2010 survey

2010 Survey

The National Lipid Association

• Non-profit organization

• Directed toward advocacy for the education of health care professionals involved in the diagnosis and treatment of lipoprotein disorders and related metabolic diseases

• Developed in 1997 as outgrowth of Southeast Lipid Association by a group of lipid researchers and clinicians from southeastern U.S.

• 5 regional chapters

• Approximately 2500 active members in 2010

LIPID PULSE Objectives

• To better understand the practice dynamics, beliefs and behaviors of HCPs who specialize in lipid management

• To delineate the differences between respondents according to their practice’s degree of focus on lipid management

• To understand the awareness and utilization of various lipid parameters & information sources

• To understand the value NLA members place on NLA offerings

3

1. Lipid Pulse Membership Survey:

• Survey Design• Survey Market Promotion• Methodology• Respondent Groupings

4

Survey Design

• On-line, ~30-Question survey that took ~13 minutes to complete

• Developed, programmed, tested and launched by a team including representatives from Genzyme, NLA staff, NLA Board Leadership and Reckner/Blueberry

Clinician InformationClinician Information

Practice InformationPractice Information

Lipid ManagementPatient Information

Lipid ManagementPatient Information

Information ServicesInformation Services

NLA MembershipNLA Membership

Survey Promotional Efforts• Target List: 2,581 NLA members (2,490 w/ email)

• Honorarium / Incentive language: • The NLA is conducting a membership survey to get to know you and your practice better. When you complete the survey, you'll receive a $25 voucher to use on NLA products, a report of the survey results, and 25 copies of the Genzyme-published patient education booklet on Familial

Hypercholesterolemia. Help us achieve 100% participation!”

• Recruited: through email, fax, mail from May 11th to June 2nd; survey closed June 14th

• Key Activities:

– May 11th: An initial email & mail invitation was sent to all members with a valid email or mailing address• Timed to coincide with the NLA Scientific Sessions in Chicago, May 13-16 2010 where kiosk was present (attendees could take survey via kiosk or smartphone)

– May 20th: Follow-up email, fax, and USPS mailed invitation was sent to members who did not respond to the initial email or USPS invite. • Also, a reminder invitation was sent (via email or fax) to those members who started the survey but did not complete the survey

– June 2nd: A second follow-up email and fax invitation was sent to members who had not yet participated. • Also, a reminder invitation was sent (via email or fax) to those members who started the survey but did not complete the survey

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Daily Responses vs. Promotional Activity

7

A star indicates a promotional activity occurred on this date (e.g., email/fax communication, USPS mailing)

# of

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Methodology

– 657 valid survey responses– 17 respondents were removed due to industry employment

– Pairwise comparisons between groups were tested at the 95% and 80% confidence interval throughout report– Charts, graphs and tables indicate comparisons that were significant at the 95% confidence level, using uppercase letters to denote columns against which comparisons were significant– Comparisons significant at the 80% confidence interval are denoted using lowercase letters– Note small base sizes of < n=30; interpret with caution

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Respondent Groupings

– Respondents grouped according to self-reported:

– Profession (e.g., Physicians, NPs/PAs, Pharmacists or other)– Specialty* (e.g., IM/GP, Cardiologists, Endocrinologists or other)– Lipid Practice Profile

• Which best describes the role lipid management (plays) in your practice? My practice is a…a) Lipid Clinic (i.e. staff and time specifically dedicated to seeing patients for lipid disorders)

b) Lipid Specialist Practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management)

c) [neither] Lipid management is incorporated into my clinical practice,but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)

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* Only applies to MDs & NPs/PAs* Only applies to MDs & NPs/PAs

2. Respondent & Practice Profile• Geographic Distribution• Profession, Specialty & Lipid Practice Profile• Years in Practice • Practice Setting• Lipid Certification Status

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Geographic Distribution - All Respondents*

* n=630 (27 respondents excluded because of undetermined addresses or international)* n=630 (27 respondents excluded because of undetermined addresses or international)

Geographic Distribution – By Lipid Practice Profile*

Lipid Clinic Lipid Clinic Other NLA RespondentOther NLA RespondentLipid Specialist Lipid Specialist

* n=628 (29 respondents excluded because of undetermined addresses or international respondents)* n=628 (29 respondents excluded because of undetermined addresses or international respondents)

Lipid Clinic Respondents Only*

* n=137* n=137

Geographic Distribution: Summary

• Lipid specialists tend to be clustered in urban areas

• Highest density of lipid clinics is seen in regions where initial NLA chapters were started: southwest, midwest and northeast

67%

8% 10%16%

0%

20%

40%

60%

80%

100%

PHYS NP/PA PHARM Other

Respondents by Profession

• Of the 657 respondents who completed the survey, 67% are physicians, 16% are NPs/PAs and 8% are pharmacists

– “Other” includes PhD/scientists, Nurses (4%), Registered Dieticians/nutritionists (RD) (4%), Ph.D. or science specialists (2%) and Certified Diabetes Educator (CDE) (<1%).

