel, tech comfort, privacy, and clinical needs. - Future research to refine protocols, improve access, and explore broader applications.   Would you like to nominate a JoGC article to be featured in the show? If so, please fill out this nomination submission form here. Multiple entries are encouraged including articles where you, your colleagues, or your friends are authors.   Stay tuned for the next new episode of DNA Dialogues! In the meantime, listen to all our episodes Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Dialogues”.    For more information about this episode visit dnadialogues.podbean.com, where you can also stream all episodes of the show. Check out the Journal of Genetic Counseling here for articles featured in this episode and others.    Any questions, episode ideas, guest pitches, or comments can be sent into DNADialoguesPodcast@gmail.com.    DNA Dialogues' team includes Jehannine Austin, Naomi Wagner, Khalida Liaquat, Kate Wilson and DNA Today's Kira Dineen. Our logo was designed by Ashlyn Enokian. Our current intern is Stephanie Schofield.

I am deeply honored to reconnect with Dr. Thomas Dayspring, who joined me in 2024 for an immensely popular five-part series. Dr. Dayspring is certified in internal medicine and clinical lipidology. He is a distinguished fellow of both the American College of Physicians and the National Lipid Association.  Today, we have the first episode in a new series of conversations with Dr. Dayspring, in which he will share more of his perspective and answer more questions from listeners. In our discussion, we review the basics about cholesterol, triglycerides, and lipoproteins, exploring the factors that contribute to the development of cardiovascular disease, the significance of ApoB and Lp(a), and the risk factors for younger women. We also dive into the limitations of traditional allopathic medicines, and Dr. Dayspring shares his views on lipids, lipid changes in menopause, specific ways to address ApoB, some of the challenges associated with statin therapy, and more.  Dr. Dayspring brings a wealth of experience and expertise to this discussion, and you are sure to find this series as invaluable as the last. IN THIS EPISODE, YOU WILL LEARN: Dr. Dayspring revisits the differences between cholesterol, triglycerides, and lipoproteins What atherosclerosis is, and why it is concerning Dr. Dayspring explains the structure and function of lipoproteins The role of ApoB in lipoprotein particles and its significance in atherosclerosis Some of the risk factors for lipid abnormalities in younger women Lipid changes that occur as women transition from perimenopause to menopause  Dr. Dayspring shares his take on statin therapy Ways to address high ApoB Dr. Dayspring's suggested goals for ApoB therapy Connect with Cynthia Thurlow   Follow on ⁠X⁠, ⁠Instagram⁠ & ⁠LinkedIn⁠ Check out Cynthia's ⁠website⁠ Submit your questions to ⁠support@cynthiathurlow.com⁠ Connect with Dr. Thomas Dayspring On⁠ X⁠ (@Drlipid) On⁠ LinkedIn⁠ ⁠Journal Article: Atherosclerosis: Non-genetic influences on lipoprotein(a) concentrations⁠  ⁠Journal of the American Heart Association: Trajectories of Blood Lipid Profiles in Midlife Women: Does Menopause Matter?⁠  

If you ordered a steak at a restaurant are you essentially ordering a heart attack or a nutrient-rich whole food?Few foods spark more debate than red meat. It's been blamed for heart disease, cancer and diabetes, but some people praise it for being high in iron, zinc, vitamin B12 and quality protein. So, if you add red meat to your plate is it helpful or harmful?Whether you eat meat or avoid it, I think you'll find today's conversation cuts through the noise of social media and clears up a lot of confusion in the nutrition space. I wanted to disentangle the obvious issues surrounding environmental concerns of eating animal products from today's discussion, and simply talk through the data as we have it. It's given me a lot to think about when it comes to recommendations for people, as well as how concerned I would be about red meat consumption overall.Today we're chatting with researcher and academic Dr. Kevin Maki, PhD, who specialises in clinical studies on nutrition, metabolism, and chronic disease risk factors. He's also an Adjunct Professor at Indiana University School of Public Health, a Master and Past President of the National Lipid Association, and a Fellow of the American Heart Association and The Obesity Society. Dr. Maki has participated in over 300 clinical trials and published more than 250 scientific papers, books and book chapters.You're going to learn about:Whether red meat is actually unhealthier than poultryWhat red meat really does to your cholesterol, your blood pressure and your long-term health riskWhether red meat is a source of unhealthy fatsTypes of red meat and which ones are less healthy than othersHow much red meat you can safely consumeWe also talk about seed oils, plus high protein diets and their relationship to kidney disease, longevity and diabetes risk.The 4 big takeaways I got from this episode were:Moderate amounts (50g per day) of unprocessed lean red meat in the diet is fineDiet quality and the addition of whole unprocessed foods is more importantHigh Protein is very important in middle aged and older adultsBeware of the 4 white poisons: Sugar, Salt, Saturated Fat and refined Starches

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

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.

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:

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