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touchMDT What promise do novel lipoprotein-lowering therapies hold for effectively reducing ASCVD risk? Perspectives from a multidisciplinary team

Select a discussion in the hub to watch our multidisciplinary faculty share their insights on how novel lipoprotein-lowering therapies can help to reduce ASCVD risk and what this may mean for patient care in the future.

 Overview & Learning Objectives

Patients with dyslipidemia at risk of atherosclerotic cardiovascular disease (ASCVD)
Cardiologist & Primary Care Physician
Watch Video
The role of lipoproteins in ASCVD risk Dr C Kosmas, Dr Y Javaid

Watch a cardiologist and a primary care physician share their specialist insights on the risk factors and lipoproteins associated with ASCVD, guideline recommendations for the management of dyslipidemias and optimizing management using an MDT approach

Watch Video
Endocrinologist & Cardiologist
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Novel lipid-lowering therapies - ASCVD Prof. L Leiter, Dr Kosmas

Watch an endocrinologist and a cardiologist share their specialist insights about the mechanism of action of novel lipid-lowering therapies and how they may help address unmet needs in patients at high risk of ASCVD. This discussion includes a patient case

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Primary Care Physician, Endocrinologist & Cardiologist
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Evidence-based decision-making - ASCVD Dr Javaid, Prof. Leiter, Dr Kosmas

Watch a primary care physician, an endocrinologist and a cardiologist consider the latest data for novel lipid-lowering therapies in ASCVD and share their specialist insights about what they may mean for patient care in the future. This discussion includes a patient case

Watch Video
Cardiologist & Primary Care Physician

Watch a cardiologist and a primary care physician share their specialist insights on the risk factors and lipoproteins associated with ASCVD, guideline recommendations for the management of dyslipidemias and optimizing management using an MDT approach
Expert Spotlight
Dr Constantine Kosmas
Cardiology Unlimited, P.C., New York, NY, USA
Dr Yassir Javaid
Nene CCG, Northampton, UK and East Midlands Clinical Network, Leicester, UK

Dr Constantine Kosmas and Dr Yassir Javaid discuss the risk factors and lipoproteins associated with ASCVD. They also consider guideline recommendations for the management of dyslipidemias and the role of the MDT in ASCVD risk management.

LISTEN on the go

 Learn more Back to MDT Hub Time: 11:58
 
Endocrinologist & Cardiologist

Watch an endocrinologist and a cardiologist share their specialist insights about the mechanism of action of novel lipid-lowering therapies and how they may help address unmet needs in patients at high risk of ASCVD. This discussion includes a patient case

Expert Spotlight
Prof. Lawrence Leiter
St. Michael’s Hospital and University of Toronto, Toronto, Canada
Dr Constantine Kosmas
Cardiology Unlimited, P.C., New York, NY, USA

Prof. Lawrence Leiter is joined by Dr Constantine Kosmas to discuss unmet needs among patients at high risk of ASCVD and the mechanism of action of novel lipid-lowering therapies

LISTEN on the go

 Learn more Back to MDT Hub Time: 13:38
 
Primary Care Physician, Endocrinologist & Cardiologist

Watch a primary care physician, an endocrinologist and a cardiologist consider the latest data for novel lipid-lowering therapies in ASCVD and share their specialist insights about what they may mean for patient care in the future. This discussion includes a patient case

Expert Spotlight
Dr Yassir Javaid
Nene CCG, Northampton, UK and East Midlands Clinical Network, Leicester, UK
Prof. Lawrence Leiter
St. Michael’s Hospital and University of Toronto, Toronto, Canada
Dr Constantine Kosmas
Cardiology Unlimited, P.C., New York, NY, USA

Three key experts in the multidisciplinary team, Dr Yassir Javaid, Prof. Lawrence Leiter and Dr Constantine Kosmas, talk about the latest data for novel lipid-lowering therapies and how they may impact upon their decision-making in treating patients at high risk of ASCVD

LISTEN on the go

 Learn more Back to MDT Hub Time: 18:01
 
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Overview & Learning Objectives
Overview

In this activity, specialists in the MDT involved in caring for patients with dyslipidemia at high risk of ASCVD share their perspectives on novel lipid-lowering therapies and how the latest clinical data translate into clinical practice.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of cardiologists, endocrinologists and primary care physicians in Europe, UK and USA.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. Relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Lawrence Leiter discloses Research Support: Amgen, AstraZeneca, Bayer, Kowa, Lexicon, Novartis and The Medicines Company.

