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CME: First and later line treatments for familial hypercholesterolemia (FH): Lowering lipids and getting to goal


Activity Description / Statement of Need:

In this online, self-learning activity:

Familial hypercholesterolemia (FH), also known as type II hyperlipoproteinemia, is an autosomal dominant genetic disorder characterized by substantially elevated plasma LDL-C levels. There are over 1600 different mutations associated with FH, and the condition arises from a significant or complete reduction in functional LDL-C receptors (LDL-Rs) and an attendant reduction in LDL-C clearance that predisposes individuals to premature atherosclerotic cardiovascular disease (ASCVD). The severity of FH is determined by the presence of heterozygous or homozygous genetic alterations. Patients with homozygous FH develop vascular disease during childhood, while those with heterozygous FH may not develop ASCVD until their 30s or 40s. FH is a relatively common disorder, affecting about 1 in every 299 people in the US. Among people with ischemic heart disease, the prevalence is about 10-fold higher, and among those with severe hypercholesterolemia, the prevalence is nearly 23-fold higher.

This learning activity has been designed to bring HCPs’ knowledge of the strategies for the diagnosis and treatment of FH up to date and to improve their competence and performance in treating it.

Target Audience:

Cardiologists, primary care physicians, physician assistants, nurse practitioners, and pharmacists who practice in cardiology; and any other clinicians with an interest in FH.

Commercial Support Disclosure: This program is supported by an educational grant from Amyrt.

This activity is free of charge.

Release Date: January 11, 2022 -- Expiration Date: January 11, 2024

Faculty: Nicholas Marston, MD, MPH


Refresher and review of FH

  • Definitions and diagnostic criteria
  • Prognosis in homozygous vs heterozygous FH
  • Pathogenesis and relationship with atherosclerosis
  • Challenges: Clinically silent until vascular event, underdiagnosis

Treatment and management of FH

  • Pharmacotherapy
    • First line therapy: Statins, ezetimibe
    • PCSK9 inhibition
    • MTP inhibition
    • ATP-citrate lyase inhibition
    • ANGPTL3 protein inhibition
  • Applying clinical trial evidence, real-world data, and expert opinions
    • Statin intolerance
    • Surrogate vs. clinical endpoints
    • Heterozygous vs. homozygous
    • Intensity of therapy
    • Role of comorbidities
    • Treatment approach in special populations
  • Patient cases

Learning Objectives

By the end of the session the participant will be able to:

  • Recall guideline recommendations for FH screening, diagnosis, and management.
  • Discuss the pathophysiology, genetics, and clinical presentation of homozygous and heterozygous FH.
  • Assess the role of novel and emerging agents for the management of homozygous and heterozygous FH in the context of common clinical challenges, including statin intolerance.
  • List present and emerging drug therapies for management of FH.
  • Formulate a treatment plan for a patient with FH.


ACCME Activity #201861264


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure: Nicholas A. Marston, MD, MPH, Cardiologist at Brigham and Women's Hospital, Harvard Medical School, has no relevant financial disclosures.

Faculty DOES NOT plan on discussing off-label uses of a commercial product.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Commercial Support Disclosure: This program is supported by an educational grant from Amyrt.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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