Hypercholesterolemia Q&A with Michael Bloch

Recently, Consultant spoke with Dr. Michael J. Bloch, MD, FACP, FASH, FNLA, FSVM. He is an associate professor at the School of Medicine at the University of Nevada, Reno, and is medical director of vascular care at the Renown Institute for Heart and Vascular Health in Reno, Nevada.

Dr. Bloch has a monthly column published in The Journal of the American Society of Hypertension and has been published in multiple journals and textbooks. He also is presenting about one of his specialties—hypercholesterolemia—at Cardiometabolic Risk Summit, powered by Consultant, this October.
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CONSULTANT: How do you define hypercholesterolemia in your practice?

MICHAEL BLOCH: Importantly, hypercholesterolemia—or dyslipidemia—is not defined solely based on cholesterol levels but in the context of overall cardiovascular risk. 

CON: What are the top strategies for preventing hypercholesterolemia?

MB: Although it takes time and effort to discuss with patients, adjustments in diet, exercise, and alcohol habits can all have a beneficial effect on hypercholesterolemia. The return on that investment of time can be substantial, since those same interventions will also help with other cardiovascular risk factors like hypertension and diabetes mellitus. 

CON: What questions should primary care providers be asking their patients after diagnosing hypercholesterolemia? What discussion should be had?

MB: The most important thing about making the diagnosis of hypercholesterolemia is to put the cholesterol values in to the context of overall cardiovascular risk. Questions about other cardiovascular risk factors like smoking and high blood pressure are just as important as those about prior cholesterol treatment. When discussing potential treatment options, I think that PCPs need to focus patients on the benefits of therapy in reducing cardiovascular risk, not just cholesterol numbers. Unfortunately, I think we often end up talking more about the potential risks of statin therapy than the potential benefits. 

CON: How has the approach to treatment changed over the years? What developments have influenced these changes?

MB: Today, I set more aggressive goals for my patients than I did when I first started treating lipids in the 1990s. This is not only because clinical trials have demonstrated that “lower is better,” but also because our treatment armamentarium has grown. Certainly, the advent of cholesterol absorption inhibitors and PCSK9 inhibitors has helped us reach more aggressive lipid targets, but most importantly, the availability of relatively low-cost, high-intensity statin therapy has lowered many of the barriers to treatment. 

CON: What are the top treatments?

MB: While those who practice in the field get excited about new pharmacologic options like PCSK9 inhibitors, which certainly have a role in some patients, the mainstay of therapy now and likely for decades to come will remain moderate and high-intensity statin therapy.

CON: How does non-adherence to treatment impact patient outcomes?

MB: Lipid-lowering medications only work when patients take them. We know that many patients have a suboptimal response to statins due to non-adherence, which in turn leads to residual cardiovascular risk.

CON: How can primary care providers ensure adherence to treatment?

MB: I think that the most important thing is to focus on the “explanatory model.” Sure we need to talk about the risks of adverse effects, but if we do not get patients to understand the beneficial effects of lipid-lowering medications on cardiovascular risk, they are less likely to be adherent. 

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For more information about Dr. Bloch’s session and to register for Cardiometabolic Risk Summit, powered by Consultant, held in October in Las Vegas, Nevada, please visit www.crsfall.com.