Advisory Board or Panel: Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Esperion, HLS, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi

Speakers Bureau: Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, HLS, Merck, Novartis, Novo Nordisk, Servier

Dr Yassir Javaid discloses Advisory Board or Panel: Novartis, Bayer, AstraZeneca, Daiichi Sankyo

Speakers Bureau: Abbott, Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Edwards, Eli Lilly, iRhythm Technologies, Medtronic, Menarini, MSD, Novo Nordisk, Novartis, Pfizer, Sanofi and Servier.

Dr Constantine Kosmas discloses Speakers Bureau: Amarin Pharma, Inc., Amgen, Inc (Relationship terminated)

Content reviewer

Madjid Mirzai-Tehrane, MD has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditation

Physicians

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 a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

PAs may claim a maximum of 1.0 Category 1 credit for completing this activity. NCCPA accepts AMA PRA Category 1 Creditâ„¢ from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 Credit™ by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 03 September 2021. Date credits expire: 03 September 2022.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Recall the mechanism of dyslipidemias and the atherogenic lipoproteins involved in increased risk of ASCVD
  • Evaluate the mechanism of action of novel lipoprotein-lowering therapies and the rationale for their use in patients with dyslipidemia at risk of ASCVD
  • Evaluate recent and ongoing clinical trial data for novel lipoprotein-lowering therapies and translate this knowledge into clinical practice

3

Faculty & Disclosures
Prof. Lawrence Leiter

St. Michael’s Hospital and University of Toronto, Toronto, Canada

Prof. Lawrence A. Leiter is Director of the Lipid Clinic; Associate Director of the Clinical Nutrition and Risk Factor Modification Centre and Associate Scientist, Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, where he was also the Head of the Division of Endocrinology and Metabolism from 2000 to 2010. He is also a Professor of Medicine and Nutritional Sciences at the University of Toronto. read more

Prof. Leiter’s research interests include prevention of atherosclerosis, diabetes mellitus, hyperlipidemia, hypertension and obesity. He was an investigator in many of the landmark diabetes trials and has authored over 750 publications in peer-reviewed journals.

Prof. Leiter is a Past-President of the Canadian Society of Endocrinology & Metabolism (CSEM) and a past Chair of the Clinical and Scientific Section of the Canadian Diabetes Association (CDA). He has been involved in many national and international committees and consensus conferences.

In 2016, Prof. Leiter received the CDA Lifetime Achievement Award for Research Excellence and the CSEM Robert Volpe Distinguished Service Award. In 2019 he was elected as a Fellow of the Canadian Academy of Health Sciences.

Prof. Lawrence Leiter discloses Research Support: Amgen, AstraZeneca, Bayer, Kowa, Lexicon, Novartis and The Medicines Company.

Advisory Board or Panel: Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Esperion, HLS, Merck, Novartis, Novo Nordisk, Pfizer, Sanofi

Speakers Bureau: Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, HLS, Merck, Novartis, Novo Nordisk, Servier

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. Relevant relationships are listed below. All individuals not listed have no relevant financial relationships.
Dr Yassir Javaid

Nene CCG, Northampton and East Midlands Clinical Network, Leicester, UK.

Dr Yassir Javaid, MA (Cantab), FRCP, FRCGP, PGDipCard, is Cardiovascular and Diabetes Lead at Nene Clinical Commissioning Group (CCG), Primary Care Cardiovascular lead at East Midlands Clinical Network and Royal College of General Practitioners (RCGP) Clinical Adviser for Cardiology in the UK. read more

Dr Javaid qualified from Cambridge University and completed his General Practitioner (GP) Vocational Training Scheme in Northampton. He has a special interest in cardiology and echocardiography and was a clinical lead in the Northamptonshire Community Cardiology service, which focussed on patients with heart failure and valve disease. He was named Pulse ‘GP of the Year’ in 2015 for his work in reducing stroke emergency admissions in the East Midlands. He is also a council member of the British Heart Valve Society, accredited member of the British Society of Echocardiography and is on the editorial board for the British Journal of Cardiology.

