APhA2026: Community Pharmacists Are Improving Outcomes in Cardio-Kidney-Metabolic Syndrome

Cardiovascular disease, chronic kidney disease, and metabolic dysfunction do not arise in isolation. The American Heart Association formalized this reality in 2023 with its landmark definition of cardiovascular-kidney-metabolic (CKM) syndrome—a framework that recognizes the deeply intertwined pathophysiology linking obesity, diabetes, hypertension, kidney disease, and cardiovascular risk into a single, progressive disease spectrum.^1,2

The prevalence in the United States population is staggering. Nearly 90% of US adults have CKM syndrome at stage 1 or higher, with more than 50% of adults over 65 having advanced disease at stages 3 or 4, and CKM-related conditions drive an estimated $900 billion in annual direct health care costs. Two posters presented at the American Pharmacists Association 2026 Annual Meeting and Exposition in Los Angeles offered concrete, real-world evidence that community pharmacists, particularly those embedded in independent and rural settings, are uniquely positioned to intervene at multiple points along this spectrum.³

Poster 1: Tackling Diabetes and Hypertension in Rural North Carolina

The first study, led by Brittney Griffin, PharmD, and colleagues from McDowell's Pharmacy in Scotland Neck, NC, and the University of North Carolina Eshelman School of Pharmacy (UNC Eshelman), assessed a pharmacist-led diabetes and hypertension management program across 2 independent rural community pharmacies. The retrospective analysis included 24 patients enrolled between August and December 2025, with 58% attributed to diabetes alone, 25% to hypertension alone, and 17% to both conditions. More than half of participants (54%) were in the 57 to 74 age range, and 63% were enrolled directly from the home pharmacy.⁴

Among the 12 patients with repeated A_1C measurements, mean hemoglobin A_1C declined from 7.71% at baseline to 7.28% at the final measurement. Perhaps more striking was the dose-response pattern in outcomes by engagement level: patients with 6 or more pharmacist visits experienced an A_1C reduction of 0.47 percentage points, compared with 0.35 points for those with 3 to 5 visits and just 0.20 points for those with 1 to 2 visits. This suggests that sustained pharmacist engagement, not a single intervention, drives meaningful glycemic improvement. Blood pressure results among the 4 patients with repeated measurements showed similarly encouraging trends, with mean systolic blood pressure falling from 135 to 116.75 mmHg and mean diastolic blood pressure dropping from 84.5 to 74 mmHg.⁴

Pharmacist interventions were documented via HL7 Pharmacist eCare Plans and spanned therapeutic recommendations, adherence packaging or medication synchronization, and lifestyle counseling on pathophysiology and local resources. The findings align with a growing body of evidence supporting pharmacist-led chronic disease management: a 2024 pharmacist-led intervention study published in the Journal of Managed Care & Specialty Pharmacy found that pharmacist consultations were associated with significant absolute increases in optimal medication adherence for diabetes (+4.0%) and hypertension (+6.3%) in patients on Medicare, alongside an estimated $10.3 million in annual cost savings for diabetes patients alone.^4,5

Poster 2: Reducing Stroke Risk Through Pharmacist-Led Prevention Services

The second study, led by Shannon Habba, BS, PharmD, and colleagues from Moose Pharmacy in Mount Pleasant, NC, and UNC Eshelman, evaluated a pharmacist-led stroke prevention service in an independent community pharmacy. Stroke remains the fifth leading cause of death in the United States, with modifiable risk factors, including hypertension, diabetes, obesity, high cholesterol, and atrial fibrillation (AFib), driving most events. The prospective quality improvement project enrolled 44 patients (mean age 66 years; 52.3% female; 86.4% White) with moderate-to-high American Stroke Association (ASA) Stroke Risk Assessment (SRA) scores, defined as 4 or greater on a 10-point scale.⁶

