Sarah Nelson, PharmD, highlights how pharmacists are uniquely positioned to prevent heart disease by identifying cardiovascular risk early, improving medication adherence, and addressing lifestyle and social factors.
In an interview with Pharmacy Times, Sarah Nelson, PharmD, clinical pharmacy specialist at UPMC Health Plan, highlights the critical role pharmacists play in cardiovascular disease prevention during American Heart Month. She emphasizes that heart disease remains the leading cause of death in the United States but is largely preventable through lifestyle modification, medication adherence, and early risk identification. Nelson explains how pharmacists can proactively assess uncontrolled hypertension, diabetes, dyslipidemia, and other overlooked risk factors, including social determinants of health and medication overuse. She also discusses the importance of simplifying medication regimens, using risk assessment tools, and collaborating with providers and payers to close care gaps.
Pharmacy Times: American Heart Month is a time to spotlight cardiovascular health. From your perspective, what are the most important messages pharmacists should be sharing with patients right now?
Sarah Nelson, PharmD: Heart disease remains the leading cause of death in the United States and is largely preventable with consistent lifestyle changes. Pharmacists are ideally positioned to interact with patients on a frequent basis, and some of the important counseling pharmacists can provide regarding cardiovascular health focuses on lifestyle modifications. This includes emphasizing healthy eating with fruits, vegetables, and lean protein; sodium reduction; physical activity; smoking cessation; adequate sleep; and stress management; and then connecting patients to available resources to help them achieve those goals.
As pharmacists, we should be assessing medication adherence and working with patients to address any barriers that may contribute to [nonadherence]. We spend a lot of time counseling patients to ensure they understand why they are taking their medications, any potential side effects they could encounter, and what to do when they have questions or concerns. Lastly, educating patients on the signs and symptoms of heart disease is critical, including recognizing differences in presentation between men and women and understanding when they need to seek care.
Pharmacy Times: What cardiovascular risk factors do you see most commonly among patients in a health plan setting, and which ones are most often overlooked?
Nelson: The cardiovascular risk factors I commonly see among patients in the health plan setting are similar to those seen in other health care settings, such as hypertension, hyperlipidemia, diabetes, obesity, and smoking. Some risk factors that may be overlooked include social determinants of health, which is an area we are putting a lot of attention on at the health plan when speaking with patients.
There are also underrecognized populations, including women, adults with mental health disorders, and younger patients, where we are seeing rising rates of diabetes and hypertension. Outside factors such as environmental exposures or behavioral risk factors, including sedentary lifestyle and alcohol use, are also important contributors. Additionally, uncontrolled primary risk factors, such as uncontrolled hypertension or diabetes where patients are not meeting their targets, play a significant role. Lastly, overuse of over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants, as well as frequent use of nitroglycerin or albuterol, can also impact overall cardiovascular health.
Pharmacy Times: How can pharmacists proactively identify patients at high risk for heart disease and intervene before serious events occur?
Nelson: Pharmacists can proactively identify patients at high risk for heart disease by reviewing patient data for uncontrolled hypertension, such as repeated blood pressure readings over 130/80 mm Hg, uncontrolled diabetes, uncontrolled cholesterol, increasing weight, or chronic kidney disease. One tool pharmacists can use is the PREVENT risk calculator, which was recently incorporated into the 2025 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guidelines to help assess cardiovascular risk.
Pharmacists can also review medication profiles to identify gaps in therapy or monitoring, such as patients on multiple antihypertensive medications who remain uncontrolled or patients with diabetes who have not had hemoglobin A1C monitored regularly. Opportunities to collaborate with providers to optimize medication therapy, including recommending or adjusting evidence-based treatments, are important. Patient education is also key, helping individuals create actionable steps to achieve their goals and continuing to follow up on progress. Strategies such as medication synchronization, adherence packaging, ongoing lifestyle counseling, and home blood pressure monitoring can further support patient engagement.
Pharmacy Times: With so many options for cholesterol and blood pressure management, how can pharmacists help simplify treatment plans and improve patient understanding?
Nelson: Pharmacists are very effective at creating personalized plans, and incorporating shared decision-making can help provide patients with tailored medication regimens. Taking the time to explain the purpose of each medication, expected outcomes, and potential side effects helps improve patient understanding. Providing written materials, such as complete medication lists, after-visit summaries, checklists, and clear next steps, can also improve adherence.
Collaboration with providers is essential to reduce regimen complexity by transitioning from twice-daily to once-daily medications when appropriate, considering pill burden, utilizing combination products, and de-escalating therapy when clinically appropriate.
Pharmacy Times: How can community and ambulatory care pharmacists better partner with payers and providers to close care gaps in heart disease prevention?
Nelson: There are several ways health care providers can work together to close care gaps, including participating in value-based models focused on high-quality patient engagement across physician offices, ambulatory and community pharmacies, and health plans. Pharmacists frequently interact with patients and can identify and flag gaps, such as uncontrolled readings, nonadherence trends, or medication optimization opportunities, and communicate these findings directly to providers.
Pharmacists can support medication titration, including hypertension management, statin optimization, and adherence interventions through chronic disease state management protocols. Proactively identifying high-risk patients with medication access issues, social barriers, or fragmented care is critical. Pharmacists can also provide preventive services, such as point-of-care testing, blood pressure monitoring and device validation, adherence interventions, and ongoing lifestyle counseling.
Pharmacy Times: Is there anything else that you would like to add?
Nelson: Cardiovascular prevention is shifting toward multisystem risk management that incorporates kidney function, metabolic factors, and social determinants of health, rather than focusing solely on blood pressure and lipid management. Pharmacists have the ability to take a holistic view of patient health across multiple comorbidities and can make heart disease prevention more proactive, more equitable, and more effective.
