From the editor: Eglerio! The Ringbearers, praise them!
2022; Elsevier BV; Volume: 16; Issue: 3 Linguagem: Inglês
10.1016/j.jacl.2022.05.004
ISSN1933-2874
Autores Tópico(s)Venomous Animal Envenomation and Studies
ResumoThe SARS-CoV-2 pandemic has not yet run its course, especially in some parts of the world, but its impact is less confining now. Life and work in most places are beginning to return to normal, or better, a new normal. Throughout the pandemic heroes have appeared in our midst, and they have been recognized, albeit inconstantly, by society. Most of them are ordinary people including healthcare providers, first responders, front-line workers. We should recall an even more significant group of heroes who preceded the pandemic and will always remain. A week ago I had a televideo visit with a dear patient, a woman in her late 60s whom I have followed for 20 years, providing lipid management in the setting of what turned out to be inclusion body myositis, a disorder giving slowly progressive weakness, presently incurable. About halfway through this time, she fell in love with a wonderful man, they married, and their faith and love have been an inspiration to many others in their church and elsewhere, including me. Another woman about 12 years ago presented with familial hypercholesterolemia, history of vigorous exercise, coronary stenting before age 40, and 3 cm Achilles tendon xanthomas. We added new lipid medications. Achilles tendinitis flared, and 2 months later she re-appeared in clinic using a walker. Earlier in my career, John Brunzell had reassured me that such a flare of tendinitis could be a sign of cholesterol removal, and indeed the tendons regressed by 0.5 cm within 9 months, and the patient resumed walking normally (1Lakey WC Greyshock N Guyton JR. Adverse reactions of Achilles tendon xanthomas in three hypercholesterolemic patients after treatment intensification with niacin and bile acid sequestrants.J Clin Lipidol. 2013; 7: 178-181https://doi.org/10.1016/j.jacl.2012.11.002Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar). Her grit was awesome. She seemed destined for great things, which proved true. Add to these the pioneering environmental scientist who studied Pfiesteria, a unicellular organism causing fish kills in North Carolina rivers in the 1990s. A laboratory accident led to his toxic exposure along with 6 others, almost all of whom have died by now. Akin to a fish kill, the demyelinating toxin severely damaged his peripheral nerves giving constant pain. He has emerged from bedbound existence to frequent walks around the farm where he lives, with the help of a big stick for balance. Through periodic office visits our friendship has grown over the years. He and his wife support each other and their extended family – and me. My son Morgan, an ordained minister, helped me in 2011 write a Lipid Spin article about the unfairness of several patients’ travails and the inspiration gained while helping them live “normally,” which means remarkably in the face of challenge. We named them Ringbearers after the humble, yet venturesome hobbit, Frodo Baggins, who through no choice of his own encountered pain and shortened life while securing the salvation of Middle Earth (2Guyton JR Guyton MA. Ringbearers: a hobbit's perspective on genomic medicine.Lipid Spin. 2011; 9: 9-10Google Scholar). I won't repeat a detailed comparison with that allegory here. Suffice it to say that our patients and their loved ones are the enduring heroes. The title of this piece quotes J.R.R. Tolkien as a shout of praise. I doubt that the word “Eglerio” appears in any human language. It comes from the woodland elves (3Tolkien JRR. The Lord of the Rings. Part 3. The Return of the King. Ballantine Books, New York1955 and 1965: 285Google Scholar). A practical way to honor our patients is to study the lipid disorders that afflict them and to devise and test new modes of treatment. This issue of JCL features case reports of an infrequent cause of familial chylomicronemia and an unusual manifestation of cerebrotendinous xanthomatosis, as well as new insight on diagnosing pediatric familial hypercholesterolemia from France and characterization of homozygous familial hypercholesterolemia in China. An update provides recommendations from the Lipid Association of India for intensive LDL-C lowering applicable to South Asian patients with acute coronary syndrome. Poornima et al. review lipid risk factors for preeclampsia in pregnancy with a focus on hypertriglyceridemia. CERT2 (Coronary Event Risk Test 2) is a new risk score based on plasma ceramides and glycerophospholipids. Papazoglou and colleagues in this issue present a meta-analysis demonstrating the value of CERT2 for prediction of major adverse cardiovascular events in secondary prevention. Laufs et al. compile patient-level data from four phase 3 clinical trials on bempedoic acid taken alone or in combination with ezetimibe to show worthwhile LDL-C lowering and no evidence for adverse muscle effects in statin-intolerant patients. Also in this issue you will find success in persistence of PCSK9 inhibitor therapy, new data on clinical associations with oxysterols, and more.
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