15

Base: All Respondents (n=657)Q1 Please indicate your profession (select one): (Are you a) Physician (MD/DO) Nurse Practitioner (NP), Physician’s Assistant (PA) , Dietician (RD), Exercise specialist,

Pharmacist, Ph.D. or science specialty, Certified Diabetes Educator (CDE) or Other: (Please specify)?

(n=439) (n=102) (n=53) (n=63)

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ProfessionProfession

50%

11%7%

32%

0%

20%

40%

60%

80%

100%

IM/FP CARD ENDO Other

Respondents by Specialty

• About half of physician respondents are self-report as IMs or FPs

• Nearly a third of the respondents are cardiologists (CARDS)

16

Base: Physicians (n=436)Q3b Please describe your board certification: Cardiology, Endocrinology, Internal Medicine, Family Medicine, Other [specify]. Other includes Pediatrics, Lipidology/Clinical

Lipidology, Medical Biochem, and Nephrology.

(n=218) (n=138) (n=50) (n=30)

Board CertificationBoard Certification

% o

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sic

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24%

43%

33%

0%

20%

40%

60%

80%

100%

Lipid Clinic Lipid Specialist Not Lipid Specialist

Respondents by Lipid Practice Profile

• About 57% of the respondents either work in a lipid clinic or receive referrals specifically for lipid management

17

Base: All Respondents (n=657)Q9 Which best describes the role lipid management (plays) in your practice [radio button]: (My practice is a) Lipid Clinic (i.e. staff and time specifically

dedicated to seeing patients for lipid disorders), lipid specialist practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management), Lipid management is incorporated into my clinical practice, but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)

(n=155) (n=220) (n=282)

Lipid Practice ProfileLipid Practice Profile

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57%57%

39%

69%

11%

7% 4%

34%

44%

19%

36%

15%

8%13%

0%

20%

40%

60%

80%

100%

Lipid Clinic Lipid Specialist Not Specialist

Other

ENDO

CARD

IM/FP

Lipid Practice Profile by Specialty

18

Base: Physicians (n=436). Q9 Which best describes the role lipid management (plays) in your practice [radio button]: (My practice is a) Lipid Clinic (i.e. staff and time specifically dedicated to seeing

patients for lipid disorders), lipid specialist practice (i.e. not a Lipid Clinic, but receive patient referrals from other clinicians for patients specifically for lipid management), Lipid management is incorporated into my clinical practice, but I do not work at a Lipid Clinic, nor do I receive referrals specifically for lipid problems (i.e. neither a nor b)

% o

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sic

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(n=89) (n=163) (n=184)AA BB CC

Lipid Practice Profile by SpecialtyLipid Practice Profile by Specialty

ABAB

CCCC

• Physician respondent, most lipid clinics/specialists are either IM/FPs or CARDs

Years in Practice by Profession

• Respondent physicians appear to be significantly older than respondent NPs/PAs or pharmacists

– 41% of the respondent physicians had more than 26 years in practice– Cardiologists skew older than other specialties

19

7% 13% 15%10%

28% 23%25%

41%40%

17%

8%6%41%

10% 17%

0%

20%

40%

60%

80%

100%

PHYS NP/PA PHARM

26+

21-25 years

10-20 years

5-9 years

0-4 years22.4

12.6 14.6

0

20

40

60

80

100

PHYS NP/PA PHARM

Base: Physician/NP/PA/Pharm (n=594)Q2 How long you have been in clinical practice? [open # box] years [RANGE: 0-60]

Av

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# o

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rs

(n=102)(n=439) (n=53)

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(n=102)(n=439) (n=53)

Average Years in Practiceby Profession

Average Years in Practiceby Profession

Years in Practice DistributionYears in Practice Distribution

AA BB CC AA BB CC

BCBC

bb

BCBC

BCBC

aa

AA

AA

AA

AA

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Why Do Older Physicians Choose to Practice Clinical Lipidology?

• Less invasive

• More cognitive

• Desire to treat pathophysiology rather than symptoms of atherosclerosis

• Appreciation that it is the right thing to do

• Remembering that financial remuneration was not the reason we entered medicine

41%

29%

1% 1%

27%

0%

20%

40%

60%

80%

100%

PassedCertification

Preparing for Certification

Aware of/NotPursuing

Not Aware Not Asked

Lipid Certification Status

• Overall awareness of the lipid certification program is high

– Two-thirds of respondents have either passed or are preparing for certification

– One-third of respondents are aware of but not pursuing an NLA certification

21

Base: Physician/NP/PA (n=541). Physicians/NPs/PAs who self-identified as “Other” in Q1 were not asked Q4. Q4 How would you characterize your status in terms of Certification for Clinical Lipidology (MD) or Clinical lipid specialist (PA/NP)? [select one] (I am/have) Passed the