Dr Yassir Javaid discloses Advisory Board or Panel: Novartis, Bayer, AstraZeneca, Daiichi Sankyo

Speakers Bureau: Abbott, Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Daiichi Sankyo, Edwards, Eli Lilly, iRhythm Technologies, Medtronic, Menarini, MSD, Novo Nordisk, Novartis, Pfizer, Sanofi and Servier.

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. Relevant relationships are listed below. All individuals not listed have no relevant financial relationships.
Dr Constantine Kosmas

Cardiology Unlimited, P.C., New York, NY, USA

Dr Constantine Kosmas, MD, PhD, FACC, FACP is a Clinical/Academic/Non-Invasive cardiologist and Clinical Lipidologist, currently serving as the Director of Nuclear Cardiology and Lipid Clinic at Cardiology Unlimited, P.C., a large private practice in New York. read more

Dr Kosmas has served as Assistant Professor of Medicine at Icahn School of Medicine at Mount Sinai and Medical Director of Mount Sinai Advanced Cardiovascular Group, as well as Clinical Assistant Professor of Medicine at the Medical School of the University of Pennsylvania and at the Weill Medical College of Cornell University. Dr Kosmas has also served as Director of Clinical Services and Associate Director of Nuclear Cardiology at Episcopal Hospital, Philadelphia, PA, as well as Acting Director of Coronary Care Unit at New York Hospital Queens, Flushing, New York.

Dr Kosmas holds Board Certifications in Cardiovascular Disease, Nuclear Cardiology and Clinical Lipidology in the USA. He has extensive teaching and lecturing experience at academic institutions and national conferences, especially on lipid-related subjects, and has published several medical papers based on his cardiovascular clinical research. In addition, he is a member of the Editorial Board and a Reviewer for several prestigious peer-reviewed medical journals.

Dr Constantine Kosmas discloses Speakers Bureau: Amarin Pharma, Inc., Amgen, Inc (Relationship terminated)

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. Relevant relationships are listed below. All individuals not listed have no relevant financial relationships.
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This Activity Is Funded By:

An independent medical education grant from Novartis Pharma AG, Basel, Switzerland. This medical education is jointly provided by USF Health and touchIME

The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CE to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 03 September 2021. Date credits expire: 03 September 2023.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/4
Which of these lipids/lipoproteins is NOT considered as a risk-enhancing factor for ASCVD?
 Correct

Serum cholesterol and its lipoprotein carriers (LDL, VLDL, and HDL) are known to be related to ASCVD.1 Elevated HDL-C, however, is seemingly not atherogenic,1 and there is a consistent and reproducible inverse association between plasma HDL-C and the risk of ASCVD.2 LDL-C is the dominant form of atherogenic cholesterol, while VLDL-C is also atherogenic; VLDL being the chief carrier of triglycerides and triglyceride-rich lipoproteins.1 The main protein component of LDL and VLDL is apoB, which is a stronger predictor of atherogenic risk than LDL-C alone. Lp(a) is a modified form of LDL that enhances atherogenic risk. Relative indications for its measurement are family history of premature ASCVD or personal history of ASCVD not explained by major risk factors. An Lp(a) ≥50 mg/dL (≥125 nmol/L) may be considered a risk-enhancing factor.1

ApoB, apolipoprotein B; ASCVD, atherosclerotic cardiovascular disease; HDL, high-density lipoprotein; HDL-C, high-density lipoprotein cholesterol; LDL, low-density lipoprotein; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein(a); VLDL, very-low-density lipoprotein; VLDL-C, very-low-density lipoprotein cholesterol

References

  1. Grundy SM, et al. Circulation. 2019;139:e1082–143.
  2.  Mach F, et al; ESC Scientific Document Group. Eur Heart J. 2020;41:111–88.
Question 2/4
Your 49-year-old female patient has an LDL-C level of 128 mg/dL
(3.3 mmol/L) and a strong family history of premature CVD. Which lipoprotein would you measure in this patient to identify if they have high levels, and therefore an increased risk of ASCVD?
 Correct

