Ridker PM, Danielson E, Fonseca FA, et al; JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195-2207.
Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305:2556-2564.
Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. New England Journal of Medicine. 1995;333:1301-1308.
Rajpathak SN, Kumbhani DJ, Crandall Jet al. Statin therapy and risk of developing type 2 diabetes: a meta-analysis. Diabetes Care. 2009;32:1924-1929.
Ridker PM, Pradhan A, MacFadyen JG, et al. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380:565-571.
Barter P. The realities of dyslipidaemia in metabolic syndrome and diabetes. Br J Diabetes Vasc Dis. 2005;5:S7-S11.
Waters DD, Ho JE, DeMicco DA, et al. Predictors of new-onset diabetes in patients treated with atorvastatin: results from 3 large randomized clinical trials. J Am Coll Cardiol. 2011;57:1535-1545.
Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol. 2014;63(25):2889-2934.
Taguchi I, Iimuro S, Iwata H, et al. High-dose versus low-dose pitavastatin in Japanese patients with stable coronary artery disease (REAL-CAD): a randomized superiority trial. Circulation. 2018;137:1997-2009
Odawara M, Yamazaki T, Kishimoto J, et al. J-PREDICT study investigators. Effect of pitavastatin on the incidence of diabetes in Japanese individuals with impaired glucose tolerance. Diabetologia. 2013;56(suppl 1):128.
Maejima T, Sugano T, Yamazaki H, et al. Pitavastatin increases ABCA1 expression by dual mechanisms: SREBP2-driven transcriptional activation and PPARalpha-dependent protein stabilization but without activating LXR in rat hepatoma McARH7777 cells. J Pharmacol Sci. 2011;116:107-115.
Braun LR, Feldpausch MN, Czerwonka N, et al. Effects of pitavastatin on insulin sensitivity and liver fat: a randomized clinical trial. J Clin Endocrinol Metab. 2018;103(11):4176-4186.
Koenig W, Ridker PM. Rosuvastatin for primary prevention in patients with European systematic coronary risk evaluation risk >/= 5% or Framingham risk >20%: post hoc analyses of the JUPITER trial requested by European health authorities. Eur Heart J. 2011;32:75-83.

CME / CE

Lipid Clinic Challenge: Maximizing Statins to Minimize New Onset Diabetes

Authors: Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed); Peter Toth, MD, PhD
CME / CE Released: 10/31/2018
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 10/31/2019, 11:59 PM EST

Target Audience and Goal Statement

This activity is intended for cardiologists, diabetologists, endocrinologists, primary care physicians, nurses, and pharmacists.

The goal of this activity is to improve clinicians' ability to choose the right statin for each patient.

Upon completion of this activity, participants will:

Have increased knowledge regarding the
- Effect of different statin therapies on the risk for new-onset diabetes
- Clinical data supporting the use of different statin therapies in patients at risk for new-onset diabetes
Have greater competence related to
- Using appropriate lipid lowering Strategies by the interprofessional team to minimize the risk for new-onset diabetes in patients at risk

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Faculty

Peter Toth, MD, PhD

Professor
Clinical Family and Community Medicine
University of Illinois
Director
Preventive Cardiology
CGH Medical Center
Sterling, Illinois

Disclosures

Disclosure: Peter Toth, MD, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amarin Corporation plc; Amgen Inc.; Kowa Company Ltd.; Merck & Co., Inc.; Novo Nordisk; Regeneron Pharmaceuticals, Inc.; Sanofi
Served as a speaker or a member of a speakers bureau for: Amarin Corporation plc; Amgen Inc.; Kowa Company Ltd.; Merck & Co., Inc.; Novo Nordisk; Regeneron Pharmaceuticals, Inc.; Sanofi

Dr Toth does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Toth does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed)

Professor
Public Health
Imperial College London
London, United Kingdom

Disclosures

Disclosure: Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed), has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Amgen Inc.; Cerenis Therapeutics; Ionis Pharmaceuticals, Inc.; Lilly; Medco Health Solutions, Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi
Served as a speaker or a member of a speakers bureau for: Algorithme Pharma inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Cipla Ltd.; Kowa Company Ltd.; Pfizer Inc; Takeda Pharmaceuticals North America, Inc.
Received grants for clinical research from: Amgen Inc.; Pfizer Inc; Regeneron Pharmaceuticals, Inc.; Sanofi

Dr Ray does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Ray does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Steering Committee

Alan S. Brown, MD

Director
Advocate Heart Institute
Advocate Lutheran General Hospital
Park Ridge, Illinois