Certification Program, Preparing to pass the Certification Program, Aware of, but not pursuing the Certification Program , or Not aware of the Certification Program

(n=224) (n=147) (n=159) (n=5)

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Lipid Certification Status Lipid Certification Status

(n=6)

Passed / Preparing 68%

Passed / Preparing 68%

Certification Status by Lipid Practice Profile

• Not surprisingly, Lipid Clinic or Lipid Specialist HCPs are more likely to be certified or plan to be certified

• About 40% of respondents who are non-lipid specialists/clinics are currently preparing to be certified

22

Base: Physician/NP/PA (n=541). Physicians/NPs/PAs that self-identified as “other” in Q1 were not asked Q4.Q4 How would you characterize your status in terms of Certification for Clinical Lipidology (MD) or Clinical lipid specialist (PA/NP)? [select one] (I am/have) Passed the

Certification Program, Preparing to pass the Certification Program, Aware of, but not pursuing the Certification Program , or Not aware of the Certification Program

28% 37%

17%17%

40%

52%60%

21%

2% 1% 1%1%1%2%21%

0%

20%

40%

60%

80%

100%

Lipid Clinic Lipid Spec Not Lipid Spec

Passed Certification

Preparing forCertification

Aware of/NotPursuing Certification

Not Aware

Not Asked

(n=114) (n=191) (n=236)

% o

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s/N

P/P

A

Certification Status by Lipid Practice ProfileCertification Status by Lipid Practice Profile

AA BB CC

CCaCaC

ABAB

aBaBbb

Board Certification: Limitation of Lipid Pulse Survey

• 41% of respondents stated that they are board certified by the ABCL or ACCL

• As of November 2010, 691 or the active 2,461 active members (28%) were board certified

• Thus, respondents likely represent a more engaged group than the general membership

22%

36%42%

0%

20%

40%

60%

80%

100%

Solo Group - Single Specialty Group - Multi-Specialty

Type of Practice

• Nearly four-fifths of Physicians/NP/PA/Pharms work in either a single-specialty or a multi-specialty group practice; the remainder are in solo practice.

24

(n=129) (n=249) (n=216)

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Practice TypePractice Type

AA BB CC

Base: Physician/NP/PA/Pharm (n=594)Q5 Please describe your clinical practice (select one): Is it a Solo, a Group – Single Specialty, or a Group – Multi-Specialty practice?

Group - 78%Group - 78%

Base: Physician/NP/PA/Pharm (n=594). Respondent may report more than on practice setting.Q6 Which best describes your practice setting (select all that apply): a) Private practice

(office-based), Academic/research, Hospital-based , Pharmacy-based, Community clinic or Other setting ? [free text]

60%

28%

2%7%

0% 1%

25%

0%

20%

40%

60%

80%

100%

Office-Based(Private)

Academic Hospital-based Pharmacy-based

Clinic* Residency Other misc.

Practice Setting

• A majority (60%) of respondents are office-based

• More than one-fourth work in a hospital (outpatient clinics included)

• “Academic” indicates both hospital and clinic affiliation with an academic institution

25

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Practice Setting(check all that apply)Practice Setting

(check all that apply)

*Includes Community, HMO and Other

3. Staffing & Patient Volume• FTEs• Total Patient Volume • Hours Per Week Seeing Patients

26

11.7 12.0

9.2

0

5

10

15

20


28%23%

11%

31%33%

15%8%

32%36%

6%

27%

7%12%

15%16%

0%

20%

40%

60%

80%

100%

0-2.0 2.1-4.0 4.1-6.0 6.1-8.0 8.1 ore more

Lipid Clinic

Lipid Spec

Not Lipid Spec

(n=205)

(n=134)

(n=255)

AA

BB

CC

Total Clinician Staffing in Practice (FTEs)

• Reflecting presence in group practices, Lipid Clinics and Lipid Specialists describe working with more staff

27

% o

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Average # of FTEsAverage # of FTEs Staffing in FTEs DistributionStaffing in FTEs Distribution

(n=205)(n=134) (n=255)AA BB CC

Base: Physician/NP/PA/Pharm (n=594)Q12 In terms of full-time equivalents (FTEs), including yourself, how many clinicians are in your practice?

Av

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# o

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TE

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aa AA

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# of FTEs

Total Patient Volume

• Respondent clinicians who work in lipid clinics see a lower overall volume of patients

– Possible reasons include academic research, clinical trial activities and other responsibilities

28

Base: Physician/NP/PA/Pharm (n=594)Q8 How many patients are under your care in your personal practice? If NA enter zero. [# box – 5 digits (0-99999)]

13% 11%

20%

5% 2%7%

29%

14% 15%

28%34%

26%25%

39%33%

0%

20%

40%

60%

80%

100%


0 1-99 100-499 500-1,999 2,000+

1,082

1,6921,430

0

1000

2000

3000


Av

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# o

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ati

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ts

(n=205)(n=134) (n=255)

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(n=205)(n=134) (n=255)

