Part 2: LDL-C Reduction in the Patient with Diabetes: How Low Should We Go and How Should We Get There?

Cardiology
Curriculum:
LDL-C Reduction in the Patient with Diabetes
Credits:
0.75 AMA PRA Category 1 Credit(s)™
Launch Date:
16-Aug-16
Expiration Date:
The accreditation for this activity has expired.

Primary Audience:

Endocrinologists, Cardiologists, Internal Medicine, Family Practice, Pharmacy, Nurses, Physician Assistants, Lipidologists, General Practice, and other healthcare providers who care for patients with type 2 diabetes and patients with hyperlipidemia

Relevant Terms:

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

Sergio Fazio, MD, PhD

Sergio Fazio, MD, PhD, FAAP, FASCI
William and Sonja Connor Chair of Preventive Cardiology
Professor of Medicine, Physiology & Pharmacology
Director, Center for Preventive Cardiology
Knight Cardiovascular Institute
Oregon Health and Science University
Portland, OR

Dr. Fazio is the William and Sonja Connor Chair of Preventive Cardiology, Professor of Medicine, Physiology & Pharmacology, and Director of the Center for Preventive Cardiology of the Knight Cardiovascular Institute at Oregon Health and Science University in Portland, OR. He earned his medical degree, completed an internal medicine residency, and was a clinical fellow in metabolic diseases at the University of Rome in Italy. He holds a doctorate in Experimental Medicine from the University of Siena and completed his research training at the University of California, San Francisco. Dr. Fazio's clinical interest is in the management of patients with dyslipidemia and elevated CVD risk, and his research interests include the pathogenesis of genetic dyslipidemias and the role of macrophages in atherogenesis. The results of his research have been published in journals such as the New England Journal of Medicine, Science, Nature, and Circulation. Dr. Fazio is also the author of several review articles and book chapters on lipid metabolism and atherosclerosis. A principal investigator on several projects sponsored by the NIH for the last 22 years, he serves on the editorial boards of Circulation Research; Arteriosclerosis, Thrombosis, and Vascular Biology; Journal of Lipid Research; and Journal of Clinical Lipidology. He is a member of the American Society for Clinical Investigation and the Association of American Physicians.

Yehuda Hendelsman, MD

Yehuda Hendelsman, MD, FACP, FACE, FNLA
Medical Director and Principal Investigator
Metabolic Institute of America
Immediate Past 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 diabetes, lipid disorders, obesity, hypertension, insulin resistance, pre-diabetes, and the comprehensive approach to the management and prevention of cardiovascular disease. He is a pioneer and leader in the understanding of the body's metabolic and energy systems, fat, and the kidney's role in glucose homeostasis. A clinician, researcher, and educator, he publishes and lectures extensively. He is the immediate past President of the American College of Endocrinology, past President of the American Association of Clinical Endocrinologists, and treasurer of the Pacific Lipid Association. He is Chair of the AACE Diabetes and Lipids Scientific Committees and a member of the Obesity Scientific Committee. Dr. Handelsman is Chair, Founder, and Program Director of the acclaimed annual World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease; Chair and Founder of the International Lipid Forum; an Associate Editor of the Journal of Diabetes; member of the editorial board of several journals; and a frequent guest editor for publications such as the Journal of Clinical Hypertension. He is Chair of the AACE 2015 Comprehensive Diabetes Guidelines and a member of the AACE 2015 and 2016 Comprehensive Diabetes Algorithm and the 2012 and 2016 AACE lipid guidelines. He also Co-Chaired the AACE consensuses on SGLT2i & DKA, diabetes & cancer, insulin resistance, lipodystrophy, and pre-diabetes. Dr. Handelsman has been listed repeatedly in "Top Doctors of Los Angeles," "Southern California Super Doctors," "The Leading Physicians of the World," and "Best Doctors of America." His book, "Clinical Management of Cardiovascular Risk in Diabetes and Obesity," was recently published by Professional Communications, Inc.

