Ballantyne: Prevention of heart disease crucial, core of NLA’s mission
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Key takeaways:
- Much of the cardiology field is focused on treating end-stage heart disease, but prevention is more important.
- The National Lipid Association (NLA) is prioritizing research and education on prevention of CVD.
Prevention of heart disease will do more good in the long run than procedures to treat advanced heart disease, the incoming president of National Lipid Association said at the NLA’s Scientific Sessions.
“There’s a huge focus on treating end-stage disease,” Christie M. Ballantyne, MD, FACC, FACP, FAHA, FNLA, chief of the section of cardiovascular research and professor of medicine at Baylor College of Medicine, said during the incoming presidential address. “Our fellows are thrilled to go work in the cath lab [or with left ventricular assist devices and] artificial hearts. It’s like being a fireman, where you come in during a disaster and make rescues. But the problem [is that] it’s really too little, too late. If we look at what is more effective, it’s not a heroic effort in a burning building, it’s having smoke alarms, having well-designed buildings and doing things in a way that you’re not going to have catastrophes. That’s what we do as preventive cardiologists. Unfortunately, most of the fellows think it’s pretty boring, although they know it’s important. Too much of the resources go into the end-stage late disease.”
Systematic approach to CVD prevention
Ballantyne, who said he became a cardiologist in part because people on both sides of his family had premature heart disease, said the future should bring a more systematic approach to prevention of CVD, in which “where we’re going to end up is screening at birth in terms of some genetic testing, identification of [familial hypercholesterolemia], maybe even polygenic risk scores very early on in life, looking at things like lipoprotein(a). This will allow things like family lifestyle planning and let us know who is going to be at risk [and should be considered for] early initiation of therapies. Imaging will keep improving and we will have more personalized therapies. We will hopefully do a much better job so we don’t get into the catastrophic secondary preventions with [atherosclerotic] CVD. At the other end [of life], we will focus on healthy aging and prevention of heart failure, making sure we have cardiovascular health, which is critical to cognitive health. More people end up with dementia from vascular disease than Alzheimer’s.”
It is NLA’s mission to make a difference in these areas and to move the field forward via advocacy and policy, education, developing tools to improve care, providing leadership nationally and locally, conducting research and providing direct patient care, he said.
NLA priorities
An immediate priority for the NLA is the LDL-C quality measurement project, the aim of which is to get CMS to include LDL measurement in its “Universal Foundation” of quality measures, from which it is missing despite the inclusion of BP and glucose measurements, Ballantyne said.
“We manage what we measure, so ... no requirement for a lipid panel is insufficient to improve LDL-C management,” he said.
Another short-term priority is to request that CMS designate lipidology as a specialty taxonomy code, he said.
He also said the NLA will prioritize the following in terms of scientific statements:
- updating the 2013 manuscript on FH;
- developing an expert clinical consensus on chylomicronemia resistant to traditional triglyceride-lowering treatments;
- developing a team-based approach to management of lipids and cardiometabolic disease;
- creating an expert clinical consensus on making primary prevention simple;
- making a document in collaboration with the Family Heart Foundation on how to perform cascade screening; and
- developing an expert clinical consensus on managing LDL for the primary care and internal medicine audience.
The NLA also wants to expand its educational offerings, increase efforts to retain and expand membership, enhance its social media presence and conduct podcasts, work with other organizations to develop cascade screening for FH and Lp(a), assess the effectiveness of at-home cholesterol testing and create a registry of patients with severe hypertriglyceridemia or chylomicronemia, Ballantyne said.
“How do we accomplish these goals and move the field forward? The main thing is that we get involved,” he said. “We are all members of a team, and it is really important that each member play a role in our mission.”
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Ballantyne CM. NLA incoming president’s address. Presented at: National Lipid Association Scientific Sessions; May 30-June 2, 2024; Las Vegas (hybrid meeting).
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