key: cord-0708242-uugr7uly authors: Guyton, John R. title: From the editor: Plagues and the ancient legacy of Epimenides date: 2020-06-08 journal: J Clin Lipidol DOI: 10.1016/j.jacl.2020.05.004 sha: 2b72a186ac75ecd763b65438eb123dfaa75a07de doc_id: 708242 cord_uid: uugr7uly nan From the editor: Plagues and the ancient legacy of Epimenides Infectious disease epidemics used to happen frequently, a woeful recurrent theme of life on this planet. Now they are uncommon at least in the developed world. My grandparents experienced the influenza pandemic of 1918, but my parents, born shortly thereafter and now departed, never experienced what we are going through today. The lipidology community is adapting, mostly learning to do telemedicine from home. Some are providing front-line service in emergency departments, hospital wards, intensive care units, testing stations, and research studies. While most of the concerns of COVID-19 relate to the lungs and to hyperinflammation, pre-existing atherosclerotic cardiovascular disease increases risk for adverse outcomes. Add the ongoing risk of ''routine'' heart attack and stroke, and it's clear that lipid practice remains important. Two articles in this issue of the Journal deal with COVID-19. Wei and colleagues, reporting from the original epicenter in Wuhan, China, found hypolipidemia in almost 600 patients presenting with SARS-CoV-2 infection. LDL cholesterol (LDL-C) levels correlated inversely with clinical severity and with markers of inflammation, and positively with lymphocyte counts. 1 While the variability of baseline LDL-C makes it difficult to view an isolated test as a biomarker, some of our patients will have known baseline levels, and a precipitous fall in LDL-C might give a rapid assessment of metabolic stress associated with infection. Also of importance in this issue, Dean Karalis in an editorial cites evidence for safety of statin medications in patients at risk for COVID-19 and even in those with infection up to the point of hospitalization. Observational experience suggests that statin users compared to non-users could have a small improvement in clinical outcomes from seasonal influenza. Early observational data in coronavirus infection also trends favorably. 2 There is no data, however, to support continuation of statin therapy in patients hospitalized with COVID-19, and given the known infrequent risks, statin continuation in hospitalized COVID-19 patients should probably be limited to randomized clinical trials. This issue also features a systematic review by Dixon and colleagues of 26 randomized controlled trials that strongly support the roles of clinical interventions by pharmacists in reducing LDL-C. 3 Our Roundtable discussion, which might make you hungry, outlines the good and bad in South Asian and Hispanic diets, as well as the mostly beneficial effects of the authentic Mediterranean diet as opposed to some variants in the US and other places. 4 Further topics addressed in this issue include economic aspects of lipid treatment, genetic identification of familial hypercholesterolemia, use of alirocumab in pediatric patients, asymptomatic intracranial atherosclerosis, and others. An afterthought about the viral pandemic: Will life return to ''normal'' after COVID-19 runs its course, or will life, including medical practice, be forever changed? Could it even improve? One of the feelings of this stressful time is a sense of community. We're all in it together. The sense of community extends to our nation and more broadly to the world. William Mitchell Ramsay described a plague that struck Athens around 500 BCE 5 : Under the Pisistratidae Athens grew from a small town into an important city; but in this too rapid increase it outgrew healthy conditions. The laws of sanitation, which the old religion had prescribed for small social groups, were quite inadequate for a large city. Athens was ripe for a pestilence; and, after the tyrants were expelled, the slackness and want of forethought which attended Athenian democracy aggravated the evils of city management, while party strife distracted attention. The result was as recorded by Maximus, Diogenes, and others; a plague struck the city. The Athenians decided to bring in a consultant, Epimenides of Crete. According to the ancient historian Diogenes Laertes 6 : He was considered by the Greeks as a person especially beloved by the Gods, on which account, when the Athenians were afflicted by a plague, and the priestess at Delphi enjoined them to purify their city; they sent a ship and Nicias the son of Niceratus to Crete, to invite Epimenides to Athens; and he, coming there in the fortysixth Olympiad, purified the city and eradicated the plague for that time.. Epimenides brought more than sanitation and social distancing to Athens. He encouraged an entirely new way of thinking. Within 2 generations Athens entered the golden age of Pericles, Socrates, and Plato. The legacy of Epimenides persists today in the form of 2 quotations and 1 object described in the biblical New Testament, though his name does not appear there. Let's take inspiration anyway from his example. We can do better and make progress for humanity as they did in Athens. The briefer and more famous quote from Epimenides bespeaks a sense of humor, humility, or sly wisdom -''Cretans, always liars.'' Was he lying? Hypolipidemia is associated with the severity of COVID 19 Are statins safe in patients with COVID 19? Effect of pharmacist interventions on reducing lowdensity lipoprotein cholesterol (LDL-C) levels: a systematic review and meta-analysis JCL Roundtable: healthy ethnic diets Asianic Elements in Greek Civilisation The lives and opinions of eminent philosophers Dr. Guyton has received research grants from Amarin, Regeneron, and Sanofi.