LDL-C Reduction in the High-Risk Patient: How Low Should We Go?

Cardiology
Curriculum:
How Low Can you Go?
Credits:
1.75 AMA PRA Category 1 Credit(s)™
Launch Date:
September 29, 2015
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Endocrinologists, Diabetologists, Diabetes Educators, Internists, Clinical Cardiologists, Geriatricians, Nurse Practitioners, Physician Assistants

Relevant Terms:

diabetes, lipidology, cardiovascular risk assessment, genetic studies, clinical trials

Yehuda Handelsman, MD

Yehuda Handelsman, MD, FACP, FACE, FNLA
Medical Director & Principal Investigator
Metabolic Institute of America
President, American College of Endocrinology
Tarzana, CA

Dr. Handelsman is an endocrinologist in private practice, and Medical Director and Principal Investigator of the Metabolic Institute of America. He is a nationally and internationally recognized authority on obesity, insulin resistance, pre-diabetes, and the comprehensive approach to treating diabetes, controlling all cardiovascular risks. He is a pioneer and leader in the understanding of the body’s metabolic and energy systems, fat, and the gut-brain connection. A clinician, researcher, and educator, he publishes and lectures extensively. He is president of the American College of Endocrinology; past President of the American Association of Clinical Endocrinologists (AACE); Chair of AACE Diabetes & Lipid scientific committees and secretary of the Pacific Lipid Association. He is Chair, Founder, and Program Director of the acclaimed annual World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease; Associate Editor of the Journal of Diabetes; a frequent guest editor for publications such as the Journal of Clinical Hypertension; Chair of the AACE/ACE 2015 Comprehensive Diabetes Guidelines, member of the AACE/ACE 2015 Comprehensive Diabetes Algorithm and the 2012 AACE Lipid Guidelines; he also Co-Chaired consensuses on diabetes and cancer, insulin resistance, and pre-diabetes. Dr. Handelsman has been listed repeatedly in “Top Doctors of Los Angeles,” “Southern California Super Doctors,” and “Best Doctors of America”.

Robert H. Eckel, MD

Robert H. Eckel, MD
Professor of Medicine, Physiology & Biophysics
Charles A. Boettcher Endowed Chair in Atherosclerosis
University of Colorado
Aurora, CO

Dr. Eckel is Professor of Medicine, Physiology & Biophysics and the Charles A. Boettcher Endowed Chair in Atherosclerosis at the University of Colorado in Aurora, CO. Dr. Eckel received his medical degree from the University of Cincinnati. He completed his internship and residency training in Internal Medicine at the University of Wisconsin Hospitals and completed a senior fellowship in Endocrinology and Metabolism at the University of Washington. Dr. Eckel’s research is focused on the relationship between nutrition, insulin action, energy balance, and body weight regulation, with experiments carried out in both humans and mice. His research also bridges the gap between metabolic diseases and cardiovascular disease. His research and clinical activities have led to his involvement and presidency in a number of national organizations, including the American Heart Association, the Western Society for Clinical Investigation, the North American Association for the Study of Obesity, and the Association for Patient Oriented Research. Dr. Eckel has over 300 publications in numerous peer-reviewed journals, including Arteriosclerosis, Thrombosis, and Vascular Biology, Cell Metabolism, Circulation, Diabetes, and the Journal of Clinical Endocrinology and Metabolism.

Jorge Plutzky, MD

Jorge Plutzky, MD, FACC
Associate Professor
Harvard Medical School
Director, Vascular Disease Prevention Program
Brigham and Women's Hospital
Boston, MA

