Statins are widely used for reducing low-density lipoprotein cholesterol (LDL-C) and lowering atherosclerotic cardiovascular disease (ASCVD) risk. However, residual ASCVD risk in statin-treated patients is prevalent. Among the drivers of increased risk is persistent LDL-C elevation due to statin-associated side effects, which often leads to statin discontinuation or under-dosing. A survey of primary care practitioners revealed that recognizing residual risk and statin intolerance might be impediments to managing cholesterol levels in their patients. In-depth knowledge about the available and emerging non-statin adjunctive and alternative therapies, as well as understanding the guidance from national organizations about when they should be implemented, are the keys to improving patient care.

Learning Objectives

  • Recognize statin-associated side effects and other characteristics of patients who may be at residual risk of ASCVD
  • Describe the available non-statin LDL-C-lowering medications and apply them according to the recommendations of the 2018 AHA/ACC/Multi-Society Cholesterol Guideline
  • Analyze the evidence supporting the use of bempedoic acid and the bempedoic acid/ezetimibe combination tablet for LDL-C lowering


James A. Underberg, MD, MS, FACP, FNLA

Clinical Assistant Professor of Medicine
NYU School of Medicine &
NYU Center for Prevention of Cardiovascular Disease
Director, Bellevue Hospital Lipid Clinic
Past President, National Lipid Association
President, American Board Clinical Lipidology Guidelines


Clinical Associate
University of Pennsylvania School of Nursing
Past President, National Lipid Association
Past President, Preventive Cardiovascular Nurses Association
Board Member, Foundation of the National Lipid Association
Consultant and Speaker, Cardiovascular Risk Intervention
West Chester, Pennsylvania


The following relevant financial relationships have been disclosed by faculty, and all have been mitigated by Pri-Med Institute.

James A. Underberg, MS, MD, FACP, FNLA

Speaker’s Bureau for Amgen, Esperion, Amryt, Amarin; Advisory Board for Amgen, Esperion, Amarin, Novartis; Contracted Research for Amyrt; Consultant for Amgen


Speaker’s Bureau for Amgen, Amarin, Regeneron, Esperion; Speaker’s Bureau and Consulting Fee for Kaneka


Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose. 

CME/CE Information

AMA PRA Category 1 Credits

Accreditation Statement

Pri-Med Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement

pmiCME designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Pri-Med Institute and Integrity CE. Pri-Med Institute is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider Number 040308.

Designation Statement

This program has been approved for 0.53 contact hour of continuing education, which includes 0.15 hour of pharmacology.

Instructions for Obtaining Credit

Once you have completed the activity, please click the "next" button to advance to the post-activity assessment. To complete this activity and claim credit, you must answer 2 out of the 3 questions correctly. If you are not successful after your first attempt, you will be given an opportunity to reflect upon the answer rationales and have the opportunity to review the educational content before proceeding. Once you have selected your answers, click the "submit" button to complete the evaluation questions and proceed to the claim credit screen.

MOC Credit Information

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 Medical Knowledge & Patient Safety MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. 

Commercial Supporter

Esperion Therapeutics, Inc.

Education Partner

Integrity CE

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Clinical judgment must guide each clinician in weighing the possible risks, benefits, or contraindications of any diagnostics, interventions or treatments discussed. Clinicians should review manufacturers’ product information and consider these with the recommendations of other authorities when applying the assessment and/or clinical management strategies discussed in this activity to the care of their patients.

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Pri-Med programs are owned and operated by DBC Pri-Med, LLC, a division of Diversified Communications, Inc. Pri-Med Institute, the accredited division of Pri-Med, is accredited with commendation by the ACCME and approved as a provider of continuing education by the AANP. Pri-Med Institute is the accredited provider for this activity.

Disclosures and Conflict of Interest
Pri-Med Institute requires all individuals in a position to influence educational content for Pri-Med Institute-certified CME/CE activities to disclose relevant personal financial relationships with commercial interests prior to contributing to its educational activities. Pri-Med Institute assesses disclosed relationships and follows a defined process to resolve real or implied conflicts to ensure, to the best of its ability, that all educational content is free of commercial bias. Financial disclosures are listed in the activity syllabus and will also be printed on the slides and announced at the start of each presentation.

Discussion of Off-Label Uses and Investigational Products
During the course of their presentations, the faculty may mention uses of products that have not been approved in the United States for the indication(s) being discussed. All presenters are instructed to notify participants when they are discussing unapproved uses or investigational agents. In addition, specific slides will include notation of the off-label use or investigational agent being discussed. Views presented related to unapproved uses of products are solely those of the presenter(s) and are not endorsed by Pri-Med Institute or DBC Pri-Med, LLC.

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