Holistic Lipid Management and CVD Prevention Yield Results
The time to rigorously manage lipids and cardiovascular disease risk factors is now. That’s the position Peter Dionisopoulos, MD, takes as medical director of the Cardiovascular Health and Lipid Clinic at the Nebraska Heart Institute in Lincoln
“When we started the clinic back in 2001, it was primarily a lipid clinic,” he said. “It was for individuals whose lipids were not controlled, usually because of intolerances to medications.”
Tactics for managing lipids and preventing heart disease continue to evolve.
“When you look at goals, the recent guidelines aren’t really pushing toward a specific number, they’re pushing at treating people aggressively,” said Dr. Dionisopoulos, who is also chief medical officer of CHI Health cardiovascular services.
“For example, if someone has had an event — a heart attack, a stent, or bypass surgery — those individuals we know need to be treated with statins. They need to be treated with what we call high-potency statins and they need to be treated at very high levels.”
To get patients to goal, the Cardiovascular Health and Lipid Clinic brings together a cardiologist, physician assistant, dietitian and medical technologist.
“We have to take the whole patient into account, take the whole risk profile into account, put them on the appropriate medications and then see if there’s still what we would call a gap in that treatment that we need to be more aggressive in treating,” said Dr. Dionisopoulos.
As many as 33 percent of people fall into that category, and benefit from advanced lipid and metabolic lab testing. “Sometimes individuals may appear to be where you want them to (be), but the more advanced numbers show you that they are still far away from their actual goals,” said Dr. Dionisopoulos.
Cardiovascular risk factors that patients can control, such as smoking, diet and activity, require lifestyle changes that can be difficult to achieve. Presenting real-life scenarios makes the risks real for patients. “If you continue, for example, smoking, or if you continue not eating correctly, or if you continue with your diabetes being out of control, what are the potential ramifications of that?” said Dr. Dionisopoulos.
Those scenarios are followed with solutions. According to Dr. Dionisopoulos, “We do feel that with education, a lot more patients are willing to change than if we just prescribed a medication to them and sent them out the door.”
The team approach extends to referring physicians. Dionisopoulos cited triglyceride abnormalities in diabetic patients as an incidence where physician collaboration yields results. “If we don’t work together with the primary care or endocrinologist to get (patients’) diabetes under control, getting their triglycerides under control is very, very difficult,” he said.
Patients who successfully reduce their risk factors can avoid a future heart attack or stroke but it starts with a clear picture.
“We’re actually looking at the whole individual, helping the individuals identify and correct those risk factors, so that they stay healthy and the chance of them having a cardiovascular event is drastically reduced,” said Dr. Dionisopoulos.