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NLA publishes recommendations for lipid management in high-risk populations
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The National Lipid Association published the second part of its recommendations for patient-centered management of dyslipidemia, focusing on lifestyle interventions and lipid management in special populations.
The recommendations, written by an expert panel convened by the National Lipid Association (NLA), were published in the Journal of Clinical Lipidology and posted on the NLA’s website.
Carl Orringer
When addressing the management of cholesterol levels in special populations, the NLA expert panel examined “diverse ethnic and racial groups such as African Americans, Hispanics and South Asians, and also looked at conditions that span the lifespan, from children to seniors and from pregnancy to menopause,” Carl Orringer, MD, FACC, FNLA, president of the NLA, associate professor of medicine at the University of Miami Miller School of Medicine, and a member of the expert panel, said in an interview with Cardiology Today. “Part two also covers conditions not previously identified as high risk, such as individuals with HIV and rheumatoid arthritis.”
Lifestyle control
Some ethnic and racial minorities have elevated rates of obesity, diabetes and metabolic syndrome, and many members of these groups may need lifestyle parameters controlled aggressively, the panel wrote.
The recommendations state that lifestyle therapy should be attempted first for cholesterol lowering in these populations, and that if drug therapy is necessary, statins are the therapy of choice. If high-risk patients cannot attain atherogenic cholesterol goals despite a maximally tolerated statin dose, physicians should consider adding other lipid-lowering therapies such as ezetimibe (Zetia, Merck), the panel wrote.
The panel recommended many measures related to diet. “When it comes to nutrition and cardioprotective eating, the NLA recommends limiting dietary cholesterol intake to less than 200 mg/day in order to lower levels of atherogenic cholesterol, and we also emphasize the importance of eating a variety of plant-based foods and lean sources of protein,” Orringer told Cardiology Today.
Exercise crucial
Physical activity also plays an important role in the CV health of these special populations, Orringer said. “We recommend a minimum of 150 minutes of moderate- or high-intensity exercise — that is, aerobic CV exercise — per week as a way to maintain weight,” he said. “Those who want to lower their weight if they are overweight or obese are going to need more than that on a weekly basis to achieve some success in their weight-loss program.”
The panel also recommended that physicians discuss adherence to lifestyle and drug therapies at every patient visit; give continual feedback to patients about their LDL and non-HDL levels; and when necessary, convene a multidisciplinary team — including nurses, nurse practitioners, clinical pharmacists, physician assistants and dietitian nutritionists — to help patients with adherence issues, according to a press release.
Orringer told Cardiology Today that the document addresses some issues that are not found in any other guidelines or consensus statements. “These areas that we emphasize were not specifically addressed in the 2013 American College of Cardiology/American Heart Association guidelines [on management of atherosclerotic CVD] and the 2014 NLA recommendations for management of patients with dyslipidemia,” he said. “This document will help to fill in some of the gaps in special populations.” – by Erik Swain
Disclosures: Orringer reports no relevant financial disclosures. Please see the full document for a list of the other authors’ relevant financial disclosures.
For more information:
Carl Orringer, MD, FACC, FNLA, can be reached at 1295 NW 14th St., Suite A, Miami, FL 33125; email: carl.orringer@gmail.com.
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