Disclosures

Disclosure: Alan S. Brown, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Akcea Therapeutics; Amgen Inc.; Kastle Therapeutics; Merck & Co., Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi
Served as a speaker or a member of a speakers bureau for: Amgen Inc.; Kowa Company Ltd.; Regeneron Pharmaceuticals, Inc.; Sanofi

Harold Edward Bays, MD

Medical Director
Louisville Metabolic and Atherosclerosis Research Center
Louisville, Kentucky

Disclosures

Disclosure: Harold Edward Bays, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Akcea Therapeutics; Alnylam Pharmaceuticals, Inc.; Amgen Inc.; AstraZeneca Pharmaceuticals LP; Eisai Inc.; Esperion Therapeutics, Inc.; Ionis Pharmaceuticals, Inc.; Janssen Pharmaceuticals; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Kowa Company Ltd.; Lilly; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; ProSciento; Regeneron Pharmaceuticals, Inc.; Sanofi
Served as a speaker or a member of a speakers bureau for: Amarin Corporation plc; Amgen Inc.; Eisai Inc.; Kowa Company Ltd.; Orexigen Therapeutics, Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi
Received grants for clinical research from: Alere; Allergan, Inc.; Amarin Corporation plc; Amgen Inc.; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Catabasis Pharmaceuticals, Inc.; Chiltern; ChromaDex, Inc.; Dr. Reddy's Laboratories Ltd.; Eisai Inc.; Elcelyx Therapeutics, Inc.; Esperion Therapeutics, Inc.; Ferrer; Gemphire Therapeutics Inc.; Gilead Sciences, Inc.; GlaxoSmithKline; Home Access Health; Ionis Pharmaceuticals, Inc.; iSpecimen; Janssen Pharmaceuticals; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lilly; Merck & Co., Inc.; Nektar Therapeutics; Nichi-Iko Pharmaceutical Co., Ltd.; Novartis Pharmaceuticals Corporation; Novo Nordisk; Omthera Pharmaceuticals, Inc.; Pfizer Inc; Regeneron Pharmaceuticals, Inc.; Sanofi; Selecta Biosciences, Inc.; Takeda Pharmaceuticals North America, Inc.

Joseph L. Lillo, DO

Assistant Professor
Family Medicine
Midwestern University College of Osteopathic Medicine
Glendale, Arizona

Disclosures

Disclosure: Joseph L. Lillo, DO, has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: Amarin Corporation plc; Amgen Inc.; Kowa Company Ltd.; Sanofi

Kevin C. Maki, PhD

Chief Scientist
Midwest Biomedical Research
Wheaton, Illinois,

Disclosures

Disclosure: Kevin C. Maki, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Akcea Therapeutics; Amgen Inc.; Kowa Company Ltd.; Regeneron Pharmaceuticals, Inc.; Sancilio & Company, Inc.

Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed)

Disclosures

As listed above.

Joyce L. Ross, MSN, CRNP, CS

Diplomate
Accreditation Council for Clinical Lipidology
Immediate Past President
National Lipid Association
Past President
Preventive Cardiovascular Nurses Association
Philadelphia, Pennsylvania

Disclosures

Disclosure: Joyce L. Ross, MSN, CRNP, CS, has disclosed the following relevant financial relationships:
Served as a speaker or a member of a speakers bureau for: Amarin Corporation plc; Amgen Inc.; Kaneka Americas Holding, Inc.; Kowa Company Ltd.; Regeneron Pharmaceuticals, Inc.; Sanofi

Editor

Joy P. Marko, MS, APN-C, CCMEP

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Joy P. Marko, MS, APN-C, CCMEP, has disclosed no relevant financial relationships.

CME / CE Reviewer

Esther Nyarko, PharmD

Associate CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Nurse Planner

Amy Bernard, MS, BSN, RN-BC, CHCP

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbot; Heartware; Medtronic; Thoratec

Accreditation Statements

In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

For Physicians

Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Contact This Provider

For Nurses

Awarded 0.50 contact hour(s) of continuing nursing education for RNs and APNs; 0.50 contact hours are in the area of pharmacology.

Contact This Provider

For Pharmacists

Medscape designates this continuing education activity for 0.50 contact hour(s) (0.050 CEUs) (Universal Activity Number: JA0007105-0000-18-186-H01-P).