Dr. Plutzky is a practicing cardiologist and Director of the Vascular Disease Prevention Program, which includes the Lipid/Prevention Clinic and BWH/Partners Premature Atherosclerosis Center, all at Brigham and Women’s Hospital, in Boston, MA. Dr. Plutzky is an Associate Professor of Medicine at Harvard Medical School. He also directs a basic science laboratory that investigates mechanisms contributing to the development of atherosclerosis in patients with various metabolic disorders, including diabetes. This work focuses on the transcriptional regulation of vascular responses through nuclear receptors like PPARs. Dr. Plutzky’s expertise in the intersection of PPARs, dyslipidemia, atherosclerosis, and diabetes is widely renowned as evident in his role as one of four co-chairs of the International Lorenzini PPAR meeting; he also serves as an advisor to the Food and Drug Administration; and is a member of the scientific organizing committee for the Annual World Congress on the Insulin Resistance Syndrome. Dr. Plutzky is a highly sought-after lecturer nationally and internationally. Widely published in these areas in both clinical and basic science journals, Dr. Plutzky and his laboratory have received several major research awards. Most recently he was awarded The Eugene Braunwald Teaching Awards for Excellence in the Teaching of Clinical Cardiology at the Brigham and Women’s Hospital; the Ernest Klenk Lectureship, and his laboratory received the Louis N. and Arnold M. Katz Basic Science Prize from the American Heart Association. He is a manuscript reviewer for many medical journals, including Circulation: Journal of the American Heart Association, American Journal of Medicine, Journal of Clinical Investigation, Journal of Clinical Endocrinology and Metabolism and New England Journal of Medicine; he served as an Associate Editor for Prevention/Lipids for the journal Vascular Medicine from 1996 to 2006.
1. Appreciate the potential of PCSK9 inhibition and other therapeutic modalities to improve the management of patients with dyslipidemia
2. Discuss how genetic evidence has revealed insights into the causality of lipids on atherogenesis
3. Identify the major clinical issues in the management of dyslipidemia in patients with diabetes and others at high risk for CVD
4. Recognize major benefits and limitations of statin and other add-on therapies to modulate LDL-C in reaching target goals

Date of Original Release: May 13, 2015 (satellite symposium)

 
This activity is provided by the American Association of Clinical Endocrinologists.
 
 
Program management services provided by Medtelligence.
 
This activity is supported by an educational grant from Sanofi US and Regeneron Pharmaceuticals.
 
Needs Assessment
The major cause of death and complications in patients with type 2 diabetes is due to cardiovascular disease (CVD). More than 60% of all patients with type 2 diabetes die of CVD, and a greater percentage will have major adverse cardiovascular events. Dyslipidemia, one of the major risk factors associated with atherosclerotic CVD, is highly prevalent in type 2 diabetes, and, along with genetic abnormalities of LDL-C such as familial hypercholesterolemia, constitutes a key target for aggressive therapy. Statins are highly effective in lowering LDL-C levels and represent first-line treatment for prevention of CVD. For nearly two decades, statin use has been a cornerstone of CVD management. The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults essentially codified the use of statin therapy in patients at risk for cardiovascular events and stroke. Other guidelines have also endorsed the use of statins as first-line therapy, but continue to use quantitative lipid targets as treatment goals. However, despite these recommendations increasing the pool of eligible patients, many will either not take statins due to off-target effects or require intensification of therapy to avoid residual CVD risk. This requires clinicians to examine the latest data on lipid reduction and potential changes in risk reduction strategies, particularly for those at high risk of CVD and its adverse sequella.
 
Method of Participation/How to Obtain CME Credit
  • Watch/read the educational material
  • Complete the post-test and earn a passing grade of 70% or higher to receive credit
  • Complete the activity evaluation to receive CME certificate
Accreditation Statement
The American Association of Clinical Endocrinologists (AACE) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
 
The American Association of Clinical Endocrinologists (AACE) designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

COURSE VIEWING REQUIREMENTS
Supported Browsers:
Internet Explorer 9.0+ for Windows 2003, Vista, XP, Windows 7, Windows 8         
Google Chrome 28.0+ for Windows, Mac OS, or Linux
Mozilla Firefox 23.0+ for Windows, Mac OS, or Linux
Safari 6.0+ for Mac OSX 10.7 and above

For video playback, install the latest version of Flash or Quicktime.
For questions regarding this CME activity, please contact:
AACE c/o Elisabeth Ball
Phone: (904) 353-7878
Email: eball@aace.com
 
Copyright
Copyright 2015, AACE. All rights reserved. No part of this enduring material may be reproduced or transmitted in any other form or by any other means, electronic or mechanical, without first obtaining written permission from AACE.
 
