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Lipid Care 360: Overcoming Escalation Hesitancy to Optimize Lipid Control

Clinical pharmacology and therapeutics

Endocrinology and diabetes mellitus

General Practice

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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 explores the challenge of escalation hesitancy in lipid management for patients with or at risk of atherosclerotic cardiovascular disease (ASCVD). Despite clear guideline recommendations, many clinicians hesitate to intensify therapy when LDL-C remains above target—often due to concerns about safety, patient acceptance, or uncertainty in applying thresholds consistently.

Through practical, case-based scenarios, Dr. Cannon highlights how to overcome escalation barriers, apply LDL-C targets with confidence, and ensure timely initiation of advanced lipid-lowering therapies. The session emphasizes evidence-based approaches to treatment intensification that improve outcomes while addressing patient and clinician concerns.

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

This concise, expert-led program combines guideline-driven insights with real-world examples to help clinicians strengthen their decision-making and deliver optimal lipid control.

Learning Highlights

Recognize the common drivers of escalation hesitancy in lipid management.
Apply guideline-recommended LDL-C thresholds to support timely therapy intensification.
Incorporate advanced therapies (e.g., ezetimibe, PCSK9 inhibitors) confidently when LDL-C remains above goal.
Communicate effectively with patients to build trust and support adherence during therapy escalation.

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: Overcoming Escalation Hesitancy to Optimize Lipid Control

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:

Design strategies to overcome clinical inertia and streamline access to guideline-recommended lipid-lowering therapies for different patient profiles.

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

Design strategies to overcome clinical inertia and streamline access to guideline-recommended lipid-lowering therapies for different patient profiles.

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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.

