How to Receive Credit

Please go to www.jhasim.com/lipids-pre to complete a brief pre-assessment before continuing with the supplement.

After reading this supplement, participants may receive credit by completing the CME test, evaluation, and receiving a score of 70% or higher. Certificates can be printed immediately online.

To complete the post-test and evaluation, please go to www.jhasim.com/lipids-post .

Continuing Medical Education Accreditation

The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: September 15, 2016. Expiration date: September 15, 2018.

Continuing Medical Education Accreditation

The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2.5 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: September 15, 2016. Expiration date: September 15, 2018.

Instructions

After reading “The Future of Lipid Management: New Perspectives and Target for Lowering LDL-C,” select the 1 best answer to each of the following questions. At least 7 of 10 answers must be correct to receive CME credit. Estimated time for reading this issue and taking the test is 2.5 hours.

• 1.
  

  In the most recent American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for treating patients with elevated blood cholesterol, atherosclerotic cardiovascular disease (ASCVD) risk is first estimated using:

  
  
  
  
  • a.
    

    Framingham score

    
    
  • b.
    

    Pooled Cohort Equations

    
    
  • c.
    

    Coronary artery calcium scoring

    
    
  • d.
    

    Low-density lipoprotein cholesterol, family history of premature ASCVD, C-reactive protein concentration

  
  
  
  
• 2.
  

  Which of the following statements about the current risk prediction models is TRUE?

  
  
  
  
  • a.
    

    The Pooled Cohort Equations are especially accurate for cardiovascular disease risk prediction in younger patients with nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors such as metabolic syndrome, obstructive sleep apnea, or chronic kidney disease.

    
    
  • b.
    

    Current risk prediction models have decreased the importance of patient age compared with previous guidelines.

    
    
  • c.
    

    Pooled Cohort Equations may overestimate the risk of eventual ASCVD across the risk spectrum by up to 50-150% compared with actual observed event rates.

    
    
  • d.
    

    Risk assessment models are derived from the most recent patient populations and take into account the effects of contemporary risk factor and treatment patterns.

  
  
  
  
• 3.
  

  Alex is a 58-year-old white male who is seeing his primary care physician for a routine physical examination. Alex’s total cholesterol is 222 mg/dL, his high-density lipoprotein cholesterol is 45 mg/dL, and his systolic blood pressure is 140 mm Hg. Alex does not smoke or take any medications. Alex’s physician calculates his 10-year atherosclerotic cardiovascular disease risk to be 10.3% and suggests that he consider statin therapy. Alex considers himself to be generally healthy and is unsure whether he wants to start taking medication. According to the most recent data, during a Clinician-Patient Risk Discussion, which of the following tests would be MOST useful for determining whether Alex has subclinical atherosclerotic disease?

  
  
  
  
  • a.
    

    High-sensitivity C-reactive protein test

    
    
  • b.
    

    Calculating his ankle-brachial index score

    
    
  • c.
    

    Calculating the Framingham score

    
    
  • d.
    

    Coronary artery calcium score

  
  
  
  
• 4.
  

  An elevated coronary calcium score (eg, >100 or >300 Agatston units):

  
  
  
  
  • a.
    

    is a major determinant of coronary heart disease (CHD) events independent of patient age or other risk factors.

    
    
  • b.
    

    is a major determinant of CHD events but only in patients with several other CHD risk factors

    
    
  • c.
    

    is not a predictor of CHD events in older patients

    
    
  • d.
    

    is not significantly associated with CHD events in younger patients

  
  
  
  
• 5.
  

  Which of the following statements about familial hypercholesterolemia (FH) is TRUE?

  
  
  
  
  • a.
    

    Genetic screening is routinely recommended to diagnose patients with FH.

    
    
  • b.
    

    Cascade screening is recommended for families of patients diagnosed with FH.

    
    
  • c.
    

    Both homozygous and heterozygous FH are rare (<1:10,000).

    
    
  • d.
    

    FH is an autosomal recessive condition.

  
  
  
  
• 6.
  

  Which of the following statements about statin intolerance is TRUE?

  
  
  
  
  • a.
    

    Individuals who are intolerant of a statin rarely tolerate a different statin.

    
    
  • b.
    

    The majority of statin-related muscle symptoms are associated with an elevated CK.

    
    
  • c.
    

    In the majority of randomized trials, the rate of myalgias has not increased in those patients on statins compared to placebo.

    
    
  • d.
    

    A trial of low-dose statin therapy is rarely effective due to lack of significant low-density lipoprotein cholesterol lowering.

  
  
  
  
• 7.
  

  Monoclonal antibodies against PCSK9 lower serum low-density lipoprotein (LDL) cholesterol concentration by:

  
  
  
  
  • a.
    

    Increasing recycling of LDL receptors to the hepatocyte surface

    
    
  • b.
    

    Promoting the lysis of LDL receptors within lysosomes

    
    
  • c.
    

    Interfering with the transcription of PCSK9 mRNA

    
    
  • d.
    

    Blocking the formation of very low density lipoprotein

  
  
  
  
• 8.
  

  Which of the following is an antisense oligonucleotide that specifically inhibits the translation of ApoB mRNA to protein?

  
  
  
  
  • a.
    

    Evolocumab

    
    
  • b.
    

    Mipomersen

    
    
  • c.
    

    Lomitapide

    
    
  • d.
    

    Anacetrapib

  
  
  
  
• 9.
  

  Blockade of Microsomal Triglyceride Transfer Protein (MTP):

  
  
  
  
  • a.
    

    decreases recycling of low-density lipoprotein receptor to the hepatocyte surface

    
    
  • b.
    

    prevents the synthesis of apolipoprotein B (ApoB)

    
    
  • c.
    

    prevents the lipidation of ApoB

    
    
  • d.
    

    prevents neutral lipid transfer between lipoproteins

  
  
  
  
• 10.
  

  Which of the following has been proposed as a strategy to increase high-density lipoprotein cholesterol levels?

  
  
  
  
  • a.
    

    Monoclonal antibodies against PCSK9

    
    
  • b.
    

    Antisense therapy against apolipoprotein B

    
    
  • c.
    

    Blockade of Microsomal Triglyceride Transfer Proteins

    
    
  • d.
    

    Inhibition of cholesterol esterase transfer protein