Average # of PatientsAverage # of Patients Patient DistributionPatient Distribution

AA BB CC AA BB CC

AcAc

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aa

BCBCCC

AcAc

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Hours Per Week Seeing Patients

• Respondent clinicians who work more in lipid-focused settings spend less of their time actually seeing patients for all types of medical issues

29

Base: Physician/NP/PA/Pharm (n=594)Q10 Please indicate the number of hours per week you spend seeing patients. If NA enter zero: [# - 2 digits (0-99)]

1% 2% 4%

37%

12% 13%

38% 37%

28%25%

49%55%

0%

20%

40%

60%

80%

100%


0 1-19 20-39 40+

25.134.7 35.3

0

20

40

60

80

100


Av

era

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Ho

urs

Pe

r W

ee

k

(n=205)(n=134) (n=255)

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(n=205)(n=134) (n=255)

Average Hours Per Week Seeing Patients

Average Hours Per Week Seeing Patients

Hours Per Week Distribution

Hours Per Week Distribution

AA BB CC AA BB CC

BCBC CC CC

AA

abab

AA

AA AA

4. Lipid Practice Characteristics• Practice Services• Lipid Management Staffing• Lipid Management Patient Volume• Time Respondents Spend Seeing Lipid Management Patients• Anticipated Changes in Lipid Practice Characteristics• Loss / Profitability

30

Frequency of Practice Services

• More than half of practices provide diabetes management, nutrition/exercise programs, and weight management services.

31

69%59%

41%

24%

10% 6% 6% 5% 1%

60%

0%

20%

40%

60%

80%

100%

Diabetesmanagement

Nutrition/Exerciseprograms

WeightManagement

Clinical trialparticipation

CardiacRehab

LDLApheresis

Other HTN/Lipids

Diagnosis &Mgt.*

Other Misc./GeneralHealth**

Other CardioServices***

OtherTeaching,

EducationalServices****

% o

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Base: Physician/NP/PA/Pharm (n=594). Total is greater than 100% due to multiple responses.Q15 Please indicate which of the following services your practice provides: [check boxes], Clinical trial participation, Cardiac rehab, Diabetes management, Nutrition/exercise

programs, Weight management, LDL apheresis, Other – please specify [fill in blank]

*Includes: Lipid management, Hypertension/Anticoagulation Management, CIMT, HTN management, Advanced lipid/lipoprotein testing**Other miscellaneous mentions, Internal medicine, Lab, Sports medicine***Non-Invasive Cardiology Diagnostics, General (e.g. Stress testing/(nuclear/echo), Cardiology services (general cardiology/non specific), Preventive

Cardiology Services & Risk Assessment ((non-specific)), Interventional Cardiology****Smoking cessation, Diabetes education, Teaching/education (non-specific), Med management/education (non-specific)

60%

71%63%

34%

19%

7%1%

6%2%

71%

12%5% 4% 4% 1%

73%

52%

15%

4% 6% 9% 6%2%

79%

60%62%

30%

46%48%

26%

0%

20%

40%

60%

80%

100%

Diabetesmanagement

Nutrition/Exerciseprograms

WeightManagement

Clinical trialparticipation

CardiacRehab

LDLApheresis

Other HTN/Lipids

Diagnosis &Mgt.*

Other Misc./GeneralHealth**

Other CardioServices***

OtherTeaching,

EducationalServices****


Services Provided by Lipid Practice ProfileServices Provided by Lipid Practice Profile

Frequency of Practice Services

• Lipid Clinics (to a lesser extent Lipid Specialists) are more likely to offer nutrition/exercise programs, weight management and clinical trial participation

32

Base: Physician/NP/PA/Pharm (n=594). Total is greater than 100% due to multiple responses.Q15 Please indicate which of the following services your practice provides: [check boxes], Clinical trial participation, Cardiac rehab, Diabetes management, Nutrition/exercise

programs, Weight management, LDL apheresis, Other – please specify [fill in blank]

% o

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(n=134) (n=205) (n=255)AA BB CC

AA AABCBC

BCBC

BCBC

CC

CCcc

CC

CC

bCbC

CC

aaAbAb

bb

Frequency of Practice Services Offered:Study Limitation

• Note that 10% of respondents reported that LDL apheresis is offered in their practice

• This response is clearly not reflective of the general membership of clinical lipidologists

2% 1% 2% 1%

60% 60%

80%71%

30% 33%

11% 24%

6% 7% 5%9%

0%

20%

40%

60%

80%

100%

Lipid Clinic Lipid Spec Lipid Clinic Lipid Spec

Base: Physician/NP/PA who works in a Lipid Clinic or Lipid Specialist practice (Q9) (n=305)Q20 Please describe the changes in your lipid management practice (in terms of Decrease(d) No(t) Change(d) Increase(d))Over the past year my patient volume has… // Over the next 3 yrs, I expect patient volume to… // Over the next 3 years, I expect staffing needs to… // Over the next 3 years, I expect equipment needs to… // Over the next 3 years, I expect payer (insurance/Medicare/Medicaid) reimbursement pressures to…

