Dyslipidemia in pregnancy, ethics, genetics among key NLA topics
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The virtual National Lipid Association Scientific Session, held Dec. 10 to 12, covered topics such as dyslipidemia during pregnancy, genetic testing and the ethical concerns of lipidologists.
Daniel Soffer, MD, clinical associate professor of medicine in the division of general internal medicine at the Perelman School of Medicine of the University of Pennsylvania, discussed his personal highlights from the meeting with Healio.
“There was full attendance, lots of attendee engagement in the chat room, superb lecturers and discussion, and great content combining clinical and science,” Soffer said in an interview. “There were many highlights, but I especially appreciated the opening sessions.”
Lipid issues in pregnancy
One session discussed CV preventive care during pregnancy.
Topics during this session included how to counsel women with severe dyslipidemia regarding contraception; managing dyslipidemia during pregnancy; and nutrition therapy during high-risk pregnancy in women with severe hypertriglyceridemia.
“The pregnancy-related talks reminded me that the peripartum is an opportunity to screen young women for inherited lipid disorders and cardiometabolic risk who may have evaded early detection to date,” Soffer said in an interview. “Further, those women require additional attention during pregnancy since their underlying risk adds risk to the pregnancy and then serves as an important hallmark in their lives indicating risk later in life.”
As Healio previously reported, lipid levels increase during pregnancy, and may be a concern for women with already elevated lipid levels, according to a presentation by Pamela B. Morris, MD, FACC, FAHA, FASPC, FNLA, director of preventive cardiology and co-director of women’s heart care at the Medical University of South Carolina, who said few evidence-based options exist for women with dyslipidemia who become pregnant or are thinking about it.
“We have not had sessions devoted to pregnancy in a long time and this particular demographic is an at-risk population with complicated issues,” Soffer told Healio. “The day before, an National Lipid Association (NLA) member had emailed me for advice about a pregnant woman with severe lipid concerns; it was perfectly addressed in the NLA talks the next day.”
Ethics in lipidology
Soffer said he also found valuable a session on potential ethical dilemmas in lipidology.
Topics in this session included the ethicality of ovum selection for familial hypercholesterolemia; genetic testing for familial hypercholesterolemia before the age of consent; statin therapy and reproductive health in adolescents; and the potential job-related effects of cholesterol screening.
“I thought this session was unique because I don’t think of that many ethical dilemmas in lipidology. There was a focus on a case that was exotic, unusual and, admittedly, not something any of us are going to encounter in our practice: embryo selection based upon an inherited cholesterol disorder,” Soffer said in an interview. “One of our colleagues had a patient come in and say, ‘I’d like to make sure that my child does not inherit the same inherited cholesterol syndrome that I have,’ which, on the surface, sounds not entirely unreasonable.
“If we can identify diseases and prevent them before they appear, it is not an unreasonable thing to do, except that this particular disorder that she has is completely treatable and has normal life expectancy associated with it without any major adverse events,” Soffer told Healio. “It raised some interesting questions for people who are deep into the science of it to ponder.”
Healio also reported on the discussion of statin initiation for girls of childbearing age. According to the presentation, statin therapy at a young age is safe and effective in preventing future CV events in patients at increased atherosclerotic risk, but girls and women may require counseling for pregnancy planning.
Genetics in lipidology
During a session on the impact of genetics on clinical practice, researchers discussed topics that included genetic testing for lipid disorders; polygenic risk scores for CVD; direct-to-consumer genetic testing; and genetics and biotechnology therapies.
“A lot of it was reiteration of where we are,” Soffer said in an interview. “The NLA put out a scientific statement on the use of genetic testing in dyslipidemia in the past year. That session was not a rehash of the statement, but it affirmed why the NLA statement is what it is.
“The most common condition that we treat patients for, where a genetic test is relevant is familial hypercholesterolemia. It affirmed the value of using genetic testing for familial hypercholesterolemia,” Soffer told Healio. “There was some conversation about the complexity of using it for triglyceride disorders and other lipid disorders. Genetic testing is not quite ready for prime time in terms of every person who comes in the door with any kind of dyslipidemia. It needs to be done in a very thoughtful way.”
Read more from the NLA Scientific Sessions on Healio.
References:
- Ahmad Z. NLA Opening Session: Impact of Genetics on Clinical Practice.
- Brown EE. NLA Opening Session: Impact of Genetics on Clinical Practice.
- Ballantyne CM. NLA Opening Session: Impact of Genetics on Clinical Practice.
- Donovan GK. Session II: Ethical dilemmas in lipidology.
- Karmally W. Session I: Cardiovascular Preventive Care in Pregnancy.
- Knowles JW. NLA Opening Session: Impact of Genetics on Clinical Practice.
- Liebeskind A. Session II: Ethical dilemmas in lipidology.
- Morris P. Session I: Cardiovascular Preventive Care in Pregnancy.
- Prippi JA. Session II: Ethical dilemmas in lipidology.
- Thompson JL. Session I: Cardiovascular Preventive Care in Pregnancy.
- Wilson D. Session II: Ethical dilemmas in lipidology. All presented at: National Lipid Association Scientific Sessions; Dec. 10-12, 2020 (virtual meeting).
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Healio Interview
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