"I Didn't Do This to Myself": How Mary Katherine Cheeley Uses Lp(a) Education to Transform Patient Adherence

Mary Katherine Cheeley, PharmD, BCPS, CLS, FNLA, describes the deep well of patient misconceptions she encounters daily: that a stent or bypass means the problem is solved; that a better diet alone will fix lipid levels; and that these are diseases of personal choices rather than lifetime risk. Her most impactful intervention, she says, has been telling high-Lp(a) patients—many of them African American patients in inner-city Atlanta—that their condition is genetic, not self-inflicted. That single conversation, she explains, consistently changes everything about how they engage with their treatment.

Q: Medication adherence remains one of the biggest barriers to achieving lipid goals. What strategies or tools have you found most effective in your practice for keeping patients on track with their lipid-lowering regimens?

Mary Katherine Cheeley, PharmD, BCPS, CLS, FNLA: I love lipids, but I’ve noticed in that space that there is so much misinformation, particularly about statins. There is so much hesitation around statins. There is so much misunderstanding about cardiovascular disease in general. Our patients think, “I went in, I had a cath, they cleared out the blockage — I’m good.” Or: “I had a CABG, and they rerouted all this stuff in my heart.” Or: “I had a bypass in my leg—my legs don’t hurt anymore. I don’t need these medicines.” That education gap is really challenging. I also think lipids have this misnomer that if you just eat better, it’s going to get better—and while yes, in the immediate term that will happen and your lipid levels will go down, this is a disease of a lifetime. We’re talking about lifetime risk that probably started, depending on your socioeconomic status and your lifestyle, when you were a kid or a teenager and that impacts you when you’re 40, 50, 60, or 70. Those are things that are hard for patients to understand.

With that being said, the biggest strategy I use is just spending time with patients and making sure they understand this is a lifetime thing—that it doesn’t matter if we got rid of that blockage; it can come back. I think we’re learning so much more in the lipid space about lifetime risk. We have learned so much in the last five to ten years about Lp(a). Lipoprotein(a) is a genetic thing that you cannot change. I work in inner-city Atlanta and have a large African American patient population. Their Lp(a) levels are through the roof. The relief that I see on people’s faces when I tell them, “This is not on you—this is not something you will be able to fix.” There’s this relief that washes over them: “I didn’t do this to myself. This is something I was born with.” That has made a huge difference in their adherence, because they realize it’s not something they can fix on their own. Their willpower for eating better or exercising more — even if they have pain in their legs — is not going to change their overall Lp(a) risk. It will help, certainly, and we talk through all of that, but giving patients a reason to say yes to the medicine—”I can’t do this on my own”—has really been a measurable difference for us.

I also have the pleasure of overseeing and managing our medication adherence team at Grady. We have a team of five pharmacists whose role is making sure that patients are adherent to their diabetes, cholesterol, and hypertension meds. Those quick touchpoints with patients make all the difference. We are in such a technology-driven society now, and it’s really challenging — we want everything to be a text reminder, but that doesn’t work for patients. If you’re noticing that a patient’s PDC is 55% or that they’re only filling every two to three months when it should be every month, that quick touchpoint makes a huge difference. I know that a lot of retailers are starting to do this on the retail side too. They’re able to really hone in on those patients who need that extra education.

We have data proving that when our med adherence team is involved, clinical outcomes get better. Your A1c goes down, your blood pressure goes down, your lipids improve, and your PDC goes up. That human connection — while it’s very time consuming and labor intensive — has made the biggest difference for my patients.