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

From Medscape Education Cardiology

CME / CE

Lipid Clinic Challenge: Maximizing Statins to Minimize New Onset Diabetes

Authors: Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed); Peter Toth, MD, PhDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 10/31/2018

Valid for credit through: 10/31/2019, 11:59 PM EST

processing....

Lipid Clinic Challenge: Maximizing Statins to Minimize New-Onset Diabetes
[ CLOSE WINDOW ]

Slide 1.

Who is Vulnerable and Why
[ CLOSE WINDOW ]

Slide 2.

JUPITER: Increased Incidence of T2D With Rosuvastatin^[1]
[ CLOSE WINDOW ]

Slide 3.

Hypotheses
[ CLOSE WINDOW ]

Slide 4.

T2D Risk Increases With Statin Potency: Meta-Analysis of 5 Clinical Trials^[2]
- It has been demonstrated that for patients on a low dose of a statin, one must treat 1000 in a year to see 1 new case
- If on moderate to high dose, 500 a year to see 1 new case
[ CLOSE WINDOW ]

Slide 5.

WOSCOPS Pravastatin: Reduction in LDL-C/Reduced CAD by 30%^[3]
- When the WOSCOPS trial was first reported, it was suggested that pravastatin was protective against diabetes
- When the JUPITER trial data became available -- and the WOSCOPS investigators went back to re-examine the data and used more contemporary cut points for diabetes -- findings were the opposite
[ CLOSE WINDOW ]

Slide 6.

Statins and the Development of Diabetes^[4]
- The PROSPER trial looked at a vulnerable group of patients aged approximately 75 years to 80 years old
[ CLOSE WINDOW ]

Slide 7.

JUPITER: Rosuvastatin Therapy and Diabetes Risk^[5,13]
- The JUPITER population consisted of patients with metabolic syndrome
  - 43% and 44% of the two treatment arms had metabolic syndrome
  - They are the highest inclusion numbers of any statin trials in terms of numbers of patients with insulin resistance
[ CLOSE WINDOW ]

Slide 8.

Obesity and Metabolic Syndrome^[6]
[ CLOSE WINDOW ]

Slide 9.

Analysis of 3 Atorvastatin Trials: (TNT, SPARCL, and IDEAL)^[7]
- These trials include patients with established vascular disease
- High intensity statins are needed
- If patients developed diabetes/dysglycemia, the benefit of statin therapies was not attenuated
- Statins remain as very effective treatments for patients with diabetes
- Even patients with diabetes who do not have high LDL cholesterol levels still have high risk
[ CLOSE WINDOW ]

Slide 10.

Don't Just Blame Statins
[ CLOSE WINDOW ]

Slide 11.

2013 ACC/AHA Cholesterol Guidelines: Statin Initiation Recommendations^[8]
- American Heart Association (AHA)/American College of Cardiology (ACC) guidelines and European guidelines have continued to move us to treat to risk
- The higher level of risk, the greater the LDL reduction that is needed
[ CLOSE WINDOW ]

Slide 12.

REAL-CAD: Primary Endpoint: CV Death/MI/Ischemic Stroke/UA^[9]
- Pitavastatin and REAL-CAD showing benefit of high versus low dose
- Largest study in an Asian population
- Pitavastatin at either 1 mg or 4 mg daily was not associated with an increased signal for diabetes
[ CLOSE WINDOW ]

Slide 13.

J-PREDICT Primary Outcome: Cumulative Incidence of Diabetes^[10]
- J-PREDICT looked at people with prediabetes
- This was a large study with an oral glucose tolerance test and long follow-up
- The study showed either no effect or a lower risk of diabetes
[ CLOSE WINDOW ]

Slide 14.

ABCA1: A Very Important Transmembrane HDL Binding Protein^[11]
[ CLOSE WINDOW ]

Slide 15.

Pitavastatin: No Elevation in Serum Glucose^[9,10]
[ CLOSE WINDOW ]

Slide 16.

Managing Cardiovascular Risk
[ CLOSE WINDOW ]

Slide 17.

Hepatic Steatosis and Insulin Resistance
[ CLOSE WINDOW ]

Slide 18.

Effects of Pitavastatin on Insulin Sensitivity and Liver Fat^[12]
- Compared to placebo, pitavastatin did not affect hepatic or whole-body insulin sensitivity, and did not reduce liver fat
[ CLOSE WINDOW ]

Slide 19.

Case Study: Patient With Obesity With Hypertension and Dyslipidemia
[ CLOSE WINDOW ]

Slide 20.

Case Study: Patient With Obesity With Hypertension and Dyslipidemia
[ CLOSE WINDOW ]

Slide 21.