Past Year and Anticipated Changes: Patient Volume• About 60% of LC/LSs respondents indicate that their patient volume has

increased in the past year

• Lipid clinic respondents are slightly more likely than lipid specialists to expect increased patient volume in the next 3 years

34

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Over the past year my patient volume has… Over the past year my patient volume has… Over the next 3 years, I expect patient volume to… Over the next 3 years, I expect patient volume to…

AA

bb

Not askedIncreaseNo ChangeDecrease

(n=114) (n=191)AA BB

(n=114) (n=191)AA BB

Loss/profitability

• Respondents who work in lipid clinics (only) were asked about the profitability of their practices

– Approximately two-thirds of these respondents say they operate at break-even or better

35

Base: Physician/NP/PA/Pharm (for Profession and Lipid Practice Profile) who works in a Lipid Clinic (Q9) (n=134)Base: Physician (Speciality) who works in a Lipid Clinic (Q9) (n=89) Q21 From a financial standpoint, do you consider your lipid clinic to be operating (select one): [radio button] At break-even or better , At a loss.

34% 36% 33%25% 31% 28%

60%

42%

64% 67%75% 69% 72%

40%

58%66%

0%

20%

40%

60%

80%

100%

Lipid Clinic PHYS NP/PA PHARM FM/IM CARD ENDO Other

by Professionby Profession

(n=134) (n=90) (n=24)* (n=20)* (n=35) (n=32) (n=10)* (n=12)*

At a lossAt break-even or better

by Specialtyby Specialty

% o

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AA BB CC AA BB CC DD

cccc

abab

by Lipid Practice Profile

by Lipid Practice Profile

*Note: Small base size. Interpret with caution*Note: Small base size. Interpret with caution

Loss/Profitability:Limitations of Lipid Pulse Survey

• Survey only employed financial appraisal by clinician

• No verification by administrator of CFO

• Likely result is an overestimation of profitability of many of these programs

• Are endocrinologists really different?

5. Lipid Management Referral Patterns• Referral Patterns• Referral Reasons

37

11% 10% 4%

27%4% 3%4%

8%22%

16% 24%

15%

71% 68%50%

63%

0%

20%

40%

60%

80%

100%

IM/FP CARD ENDO Other

(n=269)Base: Respondent is a Physician, NP or PA at Q1, Lipid clinic/specialist at Q9 and has patients referred for lipid management specifically at Q17 Q18 Of referrals you receive for lipid management, please describe the type of referring clinicians: [enter the % of referred patients] GP/FP or Internist, Cardiologist,

Endocrinologist, Other, please specify______ , Other, please specify______ [sum to 100%]

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Lipid Management Referral Patterns by SpecialtyLipid Management Referral Patterns by Specialty

OtherENDOCARDIM/FP

(n=85) (n=99)AA BB

Lipid Management Referral Patterns

• Amongst LC/LSs referral sources are fairly similar across all specialty types

• Respondent IM/FPs do receive about 20% of their referrals from cardiologists

38

(n=34)CC

(n=17)*DD

dd

BB

aDaD DD

bDbD

aBaB

*Note: Small base size. Interpret with caution*Note: Small base size. Interpret with caution

Elevated LDL-C

Hypertri-glyceridemia

Isolated low HDL

Combined dyslipidemia

Statin-intolerance

Presence of CVD or evidence of risk with normal lipid profile

Other

Lipid Management Referral Reasons

• Respondent Lipid Clinics/Specialists receive patient referrals for similar reasons– About half are due to elevated LDL-C, combined dyslipedmia – Statin intolerance accounts for ~ 20%– High TGs makes up just under 20% of referrals

7% 6%

20% 19%

25% 24%

7% 8%

18% 17%

24%

1%1%

22%

0%

20%

40%

60%

80%

100%

Lipid Clinic Lipid Spec

Me

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Reasons for Lipid Management Referral by Lipid Practice ProfileReasons for Lipid Management Referral by Lipid Practice Profile

(n=269)Base: Respondent is a Physician, NP or PA at Q1, Lipid clinic/specialist at Q9 and has patients referred for lipid management specifically at Q17 Q19 Of those patients referred to you for lipid management, please indicate the reason for referral: Enter the % Patients seen for Elevated LDL-C, Hypertriglyceridemia, Isolated

low HDL, Combined dyslipidemia, Statin-intolerance, Presence of CVD or evidence of risk with normal lipid profile, Other, please specify______ , Other, please specify______ [sum to 100%]

(n=97) (n=172)AA BB

6. Beliefs & Information Sources• Tests Routinely Ordered• Parameters Most Predictive of Cardiovascular Risk• Education Needs• Information Mediums / Sources • New Product Awareness

40

Tests Routinely Ordered

41

Lipid Clinici Lipid Specj Not Lipid Speck

(n=114) (n=191) (n=236)

