Improving Outcomes for Patients with Severe Hypercholesterolemia
Credit(s): 1.00 (60 min)
Release Date: Dec 20, 2018
Expiration Date: Dec 20, 2019
CME / AMA PRA Category 1 Credit™
MOC / ABIM MOC Part 2 Credit
Hypercholesterolemia, particularly low-density lipoprotein cholesterol (LDL-C) elevation, is a major driver of atherosclerotic cardiovascular disease (ASCVD). Lipid-lowering therapies (mainly in combination with statins) are the primary treatment approach to lower LDL-C and reduce CVD risk. However, intensive statin therapy lowers CVD risk only by ~50%, leaving many patients at excessively high residual CVD risk.
Ezetimibe, which reduces absorption of cholesterol from the intestine, reduces LDL-C levels by an additional 20%-25% and modestly improves clinical outcomes when added to statin therapy. Recently approved PCSK9 inhibitors also produce robust LDL-C reduction when co-administered with statins and have been shown to improve clinical outcomes in patients with ASCVD. Improving Outcomes for Patients with Severe Hypercholesterolemia will explore all of these treatment options and their safety/efficacy profiles, while also providing participants with insights on practical applications in clinical practice to improve the outcomes of their patients with severe or difficult-to-treat hypercholesterolemia.
Welcome and Introduction
Guidelines, Trial Data, and Residual Risk
New and Emerging Treatment Options
This educational initiative is intended for clinical cardiologists, internists, and other healthcare professionals tasked with refining and updating clinical decision-making practices and establishing partnerships with ASCVD patients to improve clinical outcomes.
This program is designed to address ACGME and IOM competencies, including delivering patient-centered care, medical knowledge and practicing evidence-based medicine.
At the conclusion of this activity, participants should be able to demonstrate the ability to:
Evaluate the extent of residual CVD risk to which ASCVD patients are exposed, and treat additional CVD risk elements as appropriate
Conduct appropriate diagnosis of familial hypercholesterolemia and implement appropriate treatment and rationale for cascade screening of the families
Differentiate the clinical properties of new and emerging pharmacologic approaches to reduce LDL-C and lower CVD risk
Analyze the potential utility of new LDL-C lowering agents used in combination with statins to reduce CVD risk in patients who have ASCVD
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of USF Health and Rockpointe. USF Health is accredited by the ACCME to provide continuing medical education for physicians.
USF Health designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
MOC Points available for Internal Medicine General, Cardiovascular Disease, Clinical Cardiac Electrophysiology, and Interventional Cardiology Board Certified Physicians
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Within 60 days of the end of the activity, ABIM MOC points will be reported on your behalf.
Alan Brown, MD, FACC, FAHA, FNLA, FASPC
President, National Lipid Association
Director, Division of Cardiology
Advocate Heart Institute at Advocate Lutheran General Hospital
Co-Director, Cardiology Line Service
Advocate Medical Group
Alan Brown, MD, FACC, FAHA, FNLA, FASPC has been the Director of the Prevention Center/Lipid Clinic for Midwest Heart Specialists since its inception in 1985. He is a practicing interventional cardiologist and preventive cardiologist. He was appointed Clinical Associate Professor of Medicine and Cardiology at Loyola from 1993 until the present. Dr. Brown is board-certified in internal medicine, cardiology, echocardiography, and clinical lipidology. He is the Director of the Division of Cardiology at the Advocate Heart Institute at Advocate Lutheran General Hospital in Park Ridge, IL, as well as Co-director of the Cardiology Service Line for Advocate Medical Group/Advocate Health Care.
Dr. Brown has served as Governor/President of the Illinois Chapter of the American College of Cardiology (ACC) and subsequently was elected Chairman of the Board of Governors for the ACC in 2004. He is a Fellow of the American Heart Association, National Lipid Association, and ACC and has been a member of the ACC's Prevention of Cardiovascular Disease Committee and Annual Scientific Program Committee and serves on the current ACC Task Force for Appropriate Use Criteria. Dr. Brown served as a member of the ACC Board of Trustees from 2003 through 2006. He is currently President of the National Lipid Association and a member of the Board of Directors for the American Society for Preventive Cardiology.
Dr. Brown has authored numerous articles in the fields of lipid management and prevention, as well as two book chapters. He is the host of “Lipid Luminations,” an internet radio show on Reach MD radio that focuses on lipid topics through interviews with national thought-leaders.
