Laurence Sperling, MD

Laurence Sperling, MD: Expanding Cardiologists' Role in Obesity Management

22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC)

, Laurence Sperling, MD, founder of the Center for Heart Disease Prevention at Emory University School of Medicine, examined the evolving role of cardiologists in 

 and the integration of glucagon-like peptide-1 (GLP-1) receptor agonists into 

Sperling highlighted the paradigm shift—better termed a "paradigm extension"—as cardiologists increasingly adopt therapies like sodium-glucose co-transporter 2 (SGLT2) inhibitors, and now GLP-1 agonists, for obesity and cardiovascular risk reduction, akin to their earlier adoption of statins.

Overall, Sperling emphasized the need for multidisciplinary team-based care to optimize these therapies, sharing a real-world example of prescribing a GLP-1 receptor agonist to a coronary artery disease (CAD) patient whose primary care physician hesitated to use these agents. He stressed that beyond weight loss, these agents can reduce cardiac events, protect kidney function, and show promise in areas like dementia prevention. However, operationalizing their use requires overcoming challenges such as equity, affordability, and supporting patients in dose escalation. He noted this process demands patience and coordinated care from cardiologists, endocrinologists, primary care providers, nurse practitioners, and clinical pharmacists.

Reflecting on the meeting’s interdisciplinary focus, Sperling praised its emphasis on translating science into clinical practice, noting that collaboration is essential to managing the rising burden of obesity and its cardiometabolic consequences. He called for systemic solutions to address these challenges in a healthcare system already stretched thin while commending the innovative work showcased at the congress.

Laurence Sperling has no relevant disclosures to report.

Sperling L. A Multi-Disciplinary Approach to Obesity - Cardiology. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.

Videos

Laurence Sperling, MD described the evolving role of cardiologists in obesity care, particularly with the increasing adoption of therapies such as GLP-1 agonists.

Laurence Sperling, MD: Multidisciplinary Strategy in Cardiology to Combat Obesity Epidemic

, Laurence Sperling, MD, founder of the Center for Heart Disease Prevention at Emory University School of Medicine, explored 

 and emphasized the urgent need for multidisciplinary and upstream approaches to addressing the global obesity pandemic.

Sperling highlighted the key takeaways from a recent European Society of Cardiology (ESC) consensus statement, including a statistic that two-thirds of obesity-related deaths are cardiovascular-related, centering the pivotal role of all clinicians, particularly cardiovascular specialists, in tackling the global issue of obesity.

Sperling cited groundbreaking data from the SELECT trial, which demonstrated a 20% reduction in major adverse cardiovascular events (MACE) in individuals with ASCVD and obesity, even in the absence of diabetes. While acknowledging the transformative potential of advanced pharmacotherapies and bariatric surgery, he stressed that these individual-level interventions alone are insufficient to reverse the obesity epidemic. Instead, Sperling called for expanded collaboration across primary care, public health, and policy sectors to address systemic and societal drivers of obesity, including improving upstream prevention strategies.

Notably, Sperling pointed to alarming findings that 80% of young adults in the U.S. are already on the path to cardiometabolic disease and only 2% of adults over age 65 are free from related concerns. He urged healthcare stakeholders to move beyond siloed specialties and forge partnerships with communities to build trust and implement meaningful prevention strategies. He emphasized that while current treatment options are powerful, long-term success depends on a unified, systemic approach to reducing obesity and its cardiovascular consequences.

Laurence Sperling, MD shares insights into a multi-disciplinary approach to the management of obesity from the perspective of a cardiologist.

Laurence Sperling, MD: Multidisciplinary Strategies to Combat Obesity Epidemic

Drs. Sperling and Gianos discuss future considerations for use of lipoprotein apheresis and the evolving landscape of lipid management.

HCPLive Special report Lipoprotein Apheresis Special Report Part 3

00:00 - Challenges and Barriers in Lipoprotein Apheresis

02:28 - Patient-facing and Clinician-Specific Perspectives

05:30 - Insurance and Health System Challenges 

12:07 - Final Thoughts and Recommendations

In contemporary settings within cardiology, the word 

 is enough to conjure excitement and enthusiasm. With the field on the cusp of a potential paradigm shift in the management of lipoprotein(a) [Lp(a)] within the next 18 months, many are optimistic about the potential for additional therapeutic options to improve outcomes in patients with elevated Lp(a).

What often goes unmentioned or overlooked in these conversations is the recognition of an existing US Food and Drug Administration-approved therapy for reducing Lp(a) in lipoprotein apheresis. Beyond this recognition, data and guidelines also support the role of lipoprotein apheresis in certain patients with familial hypercholesterolemia (FH).

The recognition of the potential utility of this therapy in this context and more was the subject of the latest 

scientific statement from the American Heart Association (AHA)

. Released on October 07, 2024, the statement, titled “Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association,”, clocks in at 18 pages and length and cites more than 100 references documents. Composed on behalf of several AHA councils, the document was created by a volunteer writing committee led by committee chair Laurence Sperling, MD, Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention, and vice-chair Eugenia Gianos, MD, director of Cardiovascular Prevention at Northwell Health.

