Laurence Sperling, MD: Navigating the Changing Landscape of Lipidology

The realm of lipid management has undergone a flurry of changes in recent decades. An arena where, for decades, statins remained the only option for a slew of dyslipidemias and clinicians were often left with no effective means for achieving treatment goals. Since the turn of the century, advancements in pathophysiology and pharmacotherapies have transformed the prognosis for millions with lipid disorders.

In a recent interview, with HCPLive Cardiology, Laurence Sperling, MD, the Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention, provided his perspective on the rapidly changing landscape of lipidology, including the HDL hypothesis, lipoprotein(a) [Lp(a)], and the evolution of the care team.

HDL Hypothesis

HDL cholesterol (HDL-C) and its role in cardiovascular risk has been the subject of debate within medicine for many years. Although the concept of a U-shaped relationship with cardiovascular risk has become widely accepted by the community, other questions surrounding the specific function of HDL-C remain. One of the assumptions about HDL and its function were put to the test at ACC.24, where C. Michael Gibson, MD, presented data from a clinical trial examining CSL112, a form of ApoA-I extracted from human plasma. This trial missed its primary endpoint of reducing risk of death, heart attack or stroke within 3 months of a prior heart attack, but further analysis suggested potential long-term benefit. In our interview, Sperling discusses the work he and his institution have led related to HDL-C and its role in influencing cardiovascular risk.

Updates in Lp(a)

Few topics have captivated the field of lipidology or compelled their interest in the same manner as Lp(a). First described in 1963, it was not for another half-century before the community began to recognize the atherosclerotic cardiovascular risk associated with elevated levels of Lp(a). In recent years, this interest has been evidenced by the pipeline movement for Lp(a)-lowering agents, including olpasiran, zerlasiran, pelacarsen, as well as an emphasis on testing and awareness from major organizations. This growing recognition has also become a major theme at congresses and scientific meetings, including the upcoming Family Heart Global Summit, which Sperling is participating in as the cochair.

Learn more about the Family Heart Global Summit

Evolution of the Care Team

In the final portion of the interviewm which was recorded the day before the 2024 Summer Olympics’ opening ceremony, Sperling discusses how their rapid evolution in understanding of pathophysiology and the changing landscape of available therapies has necessitated the evolution of the care team. When discussing the topic, Sperling compares achieving lipid management goals to winning a gold medal, with both requiring the work of many individuals working in tandem for a greater goal.

Check out the entire interview below:

Sperling has no relevant disclosures to report.

References:

1. ^{Campbell P. Aegis-II misses primary endpoint, suggests potential for CSL112 in Hyperlipidemia. HCP Live. April 6, 2024. Accessed August 20, 2024. https://www.hcplive.com/view/aegis-ii-misses-primary-endpoint-suggests-potential-for-csl112-in-hyperlipidemia.}
2. ^{Koschinsky ML, Bajaj A, Boffa MB, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. Published online March 29, 2024. doi:10.1016/j.jacl.2024.03.001}
3. ^{Tsimikas S. Lipoprotein(a) in the Year 2024: A Look Back and a Look Ahead. Arterioscler Thromb Vasc Biol. 2024;44(7):1485-1490. doi:10.1161/ATVBAHA.124.319483}