LEARNER BILL OF RIGHTS
The American Association of Clinical Endocrinologists (AACE) recognizes that you are a life-long learner who has chosen to engage in continuing medical education to identify or fill a gap in knowledge, skill or performance. As part of AACE’s duty to you as a learner, you have the right to expect that your continuing medical education experience with AACE includes:
 
CONTENT that:
  • Promotes improvements or quality in healthcare;
  • Is valid, reliable and accurate;
  • Offers balanced presentations that are free of commercial bias for or against a product/service;
  • Is vetted through a process that resolves any conflicts of interests of planners, teachers or authors;
  • Is driven and based on learning needs, not commercial interests;
  • Addresses the stated objectives or purpose; and
  • Is evaluated for its effectiveness in meeting the identified educational need.
A LEARNING ENVIRONMENT that:
  • Supports learners’ ability to meet their individual needs;
  • Respects and attends to any special needs of the learners;
  • Respects the diversity of groups of learners; and
  • Is free of promotional, commercial and/or sales activities.
DISCLOSURE of:
  • Relevant financial relationships planners, teachers and authors have with commercial interests related to the content of the activity; and
  • Commercial support (funding or in-kind resources) of the activity.
Disclosure Information
Declaration of Disclosure and Conflicts of Interest
It is the policy of AACE to ensure balance, independence, objectivity and scientific rigor in all of its CME activities. Presentation content may include discussion of an unlabeled or an investigational use of a product. AACE requires that participating faculty disclose to the audience any product(s) and its use(s) discussed in the educational activity that are unapproved/unlabeled for the use by the FDA or still considered investigational in nature. 
 
Everyone who is in a position to control the content of an educational activity must disclose all relevant financial relationships. “Relevant financial relationships” are financial relationships in any amount occurring within the past 12 months that create a conflict of interest. AACE requires speakers, faculty, CME Committee and other individuals who are in a position to control the content of this educational activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly evaluated by AACE for fair balance, scientific objectivity of studies mentioned in the presentation and educational materials used as basis for content, and appropriateness of patient care recommendations. 
 
The intent of this disclosure is not to prevent a speaker with commercial affiliations from presenting, but rather to provide learners with information from which they may make their own judgments. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial influence. 
 
AACE has reviewed all disclosures and resolved or managed all identified conflicts of interest for this educational activity, as applicable.
 
CME Accreditation Committee Disclosures
Dr. Myriam Allende-Vigo reports that she has received speaker honoraria from AbbVie, Inc. and Janssen Pharmaceuticals, Inc.; and consultant honoraria from Merck & Co., Inc.
 
Dr. Felice A. Caldarella reports that he has received speaker honoraria from Novo Nordisk A/S, Salix Pharmaceuticals, Inc. and Takeda Pharmaceutical Co. Ltd.
 
Dr. Ricardo Correa reports that he does not have any relevant financial relationships with any commercial interests.
 
Dr. Stephen R. Crespin reports that he does not have any relevant financial relationships with any commercial interests.
 
Faculty Disclosures
Dr. Yehuda Handelsman reports that he has received research grant support, consultant honoraria, and fees from Boehringer Ingelheim GmbH, GlaxoSmithKline plc, and  Novo Nordisk A/S; research grant support and consulting fees from Amgen Inc., Gilead, Merck & Co., and sanofi-aventis U.S. LLC; research grant support from Intarcia, Lexicon, and Takeda Pharmaceutical Company Limited; consultant/speaker fees from Amarin Corp., Amylin Pharmaceuticals, Janssen Global Services, LLC, and Vivus Inc; and consultant fees from Halozyme Therapeutics. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Handelsman has an identified conflict of interest and it has been resolved accordingly. He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.
 
Dr. Robert Eckel reports that he has received scientific advisor consultant fees from sanofi, scientific consultant fees from Regeneron and Isis Pharmaceuticals, Inc., and research laboratory grant support from Esperion Therapeutics, Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Eckel has an identified conflict of interest and it has been resolved accordingly. He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.
 
Dr. Jorge Plutzky reports that he has received consultant fees from Amylin Pharmaceuticals, Inc., AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo Company, Limited, Eli Lilly and Company, Ember, F. Hoffman-La Roche Ltd/Genentech, Inc., GlaxoSmithKline plc, Merck & Co., Novo Nordisk A/S, Pfizer Inc., Takeda Pharmaceutical Company Limited, and Vivus Inc. He also reports that his presentation will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Plutzky has an identified conflict of interest and it has been resolved accordingly. He has been advised by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.