In this, the third and final segment of this HCPLive Special Report, Sperling and Gianos discuss the evolution, challenges, and future of lipoprotein apheresis in treating patients with severe hypercholesterolemia. Sperling, who has overseen Emory’s lipoprotein apheresis program for more than 20 years, shares insights on the program’s expansion and the barriers faced in providing this treatment, which is currently available in only 33 US states. Sperling goes on to emphasizes the need for greater awareness among clinicians about the benefits of apheresis, which can drastically reduce LDL cholesterol and Lp(a) levels, improve patients' quality of life, and prevent cardiovascular events.

Gianos, who helped establish Northwell Health’s apheresis program, highlights the importance of balancing the inconvenience of frequent treatments with the long-term health benefits for patients. She also discusses the need for more research on patient experiences and the potential for the therapy to address not only lipid reduction but also inflammation and endothelial function. Both experts agree that while emerging therapies for Lp(a) are promising, apheresis remains a vital option for patients who do not respond optimally to existing treatments. Similarly, they both stress the importance of continued education and institutional support to ensure access to this life-saving therapy.

Clinical Application of Lipoprotein Apheresis

Laurence Sperling has no disclosures to report. Relevant disclosures for Gianos include Amgen, AstraZeneca, Eli Lilly and Company, kaenka, Novartis, and Med-IQ.

Gianos E, Duell PB, Toth PP, et al. Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. Published online October 7, 2024. doi:10.1161/ATV.0000000000000177

Iapoce C. AHA scientific statement promotes expanded use of lipoprotein apheresis. HCP Live. October 11, 2024. Accessed October 17, 2024. https://www.hcplive.com/view/aha-scientific-statement-promotes-expanded-use-of-lipoprotein-apheresis.

In part 3 of our Special Report on lipoprotein apheresis, Sperling and Gianos discuss future considerations for use and the evolving landscape of lipid management.

The Future of Lipoprotein Apheresis, with Laurence Sperling, MD, and Eugenia Gianos, MD

Drs. Sperling and Gianos highlight clinical considerations for use of lipoprotein apheresis in part 2 of a 3-part series.

HCPLive Special Report on Lipoprotein Apheresis Part 2

00:00 - Eligibility and Benefits of Lipoprotein Apheresis

02:14 - Steps for Identifying and Treating Patients 

03:44 - Data and Evidence Supporting Lipoprotein Apheresis 

07:44 - Additional Benefits and Mechanisms of Lipoprotein Apheresis

09:56 - Vascular and Nephrological Benefits

12:50 - Conclusion and Broader Applications

Despite offering the potential to improve outcomes in certain patients with

 and being the only therapeutic approach currently approved by the US Food and Drug Administration for lowering lipoprotein(a) [Lp(a)], lipoprotein apheresis goes underutilized in contemporary settings, according to 

 from the American Heart Association (AHA).

In recent years, a growing body of evidence has outlined the potential of this therapeutic approach, with this growth culminating in the release of the latest scientific statement from the AHA. Released on October 07, 2024 and titled “Lipoprotein Apheresis: Utility, Outcomes, and Implementation in Clinical Practice: A Scientific Statement From the American Heart Association,”, the document reviews the historical development, available devices, indications, efficacy, vascular effects, outcomes data, use in special populations, availability, access, cost, and patient perspectives on lipoprotein apheresis.

In recognition of the efforts of the AHA and the volunteer writing committee, 

 has launched the latest Special Report series spotlighting the scientific statement with writing committee chair Laurence Sperling, MD, Katz Professor in Preventive Cardiology and founder of the Emory Center for Heart Disease Prevention, and vice chair Eugenia Gianos, MD, director of Cardiovascular Prevention at Northwell Health.

In this segment, which is part 2 of our 3-part series, Sperling and Gianos discuss the benefits and challenges of lipoprotein apheresis as a treatment for patients with severe lipid disorders, particularly those with homozygous familial hypercholesterolemia and elevated Lp(a). Sperling, who helped establish Emory’s lipoprotein apheresis program, highlights how this procedure provides life-saving options for patients with genetic lipid conditions, especially those who do not respond to standard therapies due to non-functional LDL receptors.

Gianos delves into the clinical evidence supporting lipoprotein apheresis, noting that while randomized controlled trials are limited, observational data show significant cardiovascular event reductions, with some studies reporting up to a 95% decrease in events. They also discuss the unique ability of apheresis to not only lower LDL cholesterol but also reduce inflammation and improve endothelial function, which contributes to vascular healing.

The conversation touches on underexplored areas, such as the potential for using apheresis in patients with 

 and other challenging populations, including stroke patients and pediatric cases. Both experts emphasize the need for further research and collaboration with nephrologists and other specialists to expand the use of this therapy for broader patient groups.

Laurence Sperling has no disclosures to report. Relevant disclosures for Gianos include Amgen, AstraZeneca,Eli Lilly and Company, kaenka, Novartis, and Med-IQ.

Lipoprotein apheresis, though underutilized, is the only FDA-approved method for lowering lipoprotein(a) and offers potential benefits for patients with familial hypercholesterolemia. The American Heart Association's recent scientific statement reviews its efficacy, outcomes, and implementation. Experts highlight its life-saving potential for patients with severe lipid disorders, especially those unresponsive to standard therapies. Observational data suggest significant cardiovascular event reductions. The statement calls for further research and collaboration to explore its use in broader patient populations, including those with focal segmental glomerulosclerosis and pediatric cases.

In part 2 of this 3-part series, Sperling and Gianos highlight the role of lipoprotein apheresis in contemporary settings and the supporting evidence base. 

Laurence Sperling, MD

Articles