James A. Underberg, MD, MS, FNLA
Immediate Past-President, National Lipid Association
Clinical Assistant Professor of Medicine
NYU School of Medicine and NYU Center for Prevention of Cardiovascular Disease
Director, Bellevue Hospital Lipid Clinic
New York, NY
James A. Underberg, MD, MS, FNLA is a clinical lipidologist and Clinical Assistant Professor of Medicine at NYU School of Medicine and the NYU Center for Prevention of Cardiovascular Disease. He is also the Director of the Bellevue Hospital Lipid Clinic. Dr. Underberg is a Diplomate of the American Board of Clinical Lipidology, a Fellow of the National Lipid Association, and a Past President of the National Lipid Association. He is a board member of the National Lipid Association and the Foundation of the National Lipid Association and serves as President-Elect of the American Board of Clinical Lipidology.
Dr. Underberg’s clinical interests focus on the management of patients with lipids and lipoprotein disorders, hypertension management, and cardiovascular disease prevention. He maintains an active clinical research program in these areas and has authored numerous articles and book chapters in the field of clinical lipidology. He sees patients both at Bellevue Hospital and in a university-based private-practice setting.
DISCLOSURE/CONFLICT OF INTEREST STATEMENT
USF Health endorses the standards of the ACCME that require everyone in a position to control the content of an accredited educational activity to disclose all financial relationships with commercial interests that are related to the content of the educational activity. All accredited activities must be balanced, independent of commercial bias, and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession.
A conflict of interest is created when individuals in a position to control the content of an accredited educational activity have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks, or other financial benefits.
USF Health will identify, review, and resolve all conflicts of interest that speakers, authors, or planners disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. USF Health does not endorse any products or services.
Program Faculty Disclosures
The program faculty reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:
Allan Chen, MD; Joseph J. Namey Jr., DO, MACOI, FACP; Jaclyn Capazola; Barry Watkins, PhD; Blair St. Amand: Nothing to disclose
The contents of some CME/CE activities may contain discussions of non-approved or off-label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.
In order to view this presentation, your computer must have audio capabilities (working speakers or headphones) and must have an internet browser capable of playing an HTML5 video.
INSTRUCTIONS FOR PARTICIPANTS AND OBTAINING CME CREDIT
There is no fee for this activity. To receive credit, participants must take the pre-test, view this CME activity in its entirety, and then complete the post-test, with a score of 60% or better, and evaluation. The estimated time for completion of this activity is 1 hour. To receive their certificates, participants must demonstrate mastery of the presented material via the post-test. Participant is allowed to take the post-test 2 times.
INSTRUCTIONS FOR OBTAINING MOC Points
Physicians seeking ABIM MOC Points will be required to provide:
- ABIM six-digit ID number
- First and last name
- Date of birth (mm/dd)
- ABIM specialty board
- Permission for USF Health to share completion data with ACCME, who will transmit same on their behalf to ABIM
Slide 4 – Educational Objectives
Alan Brown: The educational objectives for this activity are the following:
At the conclusion of this activity, participants should be able to evaluate the extent of residual CVD risk to which ASCVD patients are exposed, and treat additional CVD risk elements as appropriate. They should be able to conduct appropriate diagnosis of familial hypercholesterolemia and implement appropriate treatment and rationale for cascade screening of families. They should be able to differentiate the clinical properties of new and emerging pharmacologic approaches to reduce LDL cholesterol and lower cardiovascular disease risk. And finally, participants should be able to analyze the potential utility of new LDL cholesterol lowering agents used in combination with statins to reduce CVD risk in patients who have atherosclerotic cardiovascular disease.
Slide 5 – Hypercholesterolemia
We’re going to discuss the support for LDL cholesterol as a causal agent for atherosclerosis, and there are four compelling lines of evidence that we’ll discuss: experimental models, observation of human data, genetic studies, and interventional human trials.
Slide 6 – Disease Trajectories and CVD Risk Reduction
If you look at disease trajectory risk in patients who have asymptomatic cardiovascular disease to the point where they develop plaque rupture, risk factors seem to be very important in the duration of time that a patient will have asymptomatic disease. This shows you, in the red line, people who have no preventative therapy in the time of onset of atherosclerotic plaques. If we assume most everybody has them at age 30. By age 50, they’re likely to present with a clinical event. As opposed to the green line where we’ve optimized risk factors that includes adding statins plus additional lipid lowering therapy, we can see that that line gets dragged out to much later in the patient’s life; where many patients will not have symptomatic disease with plaque rupture even after age 80. Our goals are to try and begin preventative therapy early and reduce the chances of a clinical event until very late in life, and hopefully until they die of old age.
For a full transcript, click here.
Jointly provided by USF Health and Rockpointe
This activity is supported by educational funding provided by Amgen.
Clicking Start Activity indicates that you have reviewed the CME/CE information for this activity
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