Triglycerides 93% 95% 95%

HDL-C 95% 95% 96%

LDL-C 91% 93% 92%

Non-HDL 68% 78% I 77% I

CRP 63% 62% 66%

Lp(a) 62% jK 54% K 42%

Apo B 52% k 51% k 42%

Lipoprotein particle size 41% 44% 42%

Lipoprotein particle # 38% 61% IK 42%

APO E 19% k 17% k 12%

Lp-PLA2 18% 30% Ik 23%

Other apolipoproteins 14% K 10% k 6%

Genetic testing for FH 9% jK 4% 3%

Genetic markers, e.g., KIF6 7% 16% Ik 10%

None of the above 1% 1% 1%

Not asked 2% 1% 1%

Base: All Respondents (n=657)Q22-1. Of the lipid parameters and related topics listed below: What tests do you order routinely (more than once a month in your overall practice)? (check all that apply)

Global risk scores (such as the Framingham Risk Score [FRS]) that use multiple traditional cardiovascular risk factors should be obtained for risk assessment in all asymptomatic adults without a clinical history of CHD. These scores are useful for combining individual risk factor measurements into a single quantitative estimate of risk that can be used to target preventive interventions.

I IIa IIb III

Recommendations for General Approaches to Risk Stratification

Benefit>>>RiskShould be performedLimited populations

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults

>90% order lipid profileLipid profile enables global risk scoring>90% order lipid profileLipid profile enables global risk scoring

Recommendations for Measurement of C-Reactive Protein (CRP)

In men 50 years of age or older or women 60 years of age or older with LDL cholesterol less than 130 mg/dL; not on lipid-lowering, hormone replacement, or immunosuppressant therapy; without clinical CHD, diabetes, chronic kidney disease, severe inflammatory conditions, or contraindications to statins, measurement of CRP can be useful in the selection of patients for statin therapy.

I IIa IIb III


Benefit>>RiskIs reasonableLimited populations

>60% order hs-CRP>60% order hs-CRP

Lipoprotein-associated phospholipase A2 (Lp-PLA2) might be reasonable for cardiovascular risk assessment in intermediate-risk asymptomatic adults.

Recommendation for Lipoprotein-associated Phospholipase A2

I IIa IIb III


Benefit ≥ riskMay/might be consideredLimited populations

18-30% order Lp-PLA218-30% order Lp-PLA2

Measurement of lipid parameters, including lipoproteins, apolipoproteins, particle size, and density, beyond a standard fasting lipid profile is not recommended for cardiovascular risk assessment in asymptomatic adults.

Recommendation for Lipoprotein and Apolipoprotein Assessments

I IIa IIb III

Not recommended


56-61% order apo B 38-61% order LDL-P

18-28% order particle size29-35% order Lp(a)

56-61% order apo B 38-61% order LDL-P

18-28% order particle size29-35% order Lp(a)

Parameters Most Predictive of CV Risk

46

Base: All Respondents (n=657)Q22-2. Of those listed, which 5 parameters you believe to be most predictive for assessing CV risk? (select 5)


(n=114) (n=191) (n=236)

HDL-C 63% j 55% 58%

CRP 47% K 41% 36%

Non-HDL 61% 59% 57%

Apo B 61% 60% 56%

LDL-C 55% 48% 56% j

Lipoprotein particle # 50% 56% k 50%

Lp(a) 35% 32% 29%

Lipoprotein particle size 23% 18% 28% J

Triglycerides 19% 25% 29% I

Lp-PLA2 16% 22% I 18%

Genetic markers, e.g., KIF6 7% 6% 6%

Genetic testing for FH 4% 2% 5% j

APO E 3% 6% ik 3%

Other apolipoproteins 3% 3% 2%

None of the above 1% j 0% 1% j

Greatest Need for Education/Awareness

47

Base: All Respondents (n=657)Q22-3. Of those listed, the 5 topics where you believe there is greatest need for increased awareness and/or education? (select 5)


(n=155) (n=200) (n=282)

Statin intolerance: evaluation and management 57% JK 39% 36%Strategies for improving patient compliance with therapy

(medication and/or diet/lifestyle) 52% Jk 37% 43% j

Metabolic syndrome 45% jk 37% 35%Genetic testing for FH 21% j 13% 18% j

Lipoprotein particle # 34% 41% ik 33%Non-HDL 30% 26% 26%

Apo B 30% 36% ik 30%Genetic markers, e.g., KIF6 27% 30% 25%

Lp-PLA2 24% 33% I 31% I

Familial hypercholesterolemeia screening and diagnosis 23% 18% 22%Lipoprotein particle size 19% 16% 23% J