Lp(a) is a modified form of LDL that appears to possess atherogenic potential. Relative indications for its measurement are family history of premature ASCVD or personal history of ASCVD not explained by major risk factors. Lp(a) increases ASCVD risk, especially at higher levels. Thus, if a decision is made to measure Lp(a), a level ≥50 mg/dL, or ≥125 nmol/L, may be considered a risk-enhancing factor.1 Because about 90% of a person’s Lp(a) level is inherited, extremely elevated Lp(a) may represent a new inherited lipid disorder that is associated with an extremely high lifetime risk of ASCVD, and is twofold more prevalent than HeFH.2,3

ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; HeFH, heterozygous familial hypercholesterolemia; IDL-C, intermediate-density lipoprotein cholesterol; LDL, low-density lipoprotein; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein(a); VLDL-C, very-low-density lipoprotein cholesterol

References

  1. Grundy SM, et al. Circulation. 2019;139:e1082–143.
  2. Mach F, et al; ESC Scientific Document Group. Eur Heart J. 2020;41:111–88.
  3. Burgess S, et al. JAMA Cardiol. 2018;3:619627.
Question 3/4
Your 70-year-old male patient with baseline LDL-C 161 mg/dL (4.2 mmol/L), who has had repeat ASCVD events recently, has achieved LDL-C 84 mg/dL (2.2 mmol/L) with rosuvastatin 40 mg and ezetimibe 10 mg daily. Which one of these treatment options would you choose to help further lower his LDL-C levels to goal?
 Correct

Bempedoic acid is indicated in Europe for adults with primary hypercholesterolemia or mixed dyslipidemia in combination with a statin, or a statin with other lipid-lowering therapies, in patients unable to reach LDL-C goals with the maximum tolerated dose of a statin.1 It is indicated in the USA for adults with HeFH or established ASCVD who require additional lowering of LDL-C, as an adjunct to maximally tolerated statin therapy.2

The latest management guidelines were published prior to the 2020 approval of bempedoic acid. In patients at very-high risk and those with persistent high risk despite being treated with a maximally tolerated statin, the ESC/EAS recommend a combination with ezetimibe and, if still not at goal, the addition of a PCSK9 inhibitor.3 The ACC/AHA recommend that in patients with clinical ASCVD at very-high risk and considered for PCSK9 inhibitor therapy, maximally tolerated LDL-C lowering therapy should include maximally tolerated statin therapy and ezetimibe.4 Reduction of the statin dose is not recommended in such patients, nor is ezetimibe monotherapy or the use of lomitapide.

ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; HeFH, heterozygous familial hypercholesterolemia; LDL-C, low-density lipoprotein cholesterol; PCSK9, proprotein convertase subtilisin kexin type 9

References

  1. Nilemdo (bempedoic acid) Summary of Product Characteristics, 2021. Available at: www.ema.europa.eu/en/documents/product-information/nilemdo-epar-product-information_en.pdf (accessed 17 June 2021).
  2. Nexletol (bempedoic acid) Prescribing Information, 2020. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2020/211616s000lbl.pdf (accessed 18 June 2021).
  3. Mach F, et al; ESC Scientific Document Group. Eur Heart J. 2020;41:111–88.
  4.  Grundy SM, et al. Circulation. 2019;139:e1082–143.
Question 4/4
You are about to initiate the first dose of evinacumab therapy in your patient with HoFH. They ask what side effects might be expected with this treatment. Which of these statements might you include in your advice?
 Correct

Safety data based on pooled results from two RCTs that included 81 patients treated with evinacumab as add-on therapy to other lipid-lowering therapies showed that the most common adverse events occurring with evinacumab, and greater than placebo, were nasopharyngitis (16%), flu-like illness (7%) and dizziness (6%). Constipation and abdominal pain occurred more often in the evinacumab than placebo group, but in <3% of patients. Infusion-site pruritus, pyrexia, muscular weakness, nausea and nasal congestion were all infusion reactions reported following evinacumab treatment (in total, 7% of patients).

HoFH, homozygous familial hypercholesterolemia; RCT, randomized controlled trial

References

  1. Evkeeza (evinacumab) Prescribing Information, 2021. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/761181s000lbl.pdf (accessed 18 June 2021).
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