Can you please proofread this discussion post while maintaining APA 7eth ed. and answering these following questions: Summarize the article and provide a link to it. How is the pathophysiology clinically relevant or applicable? Based on the article, share 3 key points you would like to share with the class. Consider any ethical, cultural or social implications of the research that are relevant to clinical practice.

• This week I chose to discuss and review literature on hyperlipidemia because cardiovascular disease (CVD) is a significant health concern in the U.S., being the leading cause of death and a major contributor to disability and economic burden. Around 48.6% of US adults (127.9 million) were estimated to have some form of CVD between 2017 and 2020. In 2022, 702,880 people died from heart disease, which is 1 in every 5 deaths, and the Centers for Disease Control and Prevention (CDC) says that one person dies every 33 seconds from CVD(Centers for Disease Control and Prevention, 2024) . Cardiovascular disease has been linked to many modifiable risk factors in the literature, particularly blood pressure, low density lipoprotein (LDL), high density lipoprotein (HDL), glucose intolerance, and smoking. It is increasingly important to control elevated cholesterol levels in American adults in order to decrease the prevalence of cardiovascular disease and the incidence of coronary events.

The article I retain to discuss is titled: " Current management guidelines on Hyperlipidemia: the silent killer" by (Su et al., 2021). The article discusses the importance of managing hyperlipidemia to prevent cardiovascular events. Hyperlipidemia is a major risk factor for cardiovascular disease, and controlling elevated cholesterol levels is crucial. The article reviews the 2018 American College of cardiology/ American Heart association ( ACC/AHA) guidelines, which recommend a personalized approach to lipid management. It also explores new treatment options, including inclisiran, evinacumab, and bempedoic acid, which have shown promise in reducing LDL levels and cardiovascular risk.

Understanding the pathophysiology of hyperlipidemia is essential for NP and any other clinicians to develop effective treatment plans. Dyslipidemias involve clinically increased levels of cholesterol and/or triglycerides that may be accompanied with decreased HDL levels. LDL and HDL are the primary lipoprotein transporters of endogenous cholesterol esters; however, they also carry lesser amounts of triglycerides, phospholipids, and fat soluble vitamins. The lipoprotein lipid outer layer contains apolipoproteins that have several functions, including serving as a ligand for receptors and cofactors for enzymes and providing a structural basis for lipoproteins. LDL apolipoproteins include ApoB-100 and HDL apolipoproteins include ApoA-I, ApoA-II, ApoA-IV, ApoA-V, ApoC-III, and ApoE. Lipoproteins themselves serve to transport dietary lipids and hepatic lipids throughout the body to tissues that require fatty acid energy or storage. Elevated cholesterol in the body can lead to plaque formation and buildup within vasculature, leading to atherosclerotic cardiovascular disease. In my literature review I found that the article highlights the role of LDL in the development of atherosclerosis disease, which can lead to cardiovascular events. Clinically, this knowledge is relevant because it informs treatment decisions and patient education. For instance, knowing that LDL levels above 20-40 mg/dl increase the risk of atherosclerosis helps clinicians emphasize the importance of lipid control to patients.

Lipid-lowering drugs have proven to be effective in reducing the risk of atherosclerotic cardiovascular disease, highlighting the causal link between dyslipidemia and atherosclerosis. Statins, HMG-CoA reductase inhibitors, reduce plasma LDL-C levels. The article discussed A meta-analysis demonstrated a dose-dependent reduction in the risk of major cardiovascular events proportional to the reduction in LDL-C from treatment [[ 6 ]]. Ezetimibe inhibits intestinal absorption of cholesterol, where ezetimibe therapy was associated with a proportional reduction in cardiovascular events. PCSK9 monoclonal antibodies increase LDL clearance from the blood and are associated with a decreased risk of cardiovascular events. Therefore, dyslipidemia treatments decreasing lipid levels can greatly impact the cardiovascular outcomes of these patients.

In 2018 update was made into the Guideline on the Management of Blood Cholesterol by ACC/AHA, they recommended looking into risk-enhancing factors in older patients aged 40 to 75, which include family history and other health conditions in addition to examining risk factors that were commonly associated with cardiovascular disease such as high cholesterol, high blood pressure, and smoking. Another important addition to the 2018 guidelines is the use of coronary artery calcium (CAC) scoring that is utilized to reclassify risk patients at either borderline or intermediate risk, for whom the risk of statin treatment is uncertain. So, Since the 2018 lipid-lowering guidelines came out, there have been a multitude of new lipid-lowering drugs such as Inclisiran, evinacumab, and bempedoic acid. Since publication of the 2018 AHA/ACC/multi-society cholesterol guideline, 3 additional non-statin therapiesbempedoic acid, evinacumab, and inclisiranhave received FDA approval for management of hypercholesterolemia (Lloyd-Jones et al., 2022).

3 key insights I would like to share with the class are:

1. Personalized approach: The 2018 ACC/AHA guidelines recommend a personalized approach to lipid management, considering individual risk factors and health conditions
2. New treatment options: Inclisiran, evinacumab, and bempedoic acid are promising new treatment for hyperlipidemia, offering alternative options for patients who are intolerant to statins or require additional therapy.
3. Lifestyle modifications: Lifestyle modifications, such as dietary changes and regular exercise, remain crucial component of hyperlipidemia management, and as NP we should emphasize their importance to patients.

Hyperlipidemia management may vary across different populations so we need to be culturally sensitive, we should consider our patients cultural background, socioeconomic status, and health literacy when we are developing their treatment plans. Furthermore, the article did put an emphasis on the importance of addressing health disparities and ensuring equal access to healthcare services. I also want to add even though we have approved non-statin therapies we need to remember that the use of statin therapy is a key player in achieving optimal LDL levels, especially important in four high risk groups: patients with a greater than 7.5% ASCVD risk, those with a history of familial hypercholesterolemia, patients with a known history of atherosclerotic disease, and patients with diabetes mellitus.

References

Centers for Disease Control and Prevention. (2024, October 24). Heart Disease Facts. CDC. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html

Lloyd-Jones, D. M., Morris, P. B., Ballantyne, C. M., Birtcher, K. K., Covington, A. M., DePalma, S. M., Minissian, M. B., Orringer, C. E., Smith, S. C., Waring, A. A., & Wilkins, J. T. (2022). 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology, 80(14). https://doi.org/10.1016/j.jacc.2022.07.006

Su, L., Mittal, R., Ramgobin, D., Jain, R., & Jain, R. (2021). Current Management Guidelines on Hyperlipidemia: The Silent Killer. Journal of Lipids, 2021(1), 9883352. https://doi.org/10.1155/2021/9883352