From Risk Modifiers to Medication Adherence: Pharmacists as Key Players in Cardiovascular Outcomes

In an interview with Pharmacy Times, Laxmi Mehta, MD, professor in the Division of Cardiovascular Medicine and director of the lipid clinics at The Ohio State University Wexner Medical Center, addressed the low patient awareness of inherited lipid risk factors, particularly lipoprotein(a)—Lp(a)—found in a recent survey she helped lead among patients with high cholesterol, and how pharmacists can incorporate these risk modifiers into cholesterol management counseling.

Mehta noted that Lp(a) testing has only recently become more mainstream and that approximately 1 in 5 people have elevated levels—a figure supported by the American Heart Association. Because Lp(a) is genetically inherited, diet and exercise alone cannot adequately reduce it. Although no FDA-approved therapies specifically targeting Lp(a) lowering currently exist, elevated levels are associated with atherosclerosis and prothrombotic effects, making overall atherosclerotic risk reduction critical. Statins remain the first-line recommendation in these patients. Similarly, coronary artery calcium scoring, which identifies calcification in the coronary arteries as evidence of existing atherosclerosis, should prompt lipid-lowering therapy, with statins again serving as the primary agent.^1,2

On the question of lifestyle vs pharmacologic therapy, Mehta was clear: Lifestyle modification is foundational for all patients, but it is rarely sufficient on its own for those at elevated cardiovascular risk. She encouraged a collaborative framing, suggesting pharmacists reinforce that strong lifestyle habits may reduce the number or dose of medications needed, while also conveying that statins and nonstatin agents offer cardiovascular benefits that lifestyle changes simply cannot replicate.

Mehta closed by underscoring the broader stakes. Significant gaps exist nationwide in lipid-related knowledge, prescribing, and medication adherence—and pharmacists are essential to closing them. She urged the pharmacy community to communicate to patients that appropriate lipid-lowering therapy is about more than low-density lipoprotein numbers; it is about meaningfully reducing the risk of heart attack, stroke, and cardiovascular mortality.

REFERENCES

1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143. doi:10.1161/CIR.0000000000000625

2. Tsimikas S, Marcovina SM. Ancestry, lipoprotein(a), and cardiovascular risk thresholds: JACC review topic of the week. J Am Coll Cardiol. 2022;80(9):934-946. doi:10.1016/j.jacc.2022.06.019