Dr. Karen E. Aspry, director of the Cardiovascular Risk Reduction Program at Memorial Hospital of Rhode Island, recently became the first cardiologist in the state to be awarded diplomate status with the American Board of Clinical Lipidology.
Lipidologists are specially trained to treat dyslipidemia, a disruption in the amount of lipids (fats) in the blood, especially cholesterol and triglycerides. To obtain diplomate status, a doctor must complete continuing-education requirements and pass a rigorous exam.
Aspry spoke with Providence Business News about her work.
PBN: Can you explain more what lipidology entails?
ASPRY: Lipidology is the study of blood lipids or fats, specifically cholesterol and triglycerides, and how they’re absorbed, transported and metabolized in the body. It also includes the study of how abnormal blood lipid levels interact with cells in artery walls to cause atherosclerosis, and of inflammatory biomarkers that can measure the risk of cholesterol plaque rupture, the cause of most heart attacks and sudden cardiac death. Finally, and most importantly, it includes the safe and effective use of medications such as statins, niacin and others to improve blood lipids and lower cardiovascular risk.
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PBN: How big a part of cardiovascular care is lipidology? It seems to me that it’s a key part of the daily work of cardiologists and even primary care physicians.
ASPRY: You’re right. However, treatment of cholesterol disorders has become increasingly complex. From the mid-80s to mid-90s, our focus was on lowering LDL (bad) cholesterol modestly with a single drug (statins), and this was a fairly simple undertaking. However, over the last decade, in response to clinical trial data, cholesterol treatment guidelines have recommended more intensive LDL cholesterol lowering, which usually requires high-dose statin therapy, which requires more pre-selection of patients and more monitoring for side effects. Also, because studies have now clearly shown a significant residual risk from high triglycerides and/or low HDL-cholesterol even after high LDL (bad) cholesterol is lowered, the guidelines now recommend targeting them as well, which usually requires combinations of lipid drugs. Moreover, the pandemic of diabetes and obesity has markedly increased the prevalence of these other lipid disorders. So the bottom line is that providers today must treat lipids more intensively, more comprehensively, and in a larger group of individuals.
PBN: What level of expertise does this certification give you beyond what ordinary cardiologists have?
ASPRY: It enhances one’s skills at recognizing familial (genetic) lipid disorders, using combinations of lipid medications more safely, and treating more complex patients, i.e. those with coronary disease who have other medical conditions that make lipid treatment potentially more risky, like liver disease, kidney disease, HIV disease, organ transplantation, etc. Because I came from a very large, integrated health care system, I’m also comfortable using electronic databases for tracking our patients’ lipid control, which I’m lucky to have in the Memorial Hospital outpatient network, which has a robust EMR that our clinic has customized for disease management of hyperlipidemia.
PBN: Do you focus primarily on statins and other drug therapies, or what else?
ASPRY: We emphasize to our patients that the cornerstone of their lipid treatment is a low saturated fat diet and lifestyle changes, including daily exercise, weight control and stopping smoking. We discuss diet at every clinic visit. … We promote the Mediterranean diet, since it more than others has been associated with reduced cardiovascular mortality. For those with very high triglycerides, we focus on reducing total fat and refined carbohydrates. I also work with a cardiac rehab nurse in my clinic who has extensive experience counseling people about how to incorporate exercise into their daily routines.
PBN: You’re director of a prevention program. How much of an opportunity do you have to truly prevent cardiovascular disease, not just reduce the damage?
ASPRY: We see both high-risk primary prevention patients who have cholesterol disorders and other risk factors, especially a family history, but have never had a coronary event, as well as those with known cardiovascular disease with or without prior heart attack, angioplasty or bypass surgery. In all of these patients, the data show that modest lipid lowering can reduce heart attack risk by at least a third, while more intensive LDL lowering can reduce the risk by 40 to 50 percent. If you add in other interventions, like diet, exercise, stopping smoking and daily aspirin use, it’s estimated that up to 80 percent of future heart disease risk may be ameliorated. It’s intensely gratifying to keep seeing patients back in clinic, instead of in the emergency department or the cardiac cath lab.
Memorial Hospital of Rhode Island – a division of the Pawtucket-based Southeastern Healthcare System Inc. – is a community hospital serving the Blackstone Valley and southeastern Massachusetts. It is a research and teaching affiliate of Brown University’s Warren Alpert Medical School. To learn more, visit www.mhriweb.org.
