Joseph Saseen, PharmD, highlights how pharmacists can close treatment gaps in dyslipidemia by initiating appropriate statin intensity early, using combination therapy when needed, and proactively assessing adherence.
In an interview with Pharmacy Times, Joseph Saseen, PharmD, BCPS, BCACP, CLS, professor and associate dean for clinical affairs in the Department of Clinical Pharmacy at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences, discussed the critical role pharmacists play in optimizing statin therapy and improving long-term adherence to cholesterol-lowering regimens.
Saseen emphasized that many patients remain on suboptimal statin doses because initial prescribing decisions often persist indefinitely, despite evidence-based guideline recommendations for higher-intensity therapy in high- and very high-risk patients. He noted that although both gradual titration and initiating therapy at target intensity are acceptable approaches, limited health system resources and inconsistent follow-up often delay low-density lipoprotein cholesterol (LDL-C) goal attainment.
From a pharmacist perspective, Saseen advocated for initiating high-intensity statin therapy when clinically indicated rather than prolonging care with inadequate dosing. He explained that patients requiring a 50% or greater LDL-C reduction are unlikely to achieve that goal with moderate-intensity statins alone, and delays in optimization may increase cardiovascular risk. When tolerability concerns arise, pharmacists should be prepared to pivot strategies, including dose adjustments or combination therapy with nonstatin agents such as ezetimibe (Zetia; Merck & Co), to maintain therapeutic intensity.
Saseen also highlighted the importance of pharmacist-led shared decision-making, particularly when balancing efficacy, safety, and patient preferences. He encouraged pharmacists to adopt a more proactive approach to dyslipidemia management, similar to hypertension treatment models, where initiating combination therapy may be appropriate for select patients.
The worst thing we can do is identify a patient that needs a 50-plus percent reduction in LDL-C and give them a low- or moderate-intensity regimen. - Joe Saseen, PharmD, BCPS, BCACP, CLS
Regarding adherence, Saseen stressed that effective communication is foundational. Pharmacists must tailor education to patients’ health literacy levels and clearly explain the preventive nature of lipid-lowering therapy, particularly for asymptomatic conditions. He underscored the value of trustworthy educational resources and objective adherence assessments, including refill data and LDL-C response, to identify gaps in therapy engagement. Ultimately, Saseen positioned pharmacists as essential drivers of both appropriate statin intensification and sustained adherence in cardiovascular risk reduction.
