Updates to NLA’s 2016 Annual Summary of Clinical Lipidology: An Interview with Harold Bays, MD

In February of 2016, the National Lipid Association (NLA) released its Annual Summary of Clinical Lipidology, which is an update to Parts 1 and 2 of the NLA’s “Recommendations for Patient-Centered Management of Dyslipidemia,” both published in 2015.^2,3 The summary is unique in that it contains both updated content and a novel format. To shed further light on the changes in the new summary, MPR spoke to Harold E. Bays, MD, who was the lead author. 

How was the National Lipid Association Summary developed?

Lipidology is a rapidly evolving field. For this reason, NLA holds an annual summit to review the latest evidence and make sure we are remaining current. The annual summary is derived from discussions and conclusions reached during the summit. It is crafted by core authors and reviewed by almost 40 experts, and it puts forth the principles that inform patient-centered evaluation and management of dyslipidemia. We regard this as an evolving process, so each year our summary takes into account emerging research, clinical considerations, and new NLA Position, Consensus, and Scientific Statements.

What new content is presented in the 2016 summary?

The updates to the summary reflect the NLA’s “Recommendations for Patient-Centered Management of Dyslipidemia: Part 2.”³ The new sections focus on dyslipidemia management in select patient populations, including those with HIV and rheumatoid arthritis. In addition, we include updates to sections pertaining to lifestyle interventions and to groups with special considerations, such as children, adolescents, women, older adults, and minorities. (Tables 1-5)

For example, most outcomes trials have excluded individuals older than 75 years, which creates uncertainty as to how to treat them. Yet older folks are clearly at high risk for atherosclerotic cardiovascular disease (ASCVD) and should at least be candidates for lipid therapy. Our document encourages clinicians to use their own clinical judgment, which is key, and clarifies some of the factors to take into account, such as poor prognosis, severe debilitation, multiple drug interactions, cost considerations, and patient preference. After weighing the risks and benefits in light of these multiple factors, clinicians may decide that use of aggressive lipid-lowering therapy is not in the patient’s best interest or may make a different decision.

Additionally, we provide lifestyle recommendations (Table 6) and summarize strategies to improve adherence and incorporate team-based collaborative care. These are important components of a patient-centered approach. (Table 7)