NLA 2024 Scientific Sessions KOL Insights Featuring Daniel Soffer, MD, Penn Medicine, Past NLA President

My name is Dan Soffer. I'm an internist and lipid specialist at the University of Pennsylvania. And I'm also the immediate past president of the National Lipid Association as of three days ago.

We try to touch on a lot of different themes at the meeting. But if there is a single theme that got repeated over and over again it's no matter what we think is the right thing to do, we as a society, we're not keeping up with all the things that we absolutely already know are good for us. And so as we try to push the envelope and do more, we have to remember to make sure that we do at least the minimum. And we're struggling with that. And so the theme was really implementation, implementation, implementation.

I gave two talks about the role of who apolipoprotein B (apoB) in the care of our patients, and why it's a better metric than LDL cholesterol and some other measures of how well we are managing care. But that's really a nuanced approach to care.

What we have learned ever since 2015 is that when CMS dropped the LDL cholesterol monitoring as a requirement for quality, as a metric for quality care, that over that time clinicians have stopped actually measuring LDL cholesterol. They tend to put their patients on statin drug, maybe, and then not measure whether or not their patients are responding to care. And if they're not measuring whether patients are responding to care, then guess what? Their patients probably are not. If you don't measure it, you can't manage it. So even if they do respond as expected, that may not be enough. So a whole bunch of older and novel therapies for lowering LDL cholesterol and apoB further, and they're grossly underutilized in preference to just prescribing statins as the preferred approach.

And we're doing our patients a disservice by doing that. We use combination therapies for blood pressure; we use these combination therapies for depression; we use combination therapies for reflux sometimes. We definitely need to use combination therapies to optimize lipid management.

We had some late breakers at the session. We learned about therapeutics for familial hypercholesterolemia (FH). It's a rare disease but having pharmacotherapy that can really impact on patients who are desperate for treatment, who have no other therapy. There's no FDA approved therapy for that condition. And so having medication now, that hopefully will be FDA approved shortly based upon the results of this kind of clinical trial is fantastic.

We also had a late breaker from the Timi group. And they just published some data from clinical trials that were done on PCSK9 inhibitor showing that in a subset of patients who have chronic inflammatory disease that you get a very robust response from cholesterol lowering with Pcsk9 inhibitor in that population. So sort of thinking about the relationship between inflammation and the lipoproteins that, that drive that processes.

And then another presentation on the impact of a specific anti-inflammatory therapy called colchicine, which is a drug that's literally hundreds of years old that impacts inflammation, but which all doctors like myself are used to using for acute gout or maybe persistent pericarditis, but not for atherosclerosis.

And now we have accumulated evidence that shows that daily low dose colchicine in the right patient can really make a difference in terms of cardiovascular event reduction. So, another another therapeutic for that.

This is actually an unbelievably rich time in drug development in the lipid space. I don't know that anyone saw this coming necessarily. Of course, we all know about the the huge build up in drug development in the obesity and diabetes space. That's been the thing that's been catching the headlines the most. But in the lipid space, we have new ways to deliver inhibition of PCSK9 that are already available, but also, that are coming, like an oral agent for that. And even gene editing, which is super cool just to think about something as science fictiony as that.

We have novel therapies for two specific targets that you may not probably have not heard of APOC3 and ANGPTL3, both of which are key regulators of triglycerides and atherosclerosis. And in, in the last few years, we had a novel therapy called tempoyak acid. We have novel therapies with different targets, but now we have some new new targets, the APC3 and and PDL3, and some exciting new work that's on the literally on the horizon.

Related Stories

No stories found.