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Advanced Specialization as a Clinical Lipid Specialist
By Geeta Sikand, MA, RDN, FAND, CDE, CLS, FNLA,
and Julie Bolick, MS, RDN, CD, CLS, FNLA

Learn more about this certification, why RDNs should pursue it, and how to obtain it.

Just as dietitians can advance their careers and improve patient care by becoming certified as specialists in diabetes education, oncology, sports nutrition, and weight management, they also can excel by obtaining the clinical lipid specialist (CLS) credential, which can open doors to many career opportunities.

Health care professionals with a CLS certification possess a comprehensive knowledge of lipid management. Only licensed health care professionals, including RDNs, exercise physiologists, physicians, pharmacists, registered nurses, nurse practitioners, and physician assistants, can obtain the CLS credential. The CLS credential is ideal for health care professionals, including RDNs in clinical or academic practice, who are actively involved in patient management and seeking to demonstrate their expertise in clinical lipidology and commitment to continued professional development in lipid management.1

Health care professionals with a CLS credential also have advanced understanding of genetic disorders of lipid metabolism including familial hypercholesterolemia and familial hypertriglyceridemia, as these significantly increase the risk of atherosclerotic cardiovascular disease.2

A CLS certification could better position an RDN to:

provide medical nutrition therapy (MNT) to patients with complex lipid disorders;3,4 and
serve as an expert in nonpharmacologic approaches to managing patients with dyslipidemia3,4.

Obtaining the CLS Credential
RDNs can achieve advanced specialization as a CLS by meeting eligibility and training requirements and passing a certification exam. The Accreditation Council for Clinical Lipidology (ACCL) administers this exam. The ACCL is, according to its website, "an independent certifying organization that has developed standards and examinations in the field of clinical lipidology for health care professionals involved in lipid management." The mission of the ACCL is "to establish, certify, and maintain the clinical competencies of qualified health care professionals who have a focus in clinical lipidology," according to its website. The ACCL CLS certification exists to enhance the quality of care rendered to patients; establish parameters defining clinical competency for CLSs; foster continual learning and improvement over the professional's career; provide recognition of the specialized training and qualifications of those in the health care profession; serve as a valuable resource to health professionals; participate in multidisciplinary patient care in clinical lipidology to reduce cardiovascular disease (CVD) risk; and enhance the credibility of the health care professional and the specialty of clinical lipidology in the medical community, as stated on the ACCL website.

The CLS Credentialing Process
On January 1, 2014, the Commission on Dietetic Registration approved the ACCL-CLS designation for 75 hours of CPEUs for RDN recertification.5 Earning the CLS certification will allow RDNs to meet the full 75 CPEUs needed for their five-year recertification cycle, as stated in the Professional Portfolio Development Guide on the CDR website.

Dietitians are eligible for the CLS exam if they have a bachelor's degree in a related health science and 3,000 contact hours of clinical experience in the management of patients with lipid disorders or other related disorders, or if they have a master's degree or higher in a related health science and 2,000 contact hours of clinical experience. In addition, candidates must earn 200 points to successfully obtain the credential for certification. Points can be earned through primary and subspecialty board certifications, relevant academic practice, involvement in clinical research, and participation in lipid-focused continuing education, according to lipidspecialist.org.

The four-hour ACCL exam includes 150 to 200 questions focused on the following approved core curriculum in clinical lipidology:
• metabolism of lipids and lipoproteins and the pathophysiology of atherosclerosis;
• genetics, diagnosis, and management of dyslipidemias and the metabolic syndrome;
• CVD risk assessment;
• pharmacology, safety, and efficacy of lipid-altering drugs; and
• fundamentals of nonpharmacologic therapy: nutrition, exercise, behavior, and compliance.1

More information, including fees, exam schedules, and training opportunities for the CLS certification, is available on the ACCL website.

Enhancing Lipid-Related Expertise
Regardless of an RDN's plans for CLS certification, the National Lipid Association (NLA) offers many educational activities tailored to health care professionals at all stages of their career, according to its website. The NLA's educational activities have been designed to prepare RDNs, pharmacists, physicians, physician assistants, registered nurses, and licensed nurse practitioners for the certification requirements the ACCL establishes.6

In addition, the ACCL offers the Basic Competency in Clinical Lipidology certificate exam for paraprofessionals or professionals who have been away from the lipid field for some time and want to improve their basic knowledge.

