Olivia Hanson: What are the biggest unmet needs in lipid management, and how is pharmacist involvement shifting outcomes?
Craig Beavers, PharmD, FCCP, BCPS-AQ Cardiology: I think, and Glenn and Kristen can jump in, the biggest unmet need is that many patients are still not optimized. If you look at the ACC acute coronary syndrome guidelines, they emphasize that patients who’ve had an event and are not at goal should move to the next step, such as considering PCSK9 inhibitors. There’s still a lot of opportunity to continue lowering LDL [low-density lipoprotein] levels. We’re also expecting updates to the hyperlipidemia guidelines soon, and we’ll see where pharmacists can contribute. There’s excitement about a potential oral PCSK9 inhibitor coming, which may improve access. Glenn, your thoughts?
Key Takeaways for Pharmacists
- Pharmacists play a critical role in guiding statin therapy, identifying patients who are not at goal, and recommending add-on treatments such as PCSK9 inhibitors.
- Pharmacist-led hypertension programs consistently improve blood pressure control and are among the most effective team-based interventions.
- Leveraging electronic health record tools, protocols, and collaborative practice agreements ensures that guidelines are applied consistently across care settings.
Glenn Herrington, PharmD, FACC, FHFSA, BCCP, CPP, HFCert: Exactly. The first step is ensuring someone owns lipid management and that the patient knows their goals, whether that’s an LDL-C [LDL-cholesterol] less than 70 mg/dL or less than 55 mg/dL for high-risk patients. Many patients are not optimized—they may have started a statin and stopped it, or tried one or two high-intensity statins and been labeled statin intolerant. Pharmacists have strategies to navigate this and guide the next steps if LDL remains above goal, such as recommending add-on medications. Helping patients make informed decisions and ensuring they don’t independently stop therapy is critical.
Beavers: There will also be new agents coming out, including discussions around Lp(a) [lipoprotein a]. Stay tuned for updates in the guidelines.
Hanson: Despite decades of evidence, hypertension control rates remain stagnant. What pharmacist-led approaches have had the greatest impact?
Beavers: Pharmacist-led programs are among the most successful. Studies published in Circulation show that pharmacists—working alone or in team-based care—are the most effective in improving blood pressure control, even more than community health workers. The key is expanding pharmacist-led programs.
Herrington: I agree. Telehealth is increasingly helpful for more frequent patient touchpoints. We’re also seeing reimbursement opportunities for these services.
Hanson: How do pharmacists help ensure evidence-based recommendations are applied consistently across care settings?
Kristen Campbell, PharmD, BCPS, CPP, FACC: Optimizing the EHR [electronic health record] is key—using dot phrases and other tools ensures important steps aren’t missed.
Beavers: Protocols and collaborative practice agreements [CPAs] are also essential for standardizing care.