Cardiovascular disease is the no. 1 killer in the United States. Many health issues can lead to cardiovascular disease, including commonly known problems such as diabetes, cigarette smoking, obesity-related factors, and hypertension.
However, two risk factors high atop that list are talked about less frequently. One is psychosocial health; it has been shown that people who have close contacts and frequent social interaction have lower risk of cardiovascular disease than people who are socially isolated. Another significant problem is dyslipidemia, or lipid abnormalities, which could be the most important of all those risk factors.
Dyslipidemia is one of the top contributors to cardiovascular disease risk, so it is important to not only treat it but screen young people. Dyslipidemia does not usually “develop” with time. It is a polygenetic disorder of metabolismthat often presents in childhood, and sometimes even in utero. Dr. Susan Dimick is one of only five doctors in the state certified by the American Board Of Clinical Lipidology. She helps her patients determine what their lipid risks are, and develops specialized treatment plans to address their individual needs and circumstances.
Common Questions on Lipidology
What is dyslipidemia?
Lipids are the fatty substances, like triglycerides and cholesterol, that appear in our blood. Dyslipidemia is a condition in which people have either too high or too low a concentration of these lipids in their blood. Dyslipidemia is influenced by many genes, and can be further modified by lifestyle, and other medical problems and medications.
Why is early detection of dyslipidemia important?
Because some people can be affected by genetic-based lipid problems in utero, early detection is critical. Early detection is important because the effects of a lipid problem can get worse over time. In the case of people with high cholesterol, for example, Dr. Dimick explains the concept of “cholesterol years,” which is similar to how doctors talk about “pack years” with people who smoke. A patient’s cholesterol years are the number of years they have experienced high cholesterol multiplied by their cholesterol number. This number is meaningful because it explains the toll high cholesterol can take on a person’s body over time. While high cholesterol due to lifestyle might not crop up until later in life, some genetic disorders could begin much earlier. For example, for someone whose parent has familial hypercholesterolemia (also known as FH), the effects on the baby can begin in utero. In all cases, early detection of a lipid problem will shorten those cholesterol years and will help a patient find appropriate treatment faster.
Who should be tested for dyslipidemia?
Who should get screened for dyslipidemia and when it should be done varies. The American College of Pediatrics recommends that children be screened with a lipid profile at age 2 if they have a family history of premature cardiovascular disease, meaning they have a family member who’s had a major adverse cardiovascular event such as a heart attack, stroke, or bypass under 55 years old for men and under 65 years old for women.
For people with a more benign family history, guidelines may be different. Many guidelines suggest that young people be screened before puberty, then again at age 18, because lipids change a lot over time and can be affected by hormone changes as we age.
How can lipidology help prevent cardiovascular disease?
A clinical lipidologist can help prevent cardiovascular disease by screening patients for many different risk factors, as well as by doing highly specialized testing to identify genetic risk early on. This allows you and your doctor to make lifestyle or medication changes that can keep lipid problems in check and prevent them from developing into something serious later in life.
What should I expect at my first appointment with a lipidologist?
Your first meeting will begin with an extensive review of your family’s health history, which will tell Dr. Dimick how much genetic testing needs to be done. She will discuss your own health history with you in order to learn about any medical problems you’ve experienced, including inflammatory diseases like lupus or rheumatoid arthritis. She will then identify any risk factors, social history, or lifestyle history that could contribute to health problems. The first appointment will also include a physical exam. Blood work will be sent to one or more specialty labs, depending on your history and the results of the exam. This could include genetic testing if your family history indicates that should be done. Once those tests are complete, Dr. Dimick will meet with you again to go through lab results and offer treatment options.
Should I see a lipidologist if I’m already seeing a cardiologist?
Yes, Dr. Dimick frequently sees patients who have already worked with a cardiologist, pediatrician, or other physician. Many of her patients are referred to her by doctors who feel their patient’s lipid problem is out of their scope of practice, in cases where a person isn’t responding to therapy, or when a person has a genetic type of dyslipidemia. She treats people with obesity, high blood pressure, and diabetes, as well as people who have already had a cardiac event and aren’t tolerating medications. As a clinical lipidologist, Dr. Dimick has access to medications that many physicians are not familiar with.
Cardiologists are wonderfully trained doctors who treat people with heart disease. Lipidologists screen and treat early to prevent heart disease. There are some cardiologists who are also board certified in lipidology. However, most are plenty busy doing cardiology. Lipidologists like Dr. Dimick frequently work with cardiologists in the area of secondary prevention. That means she sees patients who already have atherosclerosis, to prevent a second event and to regress existing plaque.