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Lipid Care 360: Addressing Clinical Inertia and Complex Polypharmacy

Clinical pharmacology and therapeutics

Endocrinology and diabetes mellitus

General Practice

Atherosclerotic Cardiovascular Disease

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Description

This program is supported through an independent educational grant from MSD. It is intended exclusively for healthcare professionals worldwide.

In this 15-minute on-demand session, cardiovascular expert Christopher P. Cannon, MD addresses one of the most persistent barriers in lipid management: clinical inertia in the setting of complex polypharmacy. Through a focused, case-based discussion, Dr. Cannon examines how competing comorbidities, medication burden, and clinician hesitancy contribute to delayed intensification of lipid-lowering therapy in patients with or at risk of atherosclerotic cardiovascular disease (ASCVD).

Participants will gain practical strategies to balance guideline-directed lipid management with multi-drug regimens, reduce therapeutic inertia, and optimize LDL-C control without compromising patient safety or adherence.

Accreditation: AffinityCE designates this activity for 0.25 AMA PRA Category 1 Credit™.

This concise session combines real-world patient cases, evidence-based guidance, and expert commentary to equip clinicians with actionable tools for managing ASCVD risk in complex patients.

Learning Highlights

Recognize how polypharmacy and competing comorbidities drive therapeutic inertia in lipid care.
Apply strategies to streamline treatment decisions while balancing safety and efficacy.
Confidently escalate lipid-lowering therapy in patients with multiple medications.
Support adherence and long-term LDL-C control through patient-centered approaches.

Who Should Watch

Cardiologists
Endocrinologists/Lipidologists
Primary Care Physicians
Nurse Practitioners & Physician Assistants
Pharmacists
Diabetologists
Other healthcare professionals managing lipid disorders and ASCVD risk worldwide

Presented by

Christopher P. Cannon, MD – is a Professor of Medicine at Harvard Medical School, and senior physician in the Cardiovascular Division at Brigham and Women’s Hospital. He worked for 25 years as an investigator in the TIMI Study Group, and is now a member of the Brigham’s Cardiovascular Innovation group, serving as Director of Education. Dr. Cannon has published over 1000 original articles, reviews or book chapters in the field of acute coronary syndromes and prevention and has authored or edited 20 books. He has received numerous awards, including leadership awards from the American College of Cardiology, American Heart Association and National Lipid Association.

Continuing Education Information

This continuing education activity will be provided by AffinityCE and MedAll. Physicians will be eligible for AMA PRA Category 1 Credit™. A statement of participation is available for other healthcare professionals.

Disclosures

Dr Christopher P. Cannon has disclosed financial relationships within the past 24 months with the following ineligible companies: Amgen, Better Therapeutics, Boehringer Ingelheim (BI), and Novo Nordisk (research grants); salary support from the Colorado Prevention Centre (CPC) Clinical Research, which receives funding from Amgen, Bayer, Cleerly, Esperion, Lexicon, and Silence; and advisory board memberships with Amryt/Chiesi, Amgen, Ascendia, Biogen, Boehringer Ingelheim, Bristol Myers Squibb (BMS), CSL Behring, Genomadix, Lilly, Janssen, Lexicon, Milestone, Novartis, Pfizer, and Rhoshan.

These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education. Dr Cannon intends to discuss non-FDA uses of drug products and/or devices and their unlabelled indications, and will disclose this to the audience when such discussion takes place.

AffinityCE staff, MedAll staff, and all planners and reviewers have no relevant financial relationships with ineligible companies to disclose.

How to Earn Your CME Credit

In order to obtain your CME credit and receive your certificate, please join the webinar and complete the assessment at the end. You will receive a link to your certificate automatically after completing the assessment.

Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

Participation Costs

There is no cost to participate in this program.

ACCME Continuing Education Information

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose. Faculty disclosures will be declared prior to the event.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. Relevant financial relationships were mitigated by the peer review of content by non-conflicted reviewers prior to the commencement of the program.

Activity Accreditation for Health Professions

Physicians

This activity will be 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 AffinityCE and Medall. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring activity a maximum of 0.25 AMA PRA Category 1 Credits™.

Physician Assistants

This activity will be 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 AffinityCE and MedAll AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring activity a maximum of 0.25 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity will be 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 AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring activity a maximum of 0.25 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

Pharmacists

Pharmacists AffinityCE is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE).

CE Title: Addressing Clinical Inertia and Complex Polypharmacy

Pharmacist UAN: 0829-9999-25-186-H01-P

Contact Hour(s): 0.25

Activity Type: Knowledge-based

CEUs: 0.25

No cost to participate.

Participant CE records will be electronically communicated to CPE Monitor.

Pharmacist Learning Objectives

At the conclusion of this web conference, participants should be able to:

Apply current cholesterol management guidelines, including LDL-C targets, adherence strategies, and treatment escalation approaches.

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program.

Participation Costs

There is no cost to participate in this program.