Clinical lipid specialists are considered experts in the lipid management field. The CLS certification can enhance RDNs employment opportunities as coordinators or team members of lipid research clinics that conduct lipid research studies to test new cholesterol-lowering drugs. Being an RDN with CLS certification also can increase employment opportunities in pharmaceutical companies that provide MNT to patients taking specialized medications for familial hypercholesterolemia.

For more information, visit the ACCL website.

— Geeta Sikand, MA, RDN, FAND, CDE, CLS, FNLA, is cochair of the National Lipid Association Nutrition Task Force, diplomate of the Accreditation Council for Clinical Lipidology, associate clinical professor of medicine (cardiology), and director of nutrition, preventive cardiology program at the University of California, Irvine.

— Julie Bolick, MS, RDN, CD, CLS, FNLA, is a diplomate of the Accreditation Council for Clinical Lipidology, chair of the National Lipid Association's Nutrition Task Force, and is an independent consultant.

References
1. Clinical lipid specialist — who should take the exam? Accreditation Council for Clinical Lipidology website. http://www.lipidspecialist.org/certchoose/cls/. Accessed February 1, 2015.
2. Marrs JC. Pathophysiology of Atherosclerotic Cardiovascular Disease.
In: Wiggins BS, Saseen JJ, eds. Pharmacist's Guide to Lipid Management. 2nd ed. Lenexa, KS: American College of Clinical Pharmacy; 2014:1-21.
3. Sikand G. CardioProtective Dietary Patterns and Preventions of Atherosclerotic Cardiovascular Disease. In: Wong ND, Amsterdam EA, Blumenthal RS, eds. ASPC Manual of Preventive Cardiology. 1st ed. New York, NY: Demos Medical Publishing; 2014:142-155.
4. Bolick J, Sikand G. Reducing CHD risk through lifestyle management. In: Wiggins BS, Saseen JJ, eds. Pharmacist's Guide to Lipid Management. 2nd ed. Lenexa, KS: American College of Clinical Pharmacy; 2014:54-75.
5. Professional development portfolio guide. Commission on Dietetic Registration website.
https://www.cdrnet.org/vault/2459/web/files/PDP%20Guide%202015.pdf. Accessed February 1, 2015.
6. Lipid academy. National Lipid Association website. https://www.lipid.org/lipidacademy. Accessed February 1, 2015.

Importance of MNT
RDNs who administer medical nutrition therapy (MNT) provide personalized dietary counseling and promote patient adherence to a cardioprotective dietary pattern for the management of dyslipidemia and related comorbidities.1-3

Several studies, including those documented by this article's coauthor, have shown the effectiveness of including an RDN's administration of MNT in lipid management programs3-8. A recent systematic review of 34 studies of moderate- and high-intensity lifestyle and dietary interventions by Lin and colleagues reported improvements in cardiovascular disease (CVD) risk factors in subjects with dyslipidemia and related disorders such as hypertension, metabolic syndrome, and impaired fasting glucose.4 A meta–analysis of 14 studies by Aucott and colleagues in 2012 showed that diet and lifestyle modifications resulted in significant, favorable changes in lipids and body weight for up to three years.5 Based on a systematic review of eight studies, McCoin and colleagues reported that MNT by a RDN over six weeks to six months resulted in a significant decrease in LDL-C (7% to 15%).6 Studies also have reported that MNT by an RDN led to a reduction in health care costs related to lipid lowering medications.7, 8

References
1. Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 – executive summary. J Clin Lipidol. 2014;8(5):473-488.
2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99. doi: 10.1161/01.cir.0000437740.48606.d1.
3. Sikand G. Cardioprotective dietary patterns and preventions of atherosclerotic cardiovascular disease risk stratification. In: Wong ND, Amsterdam EA, Blumenthal RS, eds. ASPC Manual of Preventive Cardiology. 1st ed. New York, NY: Demos Medical Publishing; 2014:142-155.
4. Lin JS, O'Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons with Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality (US); 2014.
5. Aucott L, Gray D, Rothnie H, Thapa M, Waweru C. Effects of lifestyle interventions and long-term weight loss on lipid outcomes - a systematic review. Obes. Rev. 2011. 12(5), e412–e425.
6. McCoin M, Sikand G, Johnson EQ, et al. The effectiveness of medical nutrition therapy delivered by registered dietitians for disorders of lipid metabolism: a call for further research. J Am Diet Assoc. 2008;108(2):233-239.
7. Sikand G, Kashyap ML, Wong ND, Hsu JC. Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance. J Am Diet Assoc. 2000;100(2):218-224.
8. Sikand G, Kashyap ML, Yang I. Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia. J Am Diet Assoc. 1998;98(8):889-894.