So, I'll begin with the 2018, which are the current ACC AHA guidelines. They're due for an update next year. Um, and these guidelines begin with, uh, this is the focus on secondary prevention of patients with documented atherosclerotic cardiovascular disease. Where they divide patients into very high risk, um, which is a, a series of other additional risk factors or multi polyvascular disease, those with diabetes or CKD, uh, or other patients with ASCVD who are not at very high risk. And on the right, we have very good evidence supporting high intensity statin. Then if the LDL is above 70, still to add azetimib, and then if it's still above 70 to add a PCSK9 inhibitor, and in some cases could go straight from high intensity statin to PCSK9 inhibitor. Um, as another approach for the less high risk patients, these guidelines split by age, um, although probably unnecessarily, uh, and speak of just a high intensity statin and azetimib and less so a PCSK9 inhibitor. At the time, there weren't as many trials in that population. Now, the ESC guidelines have actually been updated uh this year, uh, and take a, a pretty, you know, thoughtful approach, uh, where the higher the risk, the lower the LDL target. And this makes perfect sense, it's very evidence-based. I'll, I'll review with you a lot of the trials that show this. The nomenclature is slightly different, um, Uh, the low and moderate risk are really the primary prevention, uh, patients, and then the high risk patients either by, um, these various factors here with other risk factors are shown. They recommend a goal of less than 70, whereas anyone that they call very high risk, um, Uh, is any evidence of, uh, atherosclerotic cardiovascular disease, especially if you also have, you know, diabetes or chronic kidney disease or FH filial hypercholesterolemia, um, they've added a new category in these guidelines of extreme risk, which are patients with ASCVD who experience a recurrent event while taking, uh, their maximally tolerated statin. Or patients with polyvascular disease, so disease in, say, the coronary bed and also peripheral arterial disease or, or cerebrovascular, where the goals for the very high risk is less than 55 mg per deciliter, uh, and less than 1.4 millimoles per liter, and then less than 40 or less than 1 millimole for the extreme risk group. And um we have very good evidence for the very high risk group in multiple trials, as, as I'll show you, um, and, uh, you know, then it makes perfect sense if patients are breaking through to push them even lower on the LDL. So, um, the great news is that we have a whole host of therapies that can do this, and, and this was a slide I put together, I think a year ago, uh, speaking of the 50 years of trials, um, and I suppose if we start from diet, uh, you know, it's 55 years now of different interventions to lower cholesterol. Um, and the benefit that's seen. So, uh, using diet is of course where we always start. Cholestyramine, a bile acid sequestrant agent, ileal bypass was tested, but then statins or high dose statins, fibrates and niacin had been targeted a little bit more towards HDL and triglycerides and had only mild LDL reduction and non-significantly mild, mildly lower clinical events. But then ezetimi, PCSK9 inhibitors, CTP inhibitors are still investigational, uh, and benpidoic acid all have been, uh, shown to reduce LDL and reduce clinical events. So a whole host, and there's even more coming, um, so a really exciting new versions of these classes coming. Uh, that will have many different ways to try and get patients to those goals that the ESC guideline has nicely highlighted. So I always start with the cholesterol treatment trial lists slide of the effect of statins, and they've normalized this for every millimole reduction or about 40 points in LDL that you can see a significant reduction in uh non-fatal MI. Coronary heart disease death, need for CABG or angioplasty or any revasc, ischemic stroke or any combination of those different vascular events, um, you know, about a 22% reduction in those events for each millimole of LDL reduction. So, one of the newer areas that I think is being incorporated into statin treatment, I wanted to share is that there is a risk, we all know of the risk of muscle aches, some people think they have muscle aches, but, but some do, and so we have to work to find a tolerated dose, and sometimes patients can't tolerate a statin. But uh the risk of new onset diabetes is one that I think people are realizing is an important factor for some. I, I find it more in the primary prevention, but um, Uh, where dose dependent effect is seen, so the low to moderate intensity statin have a very small, uh, increase in the risk of new onset diabetes. The biochemically determined would be an increase in, in the hemoglobin A1C to, to meet a risk of diabetes, about 10% higher risk of that. But the high intensity statin, it's more like a 35% increase, the, the bottom line there. And so sometimes if people have pre-diabetes, they would be pushed more rapidly towards diabetes on a high-intensity statin. So in some of those patients will use a low-intensity statin, uh, low or moderate, uh, and then start adding the non-statin agents, none of which have any effect on, on diabetes. Um, so that's one nuance on statin treatment, I think in current practice. So moving on to some of the evidence that supports the targets that the ESC guidelines have, uh, this was one of the first lipid studies I was involved with now, uh, 20 years ago. Um, where we targeted a lower LDL, so at the time, the guidelines said get less than 100, and we said, well, let's try and get less than 75 is what we had said in our protocol, um, and we got to 62 on average, um, and as shown on the right, the, the more intensive, uh, statin regimen, uh, that got the LDL down lower had a lower risk of cardiovascular events. And so that was the first randomized trial of two different strategies that, you know, lower is better for the LDL. Um, this is another way of looking at that concept where you plot out the placebo or the statin. Uh, or the high intensity statin, um, uh, event rates versus the LDL that they achieved, and you can see the lower the LDL is the lower the risk of cardiovascular events, and each pair of those, um, dots are randomized, but overall this is more of an observational look, uh, but one that we'll see time and again that the lower we push the LDL, the lower the event rates. So, knowing that intensive statin getting to LDL of 70 looks like it's helpful, um, we ask the question of, well, should we stop there or should we push lower? And so, um, in this study, we added a second agent, ezetimi, uh, got the LDL down to about 54 compared to just under 70. And as shown on the right, we did see a further reduction in clinical events. And so, even lower was even better, um, with, uh, with the addition of another agent. Now, this was also a, a non-statin agent, and so people wondered, well, is, is it as good as, as the statins that have been seen in, in so many trials to be beneficial. And so this is a plot that the cholesterol treatment trialist did, all the purple ones, and we plotted on top of it where the zetamib effect would be, and you can see that the clinical benefit relates directly to how much LDL cholesterol reduction there is, and the improvement data fall exactly on that regression line, meaning that the amount of Relates to how much change in LDL regardless of whether it was a statin or a edema.