Results demonstrated a meaningful improvement in stroke risk across the cohort. The mean SRA score declined from 5.7 ± 1.1 at the initial consultation to 4.6 ± 1.4 at follow-up. Clinically, the proportion of patients classified as high-risk (SRA score 7–10) fell from 8 patients to 7, while the proportion classified as low-risk (SRA score 0–3) increased from 0 to 9—a shift from 0% to 20% in the low-risk category. Among biometric measures, mean systolic blood pressure decreased by 5.7 mmHg, mean diastolic blood pressure fell by 2.3 mmHg, and mean total cholesterol declined by 7.5 mg/dL from baseline to follow-up.⁶

The pharmacist intervention used the ASA SRA tool at each visit alongside motivational interviewing to set individualized goals. Lifestyle modifications—particularly improvements in diet and exercise—were identified as the drivers of greatest change in modifiable stroke risk factors. Notably, atrial fibrillation (AFib) diagnosis and history of stroke or transient ischemic attack remained stable across both consultations, reflecting the chronic nature of these fixed risk factors and the importance of focusing pharmacist coaching on modifiable variables. Research has shown that pharmacist-led management under a collaborative practice agreement significantly improves blood pressure control, time to goal, and medication adherence compared to physician-only care, particularly in rural and underserved settings.^5-7

The Community Pharmacy as a CKM Intervention Hub

Taken together, these posters reinforce a compelling case for positioning community pharmacists, especially those in independent and rural practices, as frontline contributors to CKM syndrome management. Both studies focused on populations and geographies where access to multidisciplinary specialty care is limited and where pharmacists may be the most consistent health care professional a patient encounters. Equitably and effectively implementing optimal CKM care will require concerted, collaborative efforts from policymakers, health care leaders, pharmacists, public health innovators, and clinician advocates.^1,2

The dose-response relationship between the number of pharmacist visits and A_1C improvement observed in McDowell's study and the progressive reduction in SRA scores seen across repeated Moose Pharmacy consultations both suggest that longitudinal, relationship-based pharmacist care, not one-time counseling, is the model that generates results. As the CKM framework continues to reshape how clinicians think about cardiometabolic risk, community pharmacists have both the scope and the patient access to serve as a critical pillar of that care continuum.

REFERENCES

1. Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636-1664. doi:10.1161/CIR.0000000000001196

2. Halpern L. APhA: Pharmacists can drive interconnected cardio-kidney-metabolic care. Pharmacy Times. Published March 27, 2026. Accessed March 29, 2026. https://www.pharmacytimes.com/view/apha-pharmacists-can-drive-interconnected-cardio-kidney-metabolic-care

3. Hermes Z, Bhatt AS, Vaduganathan M. Cardiovascular-kidney-metabolic syndrome: a paradigm for value-based care. J Card Fail. 2025;1(1):72-78. doi:10.1016/j.cardfail.2025.01.002

4. Griffin B, McDowell T, Bullard H, et al. Assessing pharmacist-led interventions from a diabetes and hypertension management program [poster]. Presented at: American Pharmacists Association Annual Meeting & Exposition; Los Angeles Convention Center; March 27-30, 2026; Los Angeles, CA.

5. Smith-Ray R, Feng L, Singh T, et al. Pharmacists as clinical care partners: how a pharmacist-led intervention is associated with improved medication adherence in older adults with common chronic conditions. J Manag Care Spec Pharm. 2024;30(4):345-356. doi:10.18553/jmcp.2024.30.4.345

6. Habba S, Howe A, Marciniak MW, Sexton S, Rhodes LA. Assessing the impact of a pharmacist-led stroke prevention service in an independent community pharmacy [poster]. Presented at: American Pharmacists Association Annual Meeting & Exposition; Los Angeles Convention Center; March 27-30, 2026; Los Angeles, CA.

7. Lamb BM, Floyd EC, Barfield RK, et al. Impact of direct clinical pharmacist intervention on achievement of blood pressure control at a federally qualified health center within a medically underserved area. J Prim Care Community Health. 2025;16:21501319251380623. doi:10.1177/21501319251380623