Lipid clinic practice management 17% 15% 24% iJ

Lp(a) 15% 21% I 21% I

HDL-C 14% 19% I 17%CRP 12% 16% 14%

Triglycerides 11% 18% ik 12%Other apolipoproteins 8% 8% 9%

APO E 6% 10% I 13% I

LDL-C 3% 6% 10% Ij

None of the above 1% 1% 1%

Sources Used to Learn About Lipid Management

48

88%

62%

45%

27%

5% 1%

88%

0%

20%

40%

60%

80%

100%

Reading journals(printed versions)

Attendingconferences

Reading journalwebsites or email

updates

Reading other on-line sources (not

journals)

Listening to orwatching Pod-castsor other audio/video

lectures on-line

Reading orparticipating in on-

line chat roomswith peer clinicians

None of the above

% o

f R

es

po

nd

en

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Base: All respondents (n=657). Total is greater than 100% due to multiple responses. Top mentions noted in text boxes.Q23. Which sources do you use to learn about lipid management? Which ones?

Journal of Clinical Lipidology/Journal of Lipidology 45%

NEJM 23%Lipid Spin 20%JACC 20%Circulation 16%JAMA 10%

NLA

63%AHA

21%ACC

19%

NLA

23%NEJM

13%Heart.org

12%Medscape

12%

Heart.org

17%Medscape

13%NLA

12%UpToDate

11%

NLA

27%ReachMD

12%Heart.org

10%NLA

42%Heart.org

9%

• Respondents cite JCL, NEJM and JACC as most often used sources for LM information

• ~60% describe reading journals online; 45% use other (non-journal) online source

Awareness of Technologies/Therapies in Development

49

Base: All Respondents (n=657)Q26. What - if any - new therapies or technologies in development for lipid management are you aware of? Open-end - Top mentions shown.

% of Total

CETP inhibitors/blockers 11.1% (n=73)Genetic testing/screening 4.7% (n=31)

LDL Apheresis/apheresis/DALI LDL apheresis 4.6% (n=30)Mipomersen 4.3% (n=28)

New drugs (to replace statins)/new statins 2.7% (n=18)LpPLA2 2.7% (n=18)

HDL therapy/drugs/formulations/in development (unspecified) 2.4% (n=16)apoB antisense/inhibitors 2.3% (n=15)

Meds/therapy to raise HDL 1.8% (n=12)apo A1 infusion/mimetics infusion 1.8% (n=12)

KIF6 1.8% (n=12)HDL Mimetics 1.5% (n=10)

Antisense oligonucleotides/antisense therapy 1.5% (n=10)MTP inhibitors 1.5% (n=10)

Particle #/HDL particle #/lipoprotein particle #/lipid particle # 1.4% (n=9)Gene therapy 1.2% (n=8)

RNA1/antisense RNA 1.2% (n=8)Low flush/no flush niacin/niacin combo 1.2% (n=8)

CIMT 1.1% (n=7)HDL infusion therapy 1.1% (n=7)

Summary of Tests Ordered and Information Sources/ Needs

• Lipid Tests Routinely Ordered– Over 90% routinely order the standard lipid panel (e.g., HDL, LDL, TG)– About half of the MD respondents reported regularly (>once/month) ordering particle #, Lp(a), Apo B (Two-thirds said CRP) in addition to the standard lipid panel– Lp(a) and Apo B were found to be more common in more lipid-centric physicians

• Lipid Parameters Most Predictive of CV Risk– Non-HDL/Apo B believed to be the same in terms of being most predictive of risk

• However, Apo B is ordered less often, this is likely because clinicians can obtain non-HDL for free of cost w/ standard panel

– Followed by HDL, then lipoprotein particle #• Interestingly, lipid clinic physicians frequently indicated that genetic testing for FH was one of the top five parameters to measure CV Risk

• Greatest Need for Education/Awareness– Statin intolerance / patient compliance were frequently mentioned

• These are related and appear more frequently in lipid clinic responses compared to other clinicians

– Lipoprotein particle # is also a top interest

51

7. NLA Membership• Membership Benefits• Membership Continuation• Promotion to Colleagues• NLA Suggestions

NLA Membership Summary

• Respondents indicate that education, certification & The Journal of Clinical Lipidology subscription are most valued

• Over 95% of respondents intend to continue their NLA Membership & would promote it to colleagues

• About half of survey respondents offer suggestions for additional services– A majority of these respondents suggest enhancing educational programs, conferences, and using a web-based medium to increase participation

NLA Membership Benefits

• Respondent physicians and NP/PAs utilize the Journal of Clinical Lipidology subscription more than pharmacists.

• Respondent NP/PAs and pharmacists value the certification opportunities more than physicians and others.

• Respondent pharmacists value social networking/access to thought leads more than physicians and NP/PAs

53

Base: All Respondents (n=657)Q27 What benefits of NLA membership do you value most? (select up to three) Responses accounting for less than 1% (Lipid Spin, other, and none) are not shown.