CME Inquiries

For all CME policy-related inquiries, please contact us at ce@affinityced.com.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

Learning objectives

Apply current cholesterol management guidelines, including LDL-C targets, adherence strategies, and treatment escalation approaches.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

And so that's a question that we ask ourselves, and these were a few thoughts that I gathered to try and understand why don't we follow our own guidelines? One of them, unfortunately I think in 2013, uh, to great fanfare at the time there was all the statin data on intensive statin therapy that they said, oh, we don't have evidence for treat to goal and we shouldn't have an LDL goal, we should just treat with the evidence-based thing, so it led to confusion. They've subsequently changed that in 2018 to, you know, adding therapies as we saw if you don't reach a certain goal, um, but that unfortunately set the field back, I think, a good bit that introduced confusion, where before we were just titrating to the LDL goal. I think fortunately now we're getting back to that. The European guidelines always kept the LDL goals and, and said, you know, match them to the patient's risk. A second thing that I've seen is that despite all these different agents, there's a lot of awareness about statins, but less so amongst clinicians or patients for that matter, of the non-statin agents. Um, generally there's clinical inertia in part, you know, we only see patients if they're stable once a year and, you know, in cardiology anyway, and maybe twice a year for primary care, but, you know, we, we, if patients are doing well, we don't necessarily change things even though it might help further. Um, you know, system, uh, issues of lack of time and, you know, not having enough follow-up visits and things can be a factor. You know, then I think we all know of, you know, some patient reluctance, you know, everyone's heard of muscle aches with statins, um, and generally not wanting to take medications is, you know, a reasonable. You know, desire, uh, but if you have disease or have high risk, you know, we don't want to, you know, avoid things that could be helpful. So getting over that, and I think that's where the education I've found has been very helpful of showing them the picture of the, of the, um, you know, arteries and what we're trying to do. Um, this has been amplified by all kinds of stuff on the internet of people with agendas that, you know, say that the sky is green and water is blue, or, you know, I guess water is blue, but water is red, and, you know, who knows, there's all kinds of misinformation that, oh, cholesterol is, you know, not proven, it's all just a hoax, um, so that's not helpful. Um, and then, you know, in more in the primary prevention question of people will say, well, do I really need to take that? And so one area there that's been helpful, I think, is actually looking at individual patients' arteries to identify whether or not they have atherosclerosis, and then the certainty of the need is, is more clear. And then finally, the cost of new therapies is of course a barrier, but we do have several, you know, older therapies that are less expensive. So I'll walk through a few of these. I think, you know, the ESC, as I noted, have kept the LDL goals, and this is very straightforward, very logical, very evidence-based that, you know, the higher your risk, the lower we want to get the LDL to get that benefit. Um, nicely, the ACCHA did make a step in this direction by reintroducing the LDL goal and, and the less than 55 goal, um, in patients who have recently had an acute coronary syndrome, uh, where they say adding a non-statin agent if your LDL is above 70 to try and get below 55. Um, so that's a, a good step in the highest risk population, and we'll see next year how that plays out in the overall lipid guideline. Another thing could speak to the system issues, and this was something that several colleagues developed. I played a small part in it where there was remote management where we had a whole team who could call up patients, check with their LDL and their risk profile, and work with a pharmacist to prescribe and have digital technology to, you know, do cross checks on, you know, drug-drug interactions and And um what should their LDL goal be, so a different mechanism that could supplement the annual visit with the cardiologist to say, oh, actually your LDL has drifted up, we need to, you know, intensify your treatment. And so for patients who were able to follow the program, we had about a 50% lowering of of LDL shown on the right, and overall it was about 35%. Some of the people didn't always follow through, um, so this is an adjunct, a system approach that could help overall. Um, as I noted, uh, everyone's aware of the side effects, and so having a, a nice step by step approach for patients who have statin intolerance, I think is helpful, and it starts with really a discussion and shared decision making with the patient. And so making this their understanding, and I, you know, showed these diagrams uh with the patient, talk through what it is that we're worried about so that they understand, and then if patients have had issues with statins, say, OK, well, let's do a holiday. A day and, and hold the thing, see if your symptoms go away, and, and then do a re-challenge to see if they come back once you retake it, because plenty of people, uh, you know, I certainly know, I get muscle aches all the time even though I don't take a statin, I thankfully don't need one. but, you know, to sort out what are statin-related side effects versus just other, uh, you know, symptoms people have. Then trying an ultra low dose of a statin, so like half of the smallest tablet of rosuvastatin 3 times a week, is like 1/10 of the normal dose, um, many patients are open to trying it, and they say if you get your symptoms, we'll stop it and then move on to the non-statins, and we have plenty of them to, to try, but to really work through a program for each patient to, uh, to do that. Now the other big change in practice that I've seen and that I have adopted wholeheartedly in primary prevention is the use of the calcium score, and essentially this is a low radiation CT Scan to look and see is there evidence of calcified plaque in the coronary arteries. Um, and this is used in two ways. It can Uh, identify patients who have nothing in their arteries, and those patients are at very low risk. I'll show you the, the slide in the, in the next slide, or if we identify disease, we can then enter in the discussion and say, well, you actually have cholesterol building up in your arteries, and you have a lot of cholesterol building up if the score is very high, and that makes it easier to then say, well, you know, it's time to start getting that LDL down. Um, The power of zero is helpful that if you do get a score of 0, meaning that there's no sign of a calcified plaque in your heart arteries, those bottom curves there in pink show that it's very low risk, all the way out to 12 years, it's like a 3% risk of heart attack, stroke, or death. And so what a strategy some people will do is if you get a score of 0, and the patient doesn't want to start therapy, you don't really have to, you could defer and then retest after 5 years. Then if you see a little something building up, then you say, OK, now it's time. So that notion of really seeing in each patient, do they or don't they have atherosclerosis is, is very helpful. Now interestingly, one doesn't have to do a dedicated calcium score necessarily. A lot of people have already had CAT scans for various reasons, and if you see coronary calcification or indeed abdominal artery calcification, Then you know that they have disease and we want to try and get the LDL below 70 or ideally below 55. And so using the imaging really helps engender a very good discussion with each patient. So when do I do this, you know, often the patients who are younger, in their 40s and 50s, they have a family history of, you know, multiple family members with heart attacks, but the calculated risk score will be low because their age is low. Um, those are ideal patients. I have a colleague. I just did, uh, working with now, um, who's 41 years old, low risk score, but to do a calcium score, we'll see yes or no, is there something there? And if yes, then you treat. If no, we can, we can wait. Um, older patients with no risk factors, uh, also, that's one other.