Pharmacists Improve Lipid Control in Underserved Settings

New data presented at the American Heart Association (AHA) 2025 Scientific Sessions highlight the importance of pharmacists in helping patients reach their low-density lipoprotein cholesterol (LDL-C) goals across a variety of clinical settings. The data were presented on November 10, 2025, in New Orleans, Louisiana.^1,2

Virtual Interventions Improve Secondary Prevention

Secondary prevention for atherosclerotic cardiovascular disease (ASCVD) is crucial, with lipid control playing a major role. Guidelines recommend high-intensity statin therapy as a first-line treatment for ASCVD, and for patients at very high risk, providers should recommend adding a nonstatin therapy, such as ezetimibe (Zetia; Merck), or a PCSK9 inhibitor. Ensuring that a patient’s lipid levels remain controlled following a cardiovascular event is crucial to preventing further adverse outcomes.³

For patients at high risk of ASCVD and subsequent major adverse cardiac events (MACEs), guidelines recommend an LDL-C goal of less than 55 mg/dL. It is critical for patients undergoing high-intensity lipid-lowering therapy (LLT) to be monitored and followed up with on a consistent basis. Through this monitoring, opportunities for LLT escalation can be identified, which could further lower LDL-C and reduce the risk of MACEs.¹

How Did a Virtual, Pharmacist-Led Clinic Improve Lipid Control?

The current authors initiated a multidisciplinary virtual care protocol for the escalation of LLTs in an outpatient setting. Patients 18 years and older at an urban hospital who underwent a left heart catheterization (LHC) for acute coronary syndrome (ACS) were referred to the virtual clinic at discharge. Patients completed virtual check-ins at 6, 12, 24, and 36 weeks following their discharge; these visits featured pharmacist who specializes in cardiology, who evaluated medication adherence and determined whether LLT should be escalated.¹

If high-intensity statin therapy had to be escalated, ezetimibe, a PCSK9 inhibitor, and bempedoic acid were prescribed as appropriate until the patient reached their LDL-C goal.¹

A total of 196 patients underwent LHC for ACS between June 2024 and April 2025; 68 patients were excluded from the data set. Among the remaining patients, 50 (39%) met their LDL-C goal and were discharged from the clinic. Nineteen of these patients (88%) achieved their goal with high-intensity statins with ezetimibe; only 5 necessitated adjunct evolocumab (Repatha; Amgen), and 1 required bempedoic acid.¹

As of the data presentation at the AHA 2025 Scientific Sessions, 38 patients remained enrolled in the protocol. The success of the clinic highlights the important role of adherence education in delivering optimal secondary prevention for patients at high risk of ASCVD. Pharmacists can enhance this process, allowing for tailored discussions with patients regarding the addition of other LLTs to better reach their lipid goals.¹

“Our experience supports using [registered nurses, pharmacists], and titration protocols to provide high-quality care for underserved populations,” the authors wrote in their discussion.¹

Pharmacists Can Heighten Adherence to Cholesterol Medications

The risk of ASCVD progression when harboring uncontrolled lipid levels has been established. Research has affirmed that nonoptimal lipid levels can significantly heighten the risk of coronary artery calcification, a contributor to adverse cardiovascular outcomes. In patients with evidence of coronary atherosclerosis, LDL-C is almost exclusively associated with ASCVD events.^4,5

These risks are especially prevalent in underserved populations, such as those in the Veterans Affairs (VA) system. Data show that more than 65% of veterans with ASCVD are poorly managed due to a series of factors, including patient preferences, clinical inertia, and outdated therapy prescriptions. In this vein, health care providers and pharmacists can work together to improve the quality of LLT optimization.²

Can Pharmacists Optimize Veterans' Lipid Care?

The VA Lipid Optimization Reimagined Quality Improvement (VALOR-QI) program is a collaborative project between the US Department of Veterans Affairs and AHA, which seeks to positively impact the cardiovascular health of veterans. Within the program, individual VA sites work with an AHA quality improvement consultant to implement quality improvement plans to address barriers that can prevent optimal lipid care for veterans.²

The current investigation was centered on the VA Caribbean Healthcare System, which is 1 of 50 sites participating in VALOR-QI. At this center, researchers implemented a comprehensive care model focused on guideline-directed LLT, featuring both high-intensity statins and combination treatment for veterans 18 years and older with ASCVD and high levels of LDL-C or non–high-density lipoprotein cholesterol.²

Veterans who were identified as nonadherent to LLT were referred to a cardiology pharmacist for support, including targeted education, adherence counseling, refill assistance, and follow-up testing 12 weeks following therapeutic optimization. Highlighting the multidisciplinary approach of the system, a health care coach was also featured, helping to coordinate medication refills, clinical reminders, appointments, and consistent patient engagement.²

A total of 322 veterans were stratified by pharmacist involvement. Those followed by the pharmacist (n = 185) had a mean baseline LDL-C of 114 mg/dL compared with 101 mg/dL in those not followed (n = 137) by the pharmacist. Eighty-five percent of veterans followed by the pharmacist reached target LDL-C levels compared with 68% among those not followed (P < .001). Furthermore, veterans followed by the pharmacist were 71% adherent with their LLT compared with 54% of those who were not followed (P < .0001).²

Takeaways for Pharmacists

Across each setting, pharmacists were proven as critical partners in multidisciplinary clinical care for lipid-lowering optimization. Pharmacists can be essential health care providers in these settings, especially in underserved communities. Their expertise allows for myriad areas of contribution, especially in helping patients maintain their lipid goals, improving adherence in the long term, and reducing the overall burden of ASCVD.^1,2

Health care systems should work to support the integration of pharmacists into chronic disease management programs.^1,2

REFERENCES

1. Della-Penna P, Hernandez L, Clark L, et al. Optimizing secondary prevention lipid management in a safety net health system using a pharmacist-driven virtual lipid clinic. Presented at: American Heart Association 2025 Scientific Sessions; November 7-10, 2025; New Orleans, LA.

2. Alcocer L, Vazquez-Fuster J, Crowley J, et al. Pharmacist interventions boosts compliance and cholesterol medications adherence. Presented at: American Heart Association 2025 Scientific Sessions; November 7-10, 2025; New Orleans, LA.

3. Virani SS, Smith SC, Stone NJ, Grundy SM. Secondary prevention for atherosclerotic cardiovascular disease: comparing recent US and European guidelines on dyslipidemia. Circulation. 2020;141(14):1121-1123. doi:10.1161/CIRCULATIONAHA.119.044282

4. Lee H, Ahn H, Park HE, et al. The effect of non-optimal lipids on the progression of coronary artery calcification in statin-naïve young adults: results from KOICA registry. Front Cardiovasc Med. 2023;10:1173289. doi:10.3389/fcvm.2023.1173289

5. Mortensen MB, Dzaye O, Bøtker HE, et al. Low-density lipoprotein cholesterol is predominantly associated with atherosclerotic cardiovascular disease events in patients with evidence of coronary atherosclerosis: the Western Denmark Heart Registry. Circulation. 2023;147(14):1053-1063. doi:10.1161/CIRCULATIONAHA.122.061010