🌟Future of Dyslipidemia Management🌟
🧵on this great session from #ACC21 #ACCMedStudent
1/ Team-based approach to improve CV outcomes
🔸pharmacist interventions reduce LDL-C
🔸sessions with dietitian improves lipids &📉costs
🔸Multi-D lipid clinic⬆️guideline-directed treatment
2/ Familial Hypercholesterolemia (FH)
♦️ Genetically inherited, autosomal dominant
♦️ LDL-C >190 mg/dL
♦️ Family hx of premature coronary disease
Presence of corneal arcus (ring of cholesterol precipitate) or tendon xanthoma (>8mm Achilles tendon) before age 45 highly suggestive
3/ Genetic Testing for pts at risk due to family history or w/ FH phenotype
🌟Up to 30% of patients with very high LDL-C have high polygenic risk score (PRS) vs. single gene mutation🌟
4/ New Targets for LDL-C Reduction
🫀 Bempedoic Acid - prodrug, inhibits ATP citrate lyase (biosynthesis of cholesterol)
🫀 Evinacumab - antibody for angiopoetin-like protein 3 (ANGPTL3)
🫀 Inclisiran - injectable siRNA, inhibits PCKS9 translation
🫀 CRISPR -pre-clinical studies
5/ Lp(a) measurement
Major issues:
🔸units of measurement (mg/dL vs. nmol/L)
🔸lack of standardization of assays
Apo(a) isoform size heterogeneity can complicate Lp(a) measurement
Recommend➡️particle concentration units (nmol/L) rather than mass concentration (mg/dL)
6/ 🔥2021 Lipid Clinic🔥
From 1995 study showing improvement in LDL goal attainment w/ lipid clinic pubmed.ncbi.nlm.nih.gov/7487258/
To 2021...what is different?
♦️ Telemedicine
♦️ IT and billing support
♦️ COVID-19
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