3 Questions Pharmacists Should Ask Statin Prescribers and Patients

When evaluating statin use, pharmacists should refer to the latest recommendations for high cholesterol treatment.

In recent draft guidance, the US Preventive Services Task Force (USPSTF) backed recommendations for statin prescribing released by the American College of Cardiology (ACC) and American Heart Association (AHA) in 2013.

The guidelines suggest that adults aged 40 to 75 years who have at least one risk factor for heart disease and a >10% risk for experiencing a heart attack or stroke within the next decade should take a low or moderate dose of a statin—the mainstay first-line treatment for high cholesterol.

This recommendation was based on an analysis of existing clinical data from 18 randomized, controlled trials that found statin use was linked to a 17% reduced risk of death from any cause and a 36% reduced risk of death from cardiovascular disease, specifically.

Pharmacists can work with prescribers to perform medication reconciliation for patients with high cholesterol, and then apply the USPSTF draft recommendations where applicable.

Proper medication reconciliation for cholesterol drugs can have a wide-ranging impact, as an estimated 45 million Americans have cholesterol levels that make them candidates for statin therapy.

The pharmacist has a clear role to play in medication reconciliation, which is a key strategy for optimizing patient outcomes.

“Pharmacists can consistently and effectively provide medication reconciliation for patients during care transitions by standardizing the delivery of medication therapy management,” Pharmacy Times Editor-In-Chief Fred Eckel, MS, ScD (Hon), recently wrote.

Here are some questions pharmacists should ask in order to improve statin prescribing practices.

1. How old is the patient?

While the USPSTF and ACC/AHA statin recommendations are intended for patients aged 40 to 75 years, a research letter that appeared online in JAMA Internal Medicine examined the trend of increasingly high statin use among those older than 79 years.

“Although the medical community had embraced the use of statins for primary prevention in the very elderly, caution should be exercised give the potential dangers of expanding marginally effective treatments to untested populations,” the researchers wrote.

They found that statin therapy in very elderly patients might be more harmful than helpful, especially for those without vascular disease.

Furthermore, another study published in JAMA suggested that patients with limited life expectancy could see improvement in quality of life if they stop taking statins. The quality of life benefit was derived from reductions in medication costs and pill burden related to statin therapy.

2. How high of a statin dose is the patient taking and for how long?

When it comes to statins, sometimes less is more, as some studies suggest that more than 80% of a statin’s benefits occur at the lowest dose.

However, research has also shown that more-intensive statin therapy provides a greater benefit than less-intensive statin therapy, further reducing vascular events by 15%.

Although the USPSTF and ACC/AHA recommendations are generally supportive of statin use, a different study published in Expert Review of Clinical Pharmacology found a significant increase in the incidence of breast cancer among women who took statins for more than 10 years.

Statins are also related to increased rates of cataracts, diabetes, cognitive impairments, and musculoskeletal disorders.

3. Have lifestyle changes been made?

Certain lifestyle changes may be enough to manage cholesterol and reduce medication reliance, according to the AHA.

This may be especially true for patients who have high cholesterol, but not heart disease.

The AHA recommends that patients with high cholesterol adopt a heart-healthy diet focused on fruit, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts. Patients should only consume minimal amounts of red meat and sugary foods and beverages.

Another lifestyle change that has been shown to help lower high cholesterol levels is increased exercise. The AHA says just 40 minutes of aerobic exercise at moderate to vigorous intensity 3 to 4 times per week is sufficient to lower both cholesterol and blood pressure.

Smoking cessation also helps lower high cholesterol levels.

“In addition to a healthy lifestyle, statins are useful for people at an elevated risk for cardiovascular disease,” said USPSTF member Douglas Owens in an interview with Reuters.