15%

89%

43%

20%

68%

7%7%

16%

93%

71%

18%11%

23%

87%

32%

59%

11%5%

25%

89%

41%

25%

67%

14%

29%

54%

18%

59%

0%

20%

40%

60%

80%

100%

Advocacy Colleagues Educationopportunities

Certificationopportunities

Social Networking /Access to Thought

Leaders

Journal of ClinicalLipidology

subscription

Member discountfor educationalopportunities


% o

f R

es

po

nd

en

ts

(n=439) (n=102) (n=53)AA BB CC

BDBD

by Professionby Profession DD(n=63)

dd

BBbb

cc

AdAd AdAd

ABAB

cc cc

AAAA

98% 94% 97%97%

0%

20%

40%

60%

80%

100%


NLA Membership Continuation

• The vast majority of respondents plan to continue their membership.

• A very small minority plan to not renew for cost/expense or other reasons (open-ends).

54

Base: All Respondents (n=657)Q28 Do you plan to continue your membership in the NLA? (Yes/No)


% o

f R

es

po

nd

en

ts

(n=439) (n=102) (n=53) (n=63)AA BB CC DD

CC

NLA Promotion to Colleagues

• Virtually all respondents would encourage their colleagues to join the NLA.

– The few exceptions cite reasons including colleagues’ lack of expressed interest

55

Base: All Respondents (n=657)Q29 Would you encourage colleagues to join the NLA? (Yes/No)

98% 98% 94%98%

0%

20%

40%

60%

80%

100%



% o

f R

es

po

nd

en

ts

(n=439) (n=102) (n=53) (n=63)AA BB CC DD

dd dd

Suggested NLA services

• Only about half of survey respondents offer suggestions for additional services

• A majority of these respondents suggest enhancing educational programs, conferences, and using a web-based medium to enhance participation in the organization

• The top suggestions for NLA are providing more services around education/learning and conferences/meetings

56

Base: All Respondents (n=657)Q30 What else could the NLA provide its members that it does not currently provide? (open-end) Nets are shown.

PHYSA NP/PAB PHARMC OtherD

(n=439) (n=102) (n=53) (n=63)

Education/learning 17% 16% 15% 11%Conferences/meetings 10% c 8% 4% 6%

Web-based 7% 9% 13% a 10%Conference content 6% c 7% c 0% 11% aC

Miscellaneous 6% 3% 2% 6%Awareness 6% B 0% 2% b 8% Bc

Communication 3% 1% 8% aBd 2%Cost 2% 7% Ac 2% 5% a

Recognition as specialty 3% bc 0% 0% 2%Participation 1% 4% ad 4% ad 0%

Interaction 2% 2% 4% 2%Membership 1% 1% 2% 3% a

Nothing/doing great job/fine as is 33% 35% 45% a 41%Don't know 6% 13%AcD 6% 3%No answer 3% d 1% 2% 0%

Summary• Survey provided valuable, meaningful data to characterize clinicians that focus on lipid management (NLA members)

• In general, greater differences in respondents wereobserved by degree of lipid practice profile (e.g., lipid clinic vs. lipid management vs. neither) than by specialty

• Respondents that identify themselves as working in a lipid clinic or specialists are differentiated in terms of clinical environment and patient offerings

In terms of practice environment, these specialists: – Appear more likely to work in multi-specialty or group practices – Lipid clinic respondents in particular were more likely to have an academic affiliation

Summary

• Lipid Clinic (LC)/Lipid Specialist (LS) Practice Characteristics – LC/LSs report slightly lower patient volume overall and spend fewer hours/week with in partient care (potentially reflecting academic setting and related activities)

– LC/LSs tend to spend more time with their patients, especially on initial visits

– LC/LSs are more likely to offer comprehensive services beyond purely medical care to address cardiovascular risk with services such as weight management, nutrition/exercise counseling, clinical trial participation and cardiac rehabilitation services

– Respondents in these categories appear to expect an acceleration in expected demand for lipid management

Summary• Lipid Tests Routinely Ordered

– Over 90% routinely order the standard lipid panel (e.g., HDL, LDL, TG)– About half of the MD respondents reported regularly (>once/month) ordering particle #, Lp(a), Apo B in addition to the standard lipid panel; 2/3 said the same re; CRP– Lp(a) and Apo B tests appear more frequently ordered by lipid specialists and lipid clinic respondents than by those w/ out a more dedicated practice for lipid management

• Lipid Parameters Most Predictive of CV Risk– Non-HDL and Apo B are tied re: belief re: being the most predictive of risk

• However, Apo B is ordered less often, likely reflecting cost/availability– Followed by HDL, then lipoprotein particle #

• Interestingly, lipid clinic physicians frequently indicated that genetic testing for FH was one of the top five parameters to measure CV Risk

• Greatest Need for Education/Awareness– Statin intolerance / patient compliance were frequently mentioned

• These are related and appear more frequently in lipid clinic responses compared to other clinicians

– Lipoprotein particle # is also a top interest, as is Apo B

2010 survey

Documents

question survey

survey results

lipid pulse membership

valid email

followup email

fax invitation

nla offerings

nla staff