Nihar Desai, MD, MPH

Panelists discuss how reaching underserved populations requires proactive outreach, digital health tools with appropriate training, addressing health literacy barriers, and ensuring equitable access to diabetes technologies and treatments rather than waiting for patients to seek care.

Panelists discuss how clinical decision support tools, care pathways, and artificial intelligence can address primary care workforce shortages by providing real-time guidance, predictive modeling for high-risk patients, and autonomous agents for patient outreach and care coordination.

Panelists discuss how data systems and registries should focus on improving care quality rather than just reimbursement, with patient empowerment strategies that encourage individuals to advocate for better treatments like de-prescribing harmful medications.

Panelists discuss how organizations must create system-wide cultural changes through staff training, appropriate clinical environments, evidence-based treatment access, and incentive structures that support rather than punish providers for addressing obesity as a chronic disease.

Panelists discuss how unconscious bias and weight stigma create barriers to care, requiring providers to acknowledge their own biases, create welcoming clinical environments with appropriate accommodations, and approach patients with compassion rather than judgment about willpower.

Panelists discuss how effective provider-patient communication about weight requires opening conversations with empathy and collaboration, using phrases like "I'm concerned about your weight" and avoiding stigmatizing language while understanding patient motivations and readiness for change.

Panelists discuss how supporting primary care providers requires moving beyond passive quality measures to peer-to-peer education, transparent performance feedback, multidisciplinary team resources, and creative care delivery models that address the "27-hour day" problem.

Panelists discuss how UPMC's integrated delivery and financing system enables coordinated care through e-consults, proactive outreach to primary care physicians, case management, telemedicine, and streamlined referral processes that reduce friction for patients and providers.

Panelists discuss how implementing cardiovascular-kidney-metabolic health requires a team-based approach using the analogy of football, where physicians coach multidisciplinary teams to help patients overcome barriers and achieve health goals.

Panelists discuss how GLP-1 receptor agonists represent a paradigm shift by providing weight loss, glycemic control, and cardiovascular protection simultaneously, moving focus beyond A1C control to comprehensive risk reduction.

Panelists discuss how treating obesity as the root cause can create a "virtuous cycle" where weight loss improves insulin resistance, reduces medication needs, and enables better physical activity, breaking the traditional reactive approach to diabetes management.

Panelists discuss how barriers to implementing evidence-based obesity and diabetes care include limited provider time, lack of multidisciplinary teams, insufficient education about obesity physiology, and high costs of medications and programs.

Panelists discuss how ADA recommendations emphasize treating diabetes as part of overlapping conditions requiring cardiovascular and kidney protection, moving beyond just glycemic control to comprehensive care that addresses the whole person.

Panelists discuss how hormonal adaptations during weight loss in diabetes patients improve insulin sensitivity, while the DiRECT trial demonstrates that structured weight management programs can achieve diabetes remission in nearly half of newly diagnosed patients.

Experts share their final thoughts on the discussion, offering key takeaways and reflections on the importance of lipoprotein(a) (Lp[a]) testing and its role in improving cardiovascular risk management

Experts discuss lessons learned from implementing lipid-lowering therapy recommendations and explore the role value-based care models may play in successfully adopting the National Lipid Association’s (NLA) recommendation for lipoprotein(a) (Lp[a]) testing.

Experts discuss lessons learned from implementing lipoprotein(a) (Lp[a]) testing in health care systems, how health systems can prioritize patients for testing based on the National Lipid Association’s (NLA) recommendation, the role of integrated delivery networks in helping providers identify priority patients, and strategies for adding electronic health record alerts for Lp(a) testing.

Experts discuss the current prevalence of lipoprotein(a) (Lp[a]) testing in the US, both in the general population and among those with established atherosclerotic cardiovascular disease (ASCVD), its commonality within health plans, and how payers, population health decision makers, and provider groups can integrate Lp(a) testing into broader population health management strategies.

Experts discuss how knowledge of lipoprotein(a) (Lp[a]) levels can empower patients in managing atherosclerotic cardiovascular disease (ASCVD) risk factors, how providers can collaborate with patients on Lp(a) testing and risk management, the potential population-level value of improved ASCVD risk assessment, and how the National Lipid Association’s (NLA) recommendation for one-time Lp(a) testing may benefit health systems.

Experts discuss how lipoprotein(a) (Lp[a]) testing, even without targeted Lp(a)-lowering therapies, can enhance overall cardiovascular risk assessment and potentially influence the management of other risk factors.

Experts discuss FDA-approved therapies for high lipoprotein(a) [Lp[a]) levels, their benefits and shortcomings, the frequency of their use in health plans, emerging therapies in the pipeline, and the expected timeline for associated data release.

Experts discuss the cost of lipoprotein(a) (Lp[a]) tests and how these costs, along with the National Lipid Association’s (NLA) recommendation and supporting clinical evidence, may influence payer decisions regarding coverage for Lp(a) testing.

Experts discuss whether providers should wait for another complete scientific statement from the National Lipid Association (NLA) or new guidelines from organizations like the American Heart Association (AHA) before implementing the 2024 NLA recommendation for universal lipoprotein(a) (Lp[a]) measurement.

Experts discuss the evidence supporting the National Lipid Association’s (NLA) recommendation for universal lipoprotein(a) (Lp[a]) measurement and evaluate how compelling this evidence is from a clinical perspective.

Experts discuss how guideline recommendations influence formulary decisions regarding preventive measures like lipoprotein(a) (Lp[a]) testing, exploring the varying recommendations from organizations such as the American Association of Clinical Endocrinologists, the American Heart Association, and the National Lipid Association (NLA), and how these align with recent guidance from Europe and Canada.

Experts discuss an example illustrating the association between lipoprotein(a) (Lp[a]) levels and atherosclerotic cardiovascular disease (ASCVD) risk and explore how this example can inform our understanding of Lp(a) and ASCVD risk on a population level.

Experts discuss the genetic determinants of lipoprotein(a) (Lp[a]) levels, providing evidence supporting this conclusion. They also explore how the hereditary nature of Lp(a) can drive awareness of atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis risk, potentially influencing screening protocols.

Experts discuss the evidence supporting the continuous relationship between lipoprotein(a) (Lp[a]) levels and atherosclerotic cardiovascular disease (ASCVD), as recognized by the National Lipid Association, and explore how Lp(a) levels may change throughout a person’s lifetime or in response to lifestyle factors.

Experts discuss the relationship between lipoprotein(a) (Lp[a]) levels and atherosclerotic cardiovascular disease (ASCVD) risk, with findings from a large US population study, and explore how these findings could impact clinical practice and the management of patients at risk for ASCVD.

Experts discuss the clinical and economic burden of atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis in the US, exploring their impact on health care systems, the importance of prevention in reducing this burden, and the challenges of implementing preventive strategies, while considering the potential benefits of improved risk assessment and prevention in the ASCVD space.