Endocrine News talks with Connie Newman, MD, chair of the committee that created the latest Endocrine Society Clinical Practice Guideline on Lipid Management in Patients with Endocrine Disorders.
According to the latest Clinical Practice Guideline issued by the Endocrine Society, all adults with endocrine disorders should be tested for high cholesterol and triglycerides to evaluate their risk of heart attack or stroke.
“Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline” was published online last month and will appear in the December 2020 print issue of The Journal of Clinical Endocrinology & Metabolism. This guideline provides an approach to assessing and treating high cholesterol and triglycerides in patients with endocrine diseases such as hypothyroidism, menopause, and Cushing syndrome.
“This guideline is the first of its kind,” says Connie Newman, MD, New York University Grossman School of Medicine, New York, N.Y., chair of the committee that wrote the guideline. “We hope that it will make a lipid panel and cardiovascular risk evaluation routine in adults with endocrine diseases and cause a greater focus on therapies to reduce heart disease and stroke..”
Newman shares her thoughts with Endocrine News about how this new guideline will make lipid panel tests routine in patients with endocrine diseases, influence the decision-making process about treatment for clinicians in other specialties, and key take-home messages for patients.
“Practitioners in other medical specialties such as family practice, internal medicine, cardiology, and nephrology should become aware of the impact of endocrine diseases on lipids, ASCVD risk, and pancreatitis, and take this into account when making decisions about treatment.” – Connie Newman, MD, New York University Grossman School of Medicine, New York, N.Y.; chair, guideline writing committee
Endocrine News: What was the main reason for the publication of the lipid management in patients with endocrine disorders guideline – what drove the decision and why now?
Connie Newman: Hormones modulate every pathway involved in lipid metabolism. Therefore, it is not surprising that some endocrine diseases are associated with an abnormal lipid profile and increased risk of atherosclerotic cardiovascular disease (ASCVD), which is the primary cause of death in the U.S. However, with the exception of type 2 diabetes, endocrine diseases are not discussed in detail in cholesterol management guidelines. This guideline was written to address this gap in information. The guideline describes the lipid profile and atherosclerotic risk in individuals with selected endocrine diseases, and evaluates the degree to which treatment of the endocrine disease improves dyslipidemia. The guideline also makes recommendations about the use of lifestyle modification and medications to lower lipids and lipoproteins.
EN: What are your hopes for the impact of the guideline on endocrine standards of care for patients with endocrine disorders and lipid abnormalities?
CN: This guideline is the first of its kind, and the committee hopes that it will make a lipid panel and ASCVD risk assessment a routine test in adults with endocrine diseases. As discussed in the guideline, Cushing syndrome, Cushing disease, high dose glucocorticoid therapy, adult growth hormone deficiency, acromegaly and hypothyroidism enhance ASCVD risk. This knowledge may guide therapy to lower low-density lipoprotein cholesterol (LDL-C) by favoring initiation or intensification of statins and other medications as adjunct to lifestyle modification.
Other recommendations that could change clinical practice include the measurement of coronary artery calcium to refine risk assessment when the decision about statin treatment is uncertain, the use of a highly purified eicosapentaenoic acid (EPA) ethyl ester to reduce ASCVD in statin-treated adults with diabetes and triglycerides above 150 mg/dL, ruling out hypothyroidism before prescribing statins to lower LDL-C, and checking the lipid panel after treatment of hyperthyroidism when the patient is euthyroid.
“Hormones modulate every pathway involved in lipid metabolism. Therefore, it is not surprising that some endocrine diseases are associated with an abnormal lipid profile and increased risk of atherosclerotic cardiovascular disease, which is the primary cause of death in the U.S.” – Connie Newman, MD, New York University Grossman School of Medicine, New York, N.Y.; chair, guideline writing committee
In addition, the guideline attempts to clarify the uncertainty about the age at which to start statins in individuals with type 1 diabetes, and advises consideration of statin use to lower LDL-C in adults with type 1 diabetes, who may be younger than 40 years of age, but have microvascular complications or a 20-year history of type 1 diabetes. The guideline also addresses the effect of steroids on HDL-C and points out that very low HDL-C levels suggest anabolic steroid use.
EN: How do you expect other medical specialties to be affected by the Guideline Writing Committee’s recommendations?
CN: Practitioners in other medical specialties such as family practice, internal medicine, cardiology, and nephrology should become aware of the impact of endocrine diseases on lipids, ASCVD risk, and pancreatitis, and take this into account when making decisions about treatment.
Finally, I would like to thank Andrea Hickman of the Endocrine Society, and the members of the writing committee for their many contributions to this guideline.
Other members of the Endocrine Society writing committee that developed this guideline include: Michael Blaha, MD, MPH, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, Md.; Jeffrey Boord, MD, MPH, Parkview Health System in Fort Wayne, Ind.; Bertrand Cariou, MD, PhD, Nantes University Hospital, Nantes, France; Alan Chait, MD, University of Washington, Seattle, Wash.; Henry Fein, MD, Sinai Hospital, Baltimore, Md.; Henry Ginsberg, MD, Columbia University, New York, N.Y.; Ira Goldberg, MD, New York University Grossman School of Medicine, New York, N.Y.; M. Hassan Murad, MD, Mayo Clinic Evidence-based Practice Center, Rochester, Minn.; Savitha Subramanian, MD, University of Washington, Seattle, WA; and Lisa Tannock, MD, University of Kentucky, Lexington, Ky.