Patients whose cholesterol is too high can reach a healthy cholesterol goal when they are tested, treated and followed up by their pharmacist, a new study shows.
The study was published in the September/October 2016 issue of the Canadian Pharmacists Journal. Patients who were assessed, given tests, prescribed their cholesterol-lowering drugs, and followed up by their pharmacist were three times more likely to reach their cholesterol goal than patients receiving usual care and a pamphlet.
High cholesterol is a common problem in Canada. The Canadian Health Measures survey, conducted from 2007 to 2009, found that roughly 36% of all Canadians — and 43% of those aged 40 to 59 — had unhealthy levels of LDL cholesterol, the unwanted or “bad” type of cholesterol that leads to cardiovascular disease such as heart attacks and strokes.
There are many reasons that so many Canadians have unhealthy levels of cholesterol, said authors Dr. Ross Tsuyuki and Dr. Glen Pearson, both pharmacists and professors of medicine at the University of Alberta. Patients may not have a primary care physician or may not go to see their physician regularly. Even if their physician has found high cholesterol levels and prescribed medication, patients may not take it as directed.
“This is a condition that doesn’t really have any symptoms,” said Tsuyuki. Patients may feel fine and may not understand why they should take drugs to prevent heart attacks and strokes that could be years away.
As well, patients may be concerned about side effects, said Tsuyuki. This may lead them to avoid taking cholesterol-lowering drugs. Patients may not follow up with their physicians, or physicians may be unaware the patients have stopped their drugs. Or the drug dosage may not be enough to bring cholesterol levels down to a healthy level. As a result, “patients have been treated, but are not at goal,” explained Pearson.
The study was conducted from January 2012 to mid-2014 in Alberta, the only province in Canada where certified pharmacists can prescribe any needed medications for the patients they see, to find whether pharmacists could help fill gaps in preventive treatment for high cholesterol. “As front-line primary care professionals, pharmacists see many patients at risk for cardiovascular disease, and often more frequently than physicians do,” said the authors.
Pharmacists discussed the patients’ health goals and beliefs with them, offered tests to patients with risk factors, and found many with cholesterol levels that put them at risk of cardiovascular disease. “The first step is identifying people who have high cholesterol,” said Pearson. “If you can’t identify them, it doesn’t matter what you try to do.”
Pharmacists prescribed cholesterol-lowering drugs or made changes to patients’ existing prescriptions. They found that many patients had high cholesterol levels despite taking medication for it. As well, they followed up every few weeks for six months, checking the patients’ cholesterol through blood tests, and explained why it is important to meet cholesterol targets and how changes in cholesterol will cut their risk. “The whole package is important,” emphasized Pearson. “The patient needs to understand the disease — the rationale for treatment, what the benefits are expected to be.”
The lower level of cholesterol achieved would be expected to reduce heart attacks, death due to coronary disease, and the need for bypass surgery or angioplasty by 13%, and to reduce stroke by 11%, compared to a control group that received usual care.