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.
1. Identify the major clinical issues in the management of dyslipidemia in patients with diabetes
2. Recognize major benefits and limitations of statin and other add-on therapies to modulate LDL-C in reaching target goals
3. Discuss the interrelationship between dyslipidemia and diabetes
4. Appreciate the potential of PCSK9 inhibition and other therapeutic modalities to improve the management of patients with dyslipidemia
5. Use the latest evidence and guidelines to optimize management of patients with diabetes and dyslipidemia

Date of Original Release: May 26, 2016 (satellite symposium)
Release Date: August 16, 2016
Expiration Date: July 21, 2017 

 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 (T2DM), and, along with genetic abnormalities of LDL-C such as familial hypercholesterolemia (FH), 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 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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For questions regarding this CME activity, please contact:
AACE CME Department
Phone: (904) 353-7878
Email: cme@aace.com
 
Copyright
Copyright 2016, 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;
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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 use of a commercial product or an investigational use of a product not yet approved for any purpose.  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. David S.H. Bell reports that he has received speaker honoraria from Novo Nordisk A/S; speaker and consultant honoraria from AstraZeneca; and honoraria for lectures from Janssen Pharmaceuticals, 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.
 
Dr. Martin Grajower reports that he has received speaker and advisory board honoraria from Novo Nordisk A/S; and advisory board honoraria from AstraZeneca.
 
Dr. Israel Hartman reports that he has received a research grant for his role as investigator from Bayer Healthcare AG, Takeda Pharmaceutical Co. Ltd. and Teva Pharmaceutical Industries Ltd.; speaker honoraria from Eli Lilly & Co. and Novo Nordisk A/S; and speaker honoraria as well as a research grant for his role as investigator from GlaxoSmithKline, Janssen Pharmaceuticals, Inc. and sanofi-aventis US LLC
 
Dr. Virginia A. LiVolsi reports that she has received pathology consultant honoraria from Veracyte, Inc.
 
Dr. Dorothy S. Martinez reports that she does not have any relevant financial relationships with any commercial interests.
 
Dr. Fernando Ovalle reports that he has received consultant honoraria as well as a research grant for his role as investigator from AstraZeneca, Biodel, Inc., Boehringer Ingelheim GmbH, Eli Lilly & Co., GlaxoSmithKline, Janssen Pharmaceuticals, Inc., Medtronic, Inc., Novo Nordisk A/S and sanofi-aventis US LLC; and a research grant for his role as investigator from GI Dynamics, Inc., Merck & Co., Inc. and Pfizer, Inc.
 
Dr. Philip Raskin reports that he has received research support for the University of Texas Southwestern Medical Center from Amylin Pharmaceuticals LLC, Andromeda Biotech Ltd., AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly & Co., Intarcia Therapeutics, Inc., Merck & Co. Inc., Novo Nordisk A/S and Pfizer, Inc.; and advisor fees from Boston Therapeutics, Inc., GlaxoSmithKline and Janssen Pharmaceuticals, Inc. 
 
Dr. Joseph M. Tibaldi reports that he has received speaker honoraria from AstraZeneca and Merck & Co., Inc.; and speaker/consultant honoraria from Novo Nordisk A/S.
 
Dr. Dace L. Trence reports that she is a stockholder of Medtronic, Inc. and sanofi-aventis U.S. LLC. 
 
Dr. Jeff Unger reports that he has received speaker honoraria from Janssen Pharmaceuticals, Inc. and Novo Nordisk A/S.
 
Faculty Disclosures
Dr. Yehuda Handelsman
 reports that he has received consultant fees from Halozyme, Inc.; research grant support from Intarcia Therapeutics, Inc., Lexicon Pharmaceuticals, Inc. and Takeda Pharmaceuticals U.S.A., Inc.; research grant support and consultant fees from Amgen, Inc., Gilead, Merck & Co., Inc. and sanofi-aventis US LLC; consultant/speaker fees from Amarin Corporation, Amylin Pharmaceuticals LLC, Janssen Pharmaceuticals, Inc. and Vivus, Inc.; and research grant support and consultant/speaker fees from Boehringer Ingelheim GmbH, GlaxoSmithKline and Novo Nordisk A/S. He also reports that his presentation(s) 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 required 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 advisory consulting fees from sanofi-aventis US LLC. and Regeneron Pharmaceuticals, Inc. He also reports that his presentation(s) 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 required by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.
 
Dr. Sergio Fazio reports that he has received advisor/consultant fees from Aegerion Pharmaceuticals, Inc., BASF SE, Kowa Pharmaceuticals America, Inc., Merck & Co., Inc., New Haven Pharmaceuticals and sanofi-aventis US LLC. He also reports that his presentation(s) will not include discussion of any investigational or unlabeled use(s) of a product. Dr. Fazio has an identified conflict of interest and it has been resolved accordingly. He has been required by the AACE CME Accreditation Committee to base his presentation and recommendations on the best available, preferably published evidence/information.