Lowering LDL-C: When Statins Aren’t Enough

Lowering LDL-C: When Statins Aren’t Enough

Release Date: December 18, 2020 
Last Reviewed:  December 14, 2020
Expiration Date: December 18, 2021
Time to Complete Activity: 1.25 hours

*This activity expired for credit on December 18, 2021 and is no longer available for credit

Christie M. Ballantyne, MD

Professor of Medicine
Department of Medicine 
Baylor College of Medicine
Houston, TX

Pamela B. Morris, MD, FNLA
Director, Preventive Cardiology
Co-Director, Women’s Heart Care
Medical University of South Carolina
Charleston, SC

This activity is jointly provided by Paradigm Medical Communications, LLC and Educational Review Systems, Inc. 


Disclosure of Commercial Support
This activity is supported by an educational grant from ESPERION Therapeutics, Inc. 

Target Audience
This activity has been designed to address the educational needs of cardiology clinicians, including physicians, nurse practitioners (NPs), PAs, and clinical pharmacists. It may also benefit other clinicians who are interested or involved in the care of patients with risk factors for cardiovascular disease.

Statement of Need
Only about 50% of people who take a statin achieve adequate lowering of their LDL-C. The addition of ezetimibe results in a further, but modest, reduction in LDL-C. Although the levels of LDL-C can be more dramatically reduced with PCSK9 inhibitors, some patients face barriers to their access and some patients may wish to avoid its route of administration by subcutaneous self-injection. However, the US Food and Drug Administration recently approved 2 nonstatin alternatives that include the first-in-class agent, bempedoic acid. Additional nonstatin agents are emerging, including inclisiran, a synthetic siRNA molecule. Given that these new and emerging nonstatin options are not yet included in guideline recommendations, there is a clear and immediate need for education about these agents and how to position them within the existing treatment algorithms. This educational program will highlight the benefits of these new nonstatin options and how they fit within the current guideline algorithms through 3, real-world case studies to help guide learners developing evidence-based treatment plans for at risk patients.

Learning Objectives
Upon proper completion of this activity, participants should be better able to:

  • Assess patients taking statins for residual ASCVD risk to identify those with still high LDL-C levels who could benefit from additional intervention 
  • Review current lipid guidelines and their interpretation for treatment options beyond statin therapy
  • Develop evidence-based treatment plans for at-risk patients who require additional lowering of LDL-C levels, appropriately incorporating new and emerging therapies (when available)


  • Managing Secondary ASCVD Prevention
  • New and Evolving Nonstatin Therapies
  • Managing a Patient With HeHF
  • Primary Prevention of ASCVD in Very High-Risk Patients
  • Q&A

Physician Accreditation Statement
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 the joint providership of Paradigm Medical Communications, LLC and Educational Review Systems, Inc. Paradigm Medical Communications, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation Statement
Paradigm Medical Communications, LLC designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Pharmacist Accreditation and Designation Statement
Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.   Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 1.25 contact hours (0.125 CEU) submitted to CPE Monitor as early as 14 days after the event and no later than 60 days after the event.  Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time.  The participant is accountable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days.  

UAN  # 0761-9999-20-316-H01-P

This is a knowledge-based activity. 

PA Continuing Education
PAs may claim a maximum of 1.25 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. 

Nurse Practitioner Continuing Education
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME. Individuals are responsible for checking with the AANPCP for further guidelines.

Instructions for Participation 
To receive a CME certificate of participation, you should:

  • Follow instructions to register or log in with your professional information and complete the pre-activity assessment
  • View the online activity in its entirety
  • Complete and submit the online posttest and evaluation. You must answer 70% of the posttest questions correctly to earn credit. You will have unlimited opportunities to successfully complete the posttest

A certificate of participation will be available for download/printing immediately following your successful completion of the posttest and evaluation.

For questions regarding CME credit, contact the Paradigm CME Department at (845) 398-5949 or cme@paradigmmc.com.

There is no fee required for participation in this activity.

Hardware/Software Requirements
This certified CME activity is designed using HTML5 web components. As you navigate the video using the supplied controls, the slides will sync to the speaker.

Supported Browsers (Desktop/Mobile)
Chrome 45+, Firefox 40+, Edge, Edge Chromium, Safari 8+, Opera 31+

Technical Support: If you have any technical problems or playback issues email us at contactus@paradigmmc.com.

In accordance with ACCME requirements on disclosure, faculty and contributors are asked to disclose any relationships with commercial interests associated with the area of medicine featured in the activity. These relationships are described below. Any potential conflicts of interest have been resolved.

Christie M. Ballantyne, MD

Consulting Fees: Abbott Laboratories; Althera; Amarin Corporation; Amgen Inc; Arrowhead; AstraZeneca; Biotech; Corvidia; Denka Seiken; ESPERION Therapeutics, Inc; Genentech Inc; Gilead Sciences, Inc; Matinas BioPharma Inc; New Amsterdam; Novartis; Novo Nordisk, Inc; Pfizer Inc; Regeneron Pharmaceuticals, Inc; Roche; Sanofi-Synthelabo
Grant/Research Support: Abbott Laboratories; Akcea; Amgen Inc; ESPERION Therapeutics; Inc; Novartis; Regeneron Pharmaceuticals, Inc; Roche

Pamela B. Morris, MD, FNLA
Consulting Fees: ESPERION Therapeutics, Inc; NovoNordisk, Inc
Grant/Research Support: ESPERION Therapeutics, Inc

Paradigm Medical Communications, LLC staff members have no financial relationships to disclose.

Educational Review Systems, Inc staff members have no financial relationships to disclose.

Independent Peer Reviewer
Christopher P. Cannon, MD 
Consulting Fees: Aegerion Pharmaceuticals, Inc.; Alnylam Pharmaceuticals, Inc.; Amarin Corporation; Amgen Inc; Applied Therapeutics; Ascendia Pharmaceuticals;  Boehringer-Ingelheim Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Corvidia; Eli Lilly and Company; HLS Therapeutics, Inc.; Innovent Biologics, Inc.; Janssen Pharmaceuticals, Inc;  Kowa American Corporation; Merck & Co., Inc.; Pfizer, Inc; Roshan Pharmaceuticals, Inc; sanofi-aventis U.S. LLC
Grant/Research Support: Amgen; Boehringer-Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company;  Daiichi Sankyo; Janssen Pharmaceuticals, Inc.; Merck & Co., Inc.; Novo Nordisk, Inc.; Pfizer, Inc

Meghan Thomas, MD, resident reviewer, has no financial relationships to disclose.

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Paradigm Medical Communications, LLC has implemented a system to resolve conflicts of interest for each CME activity to help ensure content is objective, fair and balanced, independent, and aligned with the public interest. Conflicts, if any, are resolved through one or more processes. All CME content in this activity has been independently reviewed to ensure that it is free of commercial bias, scientifically rigorous, aligned with the public interest, and compliant with all regulatory guidance and the ACCME’s Standards for Commercial Support of Continuing Medical Education.

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This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA.

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