CME Multimedia Activities

Diagnosis and Management of Familial Hypercholesterolemia in Children and Adults

Anne C. Goldberg, MD, FACP, FAHA, FNLA, Jennifer G. Robinson, MD, MPH, FNLA,Peter P. Toth, MD, PhD, FAAFP, FAHA, FCCP, FACC, FNLA, Samuel S. Gidding, MD, Matthew K. Ito, PharmD, FNLA

This activity will provide important contents from the live FH Highlights Symposium: Diagnosis and Management of Familial Hypercholesterolemia in Children and Adults, held in New York City in May 2011. The National Lipid Association has partnered with Elsevier to create an open-access, journal-indexed Internet CME/CE activity, based on slide highlights.

Why should we be focusing specifically on the subset of lipid disorders known as FH? The first reason is the greatly increased risk of cardiovascular disease (CVD) and death that is associated with the presence of FH. FH is an inherited genetic disorder that results in pathologically high serum cholesterol concentrations, with the expected greatly increased risk of premature coronary heart disease (CHD). The condition is not so rare that it will not be seen in ordinary clinical practice. Since approximately 1 in 500 people has FH, in the United States there are an estimated 600,000 people who are affected.

If unrecognized and left untreated, FH results in substantially increased risk of CVD events in both men and women, leading to their occurring at much younger ages than in the general at-risk population without FH. The mean age of onset of CVD events in men with FH is the early 40s and in women with FH it is the early 50s. In the presence of the FH phenotype there is a 20-fold increase in the risk of an MI before age 40. The second reason to focus on FH is because FH is in fact a treatable disease. At present it is too often underdiagnosed and undertreated, but the evidence shows clearly that earlier recognition and appropriate treatment can decrease the risk of developing CHD. The goal of the FNLA's FH campaign is to raise awareness of FH as a family cholesterol issue and to motivate patients and families to talk about the condition. We want to increase public awareness of FH, encourage those at risk to explore their family cholesterol history, and for all those with FH or at risk for FH, we want to stimulate them to increase their interactions with their families, other patients, and doctors and finally, to seek out and find a lipid expert.

This activity supported by an educational grant from Genzyme.

The content posted on this online activity has been reviewed and approved by Journal of Clinical Lipidology. Author conflict of interest statements for the video presenters are accessible on this Webpage

Translating HDL Science to Clinical Practice

M. John Chapman, BS, PhD, DSc, Ernst J. Schaefer, MD, FNLA, Daniel J. Rader, MD, FNLS, Philip J. Barter, MD, PhD, Robert S. Rosenson, MD, FNLA

To provide an enduring record of the most important contents from the live HDL Highlights Symposium: Translating HDL Science to Clinical Practice, held in New York City in May 2011, the National Lipid Association has partnered with Elsevier to publish an open-access, journal-indexed Internet activity, with optional CME/CE credit, presented as a slide-driven narrative with edited text for each figure interpolated from the audio presentations. This online publication from the Journal of Clinical Lipidology provides the opportunity to access the contents visually, acoustically, and via the peer-reviewed text, as presented during this key opinion leader symposium.

There has been a lot of discussion recently about high-density lipoprotein (HDL) cholesterol and how the physiologic functioning of HDL might relate to cardiovascular disease (CVD) risk. Since it is the excess cholesterol that accumulates in macrophages embedded in the arterial wall that eventually leads to an increase in risk of CVD events, the principal function of HDL cholesterol that affects this increase in risk is its ability to promote efflux of cholesterol from macrophages. How this occurs and how this is measured in humans is the subject of this presentation.

The concept of "cholesterol efflux capacity" as a biomarker of HDL function in humans has been around for several years. It has been well demonstrated in controlled settings in vitro that HDL cholesterol promotes removal, or efflux, of cholesterol from cells such as macrophages, but clearly humans in vivo differ in their CVD risk and it is logical to assume that there are interindividual differences among humans in how functionally competent their HDL cholesterol is at promoting the efflux of cholesterol from their macrophages. The question is, how do we actually go about testing the idea that people differ in the ability of their HDL cholesterol to promote efflux, and how do we demonstrate that this is relevant to cardiovascular risk?

This activity supported by an educational grant from Genentech.

The content posted on this online activity has been reviewed and approved by Journal of Clinical Lipidology. Author conflict of interest statements for the video presenters are accessible on this Webpage (see Faculty Disclosures).