Question-and-answer session

Dr. Mary McGowan: I have a quick question for Dr. Defesche:My partner, Dr. Susan Lynch, who is here in the audience and, I have begun initiating statin treatment in kidswith familial hypercholesterolemia (FH) according to the new American Academy of Pediatrics guidelines. We are beginning treatment in children at 8 years of agewho cannot achieve low-density lipoprotein (LDL) less than 160 mg/dL. Are you doing the same? Dr. Defesche: Yes. I am. Tom Whayne: Tom Whayne, University of Kentucky. I just have two comments. The speakers can then respond. First, in terms of your guest, Dr. McGowan, that is an appalling problem. To me as a cardiologist, any young woman, no matter how young, her chest pain has to be explained, and most likely, she will end up with a stress test unless it is definitely chest tenderness. If she is a little bit older, if I can’t explain it, a cath as indicated. Dr. McGowan: Let’s see, over here? Dr. J. Ross Tanner: Hi,my question is regarding qualifying patients for LDL apheresis. I live in Anchorage, Alaska. We are the only center in the state that provides apheresis patients. We seem to live and die by standards that are set by somebody else, and one of the difficulties that I have is that wewill havepatients thatmaybeonmaximumtherapy,maybe combination therapy, we may take an LDL of, say, 250 to 350 mg/dL down to 180 mg/dL, or maybe they may be a patient that has an LDL of 250 and they don’t have coronary disease, ormaybe they have highLP(a). These people don’t qualify for LDL apheresis. How do we get the standards changed? Was this set by Centers for Medicare and Medicaid Services with the 200-mg/dL and 300-mg/dL mark? Or I mean, how did that evolve and what can we do as an organization to change