Many Issues at Play: Education is Needed
[ CLOSE WINDOW ]

Slide 22.

It Takes a Team
[ CLOSE WINDOW ]

Slide 23.

Thank you for participating in this activity
[ CLOSE WINDOW ]

Slide 24.

This content has been condensed for improved clarity.

CME / CE Information Download Slides

Print
Like Tweet

Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Faculty

Peter Toth, MD, PhD

Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed)

Steering Committee

Alan S. Brown, MD

Harold Edward Bays, MD

Joseph L. Lillo, DO

Kevin C. Maki, PhD

Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed)

Joyce L. Ross, MSN, CRNP, CS

Editor

Joy P. Marko, MS, APN-C, CCMEP

CME / CE Reviewer

Esther Nyarko, PharmD

Nurse Planner

Amy Bernard, MS, BSN, RN-BC, CHCP

Peer Reviewer

CME / CE

Lipid Clinic Challenge: Maximizing Statins to Minimize New Onset Diabetes

Target Audience and Goal Statement

Disclosures

Faculty

Peter Toth, MD, PhD

Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed)

Steering Committee

Alan S. Brown, MD

Harold Edward Bays, MD

Joseph L. Lillo, DO

Kevin C. Maki, PhD

Kausik Ray, MBChB, MD, MPhil (Cantab), FRCP (Lon), FRCP (Ed)

Joyce L. Ross, MSN, CRNP, CS

Editor

Joy P. Marko, MS, APN-C, CCMEP

CME / CE Reviewer

Esther Nyarko, PharmD

Nurse Planner

Amy Bernard, MS, BSN, RN-BC, CHCP

Peer Reviewer

Accreditation Statements

For Physicians

For Nurses

For Pharmacists

Instructions for Participation and Credit

Lipid Clinic Challenge: Maximizing Statins to Minimize New Onset Diabetes

Lipid Clinic Challenge: Maximizing Statins to Minimize New-Onset Diabetes

Slide 1.

Who is Vulnerable and Why

Slide 2.

JUPITER: Increased Incidence of T2D With Rosuvastatin[1]

Slide 3.

Hypotheses

Slide 4.

T2D Risk Increases With Statin Potency: Meta-Analysis of 5 Clinical Trials[2]

Slide 5.

WOSCOPS Pravastatin: Reduction in LDL-C/Reduced CAD by 30%[3]

Slide 6.

Statins and the Development of Diabetes[4]

Slide 7.

JUPITER: Rosuvastatin Therapy and Diabetes Risk[5,13]

Slide 8.

Obesity and Metabolic Syndrome[6]

Slide 9.

Analysis of 3 Atorvastatin Trials: (TNT, SPARCL, and IDEAL)[7]

Slide 10.

Don't Just Blame Statins

Slide 11.

2013 ACC/AHA Cholesterol Guidelines: Statin Initiation Recommendations[8]

Slide 12.

REAL-CAD: Primary Endpoint: CV Death/MI/Ischemic Stroke/UA[9]

Slide 13.

J-PREDICT Primary Outcome: Cumulative Incidence of Diabetes[10]

Slide 14.

ABCA1: A Very Important Transmembrane HDL Binding Protein[11]

Slide 15.

Pitavastatin: No Elevation in Serum Glucose[9,10]

Slide 16.

Managing Cardiovascular Risk

Slide 17.

JUPITER: Increased Incidence of T2D With Rosuvastatin^[1]

T2D Risk Increases With Statin Potency: Meta-Analysis of 5 Clinical Trials^[2]

WOSCOPS Pravastatin: Reduction in LDL-C/Reduced CAD by 30%^[3]

Statins and the Development of Diabetes^[4]

JUPITER: Rosuvastatin Therapy and Diabetes Risk^[5,13]

Obesity and Metabolic Syndrome^[6]

Analysis of 3 Atorvastatin Trials: (TNT, SPARCL, and IDEAL)^[7]

2013 ACC/AHA Cholesterol Guidelines: Statin Initiation Recommendations^[8]

REAL-CAD: Primary Endpoint: CV Death/MI/Ischemic Stroke/UA^[9]

J-PREDICT Primary Outcome: Cumulative Incidence of Diabetes^[10]

ABCA1: A Very Important Transmembrane HDL Binding Protein^[11]

Pitavastatin: No Elevation in Serum Glucose^[9,10]

Effects of Pitavastatin on Insulin Sensitivity and Liver Fat^[12]