Skip to main content
Log in

Clinical Outcomes Associated with Pharmacist Involvement in Patients with Dyslipidemia

A Review

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

The burden of cardiovascular disease in America continues to be the leading cause of death and costs significantly more to treat ($US298.2 billion in 2002) than any other disease in the US healthcare system. Incontrovertible evidence links elevated levels of total and low-density lipoprotein-cholesterol and reduced levels of high-density lipoprotein-cholesterol with an increased risk for coronary heart disease. The subsequent treatment of hyperlipidemia has been shown to dramatically decrease morbidity and mortality related to cardiovascular disease. Research continues to show that many candidates for lipid-lowering therapy are not offered therapy and many never attain recommended National Cholesterol Education Program (NCEP) guideline goals. Increased pharmacist involvement in the treatment of patients with hyperlipidemia may represent one way to help bridge the treatment gap that exists in these high-risk patients. Limited evidence has shown that lipid values, NCEP goal attainment, and medication compliance improve when a pharmacist contributes to patient care in dyslipidemia. However, larger randomized controlled studies need to be performed to confirm the results of previous smaller retrospective trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I

Similar content being viewed by others

References

  1. American Heart Association. 2002 Heart and Stroke Statistical Update. Dallas (TX): American Heart Association, 2002. Available from URL: http://ww-w.americanheart.org [Accessed 2003 Jun 11]

  2. Castelli WP, Garrison RJ, Wilson PW, et al. Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham study. JAMA 1986; 256(20): 2835–8

    Article  PubMed  CAS  Google Scholar 

  3. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990; 323: 1289–98

    Article  PubMed  CAS  Google Scholar 

  4. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990; 336: 129–33

    Article  PubMed  CAS  Google Scholar 

  5. Buchwald H, Varco RL, Matts JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia: report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 1990; 323: 946–55

    Article  PubMed  CAS  Google Scholar 

  6. Teo KK, Burton JR, Buller CE, et al. Long-term effects of cholesterol lowering and angiotensin-converting enzyme inhibition on coronary atherosclerosis: the Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT). Circulation 2000; 102: 1748–54

    Article  PubMed  CAS  Google Scholar 

  7. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas coronary Atherosclerosis Prevention Study. JAMA 1998; 279(20): 1615–22

    Article  PubMed  CAS  Google Scholar 

  8. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia: West of Scotland Coronary Prevention Study Group. N Engl J Med 1995; 333(20): 1301–7

    Article  PubMed  CAS  Google Scholar 

  9. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360(9326): 7–22

    Article  Google Scholar 

  10. Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-thanaverage cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003; 361: 1149–58

    Article  PubMed  CAS  Google Scholar 

  11. Athyros VG, Papageorgiou AA, Mercouris BR, et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study. Curr Med Res Opin 2002; 18(4): 220–8

    Article  PubMed  Google Scholar 

  12. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels: the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med 1998; 339 (19): 1349-57

  13. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events trial investigators. N Engl J Med 1996; 335(14): 1001–9

    Article  PubMed  CAS  Google Scholar 

  14. Pederson TR, Olsson AG, Faergeman O, et al. Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S). Circulation 1998; 97(15): 1453–60

    Article  Google Scholar 

  15. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol: Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341(6): 410–8

    Article  PubMed  CAS  Google Scholar 

  16. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education (NCEP) Education Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). JAMA 2001; 285: 2486–97

    Article  Google Scholar 

  17. Abookire SA, Karson AS, Fisko J, et al. Use and monitoring of “statin” lipid lowering drugs compared with guidelines. Arch Intern Med 2001; 161: 53–8

    Article  PubMed  CAS  Google Scholar 

  18. Sueta CA, