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At least 19 recordsLinked to original sources
PubMed2026

Management of complex lipid disorders in a community lipid clinic setting: Implementing a multidisciplinary model.

BACKGROUND: Large treatment gaps exist in the management of lipid disorders, and many high-risk patients have factors that complicate management efforts. While lipid clinics exist within academic medical centers, most of these patients are cared for in community settings. OBJECTIVE: To report our experience and results managing challenging and complex lipid disorders in a community-based lipid clinic. METHODS: We established a specialized lipid clinic in a community medical setting, with a focus on patients with management challenges and/or suspicion of a genetic lipid disorder, employing a multidisciplinary approach to optimize patient outcomes, emphasizing appropriate medical therapies and lipid genetic testing in selected patients. Retrospective electronic health record data were collected to analyze patient characteristics, treatment patterns, and lipid results. RESULTS: Over the period 2022 through 2024, 183 patients were seen (mean 63 years, 62% female). The challenging nature of the patient population was highlighted by high rates of statin intolerance (50%), no lipid medical therapy at baseline (50%), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], diabetes, and/or hypertension-61%). Despite this, over a mean follow-up of 9.4&#xa0;&#xb1;&#xa0;7.3 months, we observed a mean low-density lipoprotein cholesterol&#xa0;decrease of 49&#xa0;mg/dL (-24.5%, P&#xa0;<&#xa0;.001), along with significant decreases in total cholesterol and triglycerides. Pathogenic dyslipidemia genetic variants were discovered in 21 patients (of 105 tested). Significant lipid improvements in the whole cohort, as well as multiple subgroups, were associated with greater utilization of combination therapies. CONCLUSION: Patients with complex lipid disorders can be successfully managed within a specialized lipid clinic in community medical settings. Applying such a multidisciplinary model outside of traditional academic medical centers offers the potential to raise the level of lipid management and ASCVD prevention more broadly in larger populations.

Combination medical therapy↗
PubMed1979

Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Program Prevalence Study. The Lipid Research Clinics Program Epidemiology Committee.

Cross-sectional age- and sex-specific plasma lipid distributions (means, medians and selected percentiles) are given for 48,431 white participants in visit 1 of the Lipid Research Clinics (LRC) Prevalence Study. This study consisted of two visits in which 10 LRCs screened participants selected from well-defined North American target populations that included a broad range of sociodemographic subgroups. These data confirm findings from earlier studies in developed countries, showing age-related differences in plasma lipid levels. However, for overall distributions, the LRC data showed slightly lower cholesterol and markedly higher triglyceride values than those previously reported for North America. Some variation in plasma lipid values was evident among the clinic populations. The large number of participants within most subgroups permitted a variety of analytic and comparative studies. For example, data from the large pediatric population revealed a drop in plasma cholesterol levels in adolescent males and females. Males aged 20--50 years had higher cholesterol levels than females in the same age group, and higher triglyceride levels between ages 20--70 years. Numbers were also sufficient for meaningful comparisons between lipid distributions of females who were taking sex hormones and those who were not: In females taking sex hormones, cholesterol and triglyceride levels were higher for subjects younger than 45 years, but slightly lower after age 45, than lipid levels in females not taking hormones.

Adolescent↗
PubMed1979

Altered plasma lipid and lipoprotein levels associated with oral contraceptive and oestrogen use. Report from the Medications Working Group of the Lipid Research Clinics Program.

In a study of women attending ten North American Lipid Research Clinics plasma total cholesterol, triglyceride, low density (L.D.L.), very low density (V.L.D.L.), and high density (H.D.L.) lipoprotein levels in those taking oral contraceptives (O.C.) and in those taking oestrogens for menopausal symptoms were compared with those in women not taking gonadal hormones, after adjustment for age, educational attainment, and body-mass index, O.C. and oestrogen users were leaner than non-users. Compared with controls, O.C. users showed increased cholesterol, triglyceride, and L.D.L.-cholesterol and V.L.D.L.-cholesterol levels, but H.D.L.-cholesterol levels were similar. Cholesterol, triglyceride, and H.D.L.-cholesterol and V.L.D.L.-cholesterol levels were positively associated with the quantity of the oestrogen component of the O.C. preparations. Compared with non-users, menopausal oestrogen users had slightly lower cholesterol and triglyceride levels, significant decreases in L.D.L.-cholesterol and V.L.D.L.-cholesterol, and a significant increase in H.D.L.-cholesterol.

Adolescent↗
PubMed1979

Electrophoretic separation of high-density lipoprotein choelsterol evaluated and compared with the modified lipid research clinic procedure.

We evaluated a new agarose-gel-electrophoretic procedure (Corning) (I) for separating and quantitating of high-density lipoprotein cholesterol (HDLC), comparing it with the modified Lipid Research Clinics (LRC) procedure (heparin 183 kilounits/L, MnCl2 92 mmol/L) (II). Method I was insensitive to an HDLC concentration of 50 mg/L, but gave a linear dose-response curve between 130 and 1200 mg/L. Method II is sensitive to 50 mg/L and linear from 50--1200 mg/L. The within-plate CV for the Corning method varied from 26.2% for an HDLC of 168 mg/L to 6.8% for 580 mg/L. Within-day between-plate CV for the Corning method ranged from 22.1% at 155 mg/L to 8.0% at 651 mg/L, compared to 3.0 and 0.8% for the modified LRC procedure. Between-day CV for method I was 20, 12.6, 4.3, and 3.5% for HDLC concentrations of 175, 435, 542, and 678 mg/L, respectively; for method II it was 14, 5, 3.5, and 2.6%, respectively. Analysis of HDLC in 100 patients by both procedures showed mean HDLC values to be significantly lower (mean + SD, 27.8 +/- 1.7 mg/L; p less than 0.001) by method I. In 46 patients with HDLC less than 450 mg/L, this difference was accentuated (mean + SD = 40.5 +/- 2.6 mg/L) and clinically significant. Electrophoretic methods offer a promising further alternative method for HDLC separation and quantitation, but the negative bias, present limited sensitivity, and lack of precision at less than 450 mg/L indicate that they are not yet optimal for routine clinical use for patients with values less than 450 mg/L.

Child↗
PubMed1977

Altered plasma-lipids associated with oral contraceptive or oestrogen consumption. The Lipid Research Clinic Program.

Mean plasma cholesterol and triglyceride concentrations were measured in White female users and non-users of oral contraceptives and oestrogens in 10 diverse, demographically defined North American populations. About 50% of the younger women (20-24 years old) were taking oral contraceptives. In these women mean triglyceride concentrations were up to 48% higher and mean cholesterol concentrations were about 5% higher than in non-users. The 95% percentile of the total lipid distribution among non-users was used to define hyperlipidaemia. In young women on oral contraceptives hypercholesterolaemia was up to three times more common and hypertriglyceridaemia was up to five times more common than in non-users. 37% of older women (50-54 years) (presumably intramenopausal and postmenopausal) were hormone users, and in this group there were small, inconsistent alterations in plasma-triglyceride and a modest but consistent reduction in mean cholesterol concentration.

Adolescent↗
PubMed1975

Serum lipoprotein composition in different types of hyperlipoproteinemia.

Fasting serum lipoproteins (LP) were separated into VLDL, LDL and HDL by ultracentrifugation and the content of cholesterol and triglycerides analyzed in each LP class in 69 consecutive men attending a lipid clinic. The effect of using different cut off points in the definition of HLP was discussed. It was pointed out that by using lower values for the cut off points there is only an increase in the number of subjects with hyperlipoproteinemia (HLP) but also shifts in the proportions between the various types of HLP, particularly with increase in the amount of types IIB and IV. In addition to the LP abnormalities inherent in the definition of each type of HLP other LP abnormalities were observed. Thus type IIA HLP had cholesterol rich VLDL with an increased ratio cholesterol/triglycerides. The types of HLP with increased VLDL triglycerides had characteristic changes in both LDL and HDL. For LDL its triglyceride content was increased and HDL showed a lowering of its cholesterol content and a rise in triglycerides. These changes were more pronounced the higher the VLDL triglyceride concentration was. Both normo- and hyperlipoproteinemic subjects having the second pre-beta LP on agarose gel electrophoresis of the VLDL fraction called LPB (Late Pre Beta) had two characteristic LP features. VLDL had an increased cholesterol/triglyceride ratio. LDL had a raised triglyceride content. The relation of LPB to so called intermediary particles was discussed. When the SPB (Sinking Pre Beta) LP variant was present this had negligible effects on the LP composition. Type IIA was present in 14 percent of the 609 men. None had tendinous xanthomata. The LP pattern of this common type IIA was compared to the LP pattern of the uncommon type IIA where tendinous xanthomata are present, called IIA-X. Type IIA-X had much higher LDL cholesterol and in relation to the triglyceride content a more cholesterol rich LDL. Furthermore type IIA-X had lower VLDL lipids than the common type IIA, but type IIA-X was more cholesterol rich. The differences in clinical appearance as well as in quantitative and qualitative LP composition between the common type IIA and type IIA-X makes it important to separate these two types of HLP from each other.

Cholesterol↗
PubMed1975

Lipid disturbances associated with spiral muscular atrophy. Clinical, electromyographic, histochemical, and lipid studies.

Twelve patients with juvenile- and adult-onset spinal muscular atrophy have been studied. Eleven of the twelve patients had either type II, type IV, or borderline abnormal phenotypes, suggesting a possible relationship between serum lipid abnormalities and neuronal degeneration in the spinal muscular atrophies. Muscle enzyme histochemical studies provided valuable diagnostic information. Extensor toe signs and talipes cavus were common clinical observations.

Adenosine Triphosphatases↗
PubMed1978

Relation between triglycerides in human skeletal muscle and serum and the fractional elimination rate of exogenous plasma triglycerides.

Muscle triglycerides, serum lipid and lipoprotein concentrations and an intravenous fat tolerance test were determined on thirteen survivors of myocardial infarction and on fourteen subjects referred to a Lipid Clinic but without myocardial infarction. The mean concentration of triglycerides in muscle and the fractional removal rate k2 of intravenous injected Intralipid were similar in patients with and without MI. In seventeen of these subjects type IV hyperlipoproteinaemia was found. In type IV patients the muscle triglyceride concentration was twice that found in patients without hypertriglyceridaemia. A negative correlation between muscle triglyceride concentration and the k2 value was found for all subjects with a correlation coefficient of -0.62 (P less than 0.001). No independent correlations were found between muscle triglyceride and serum triglyceride concentration or the triglyceride concentrations of the major lipoproteins.

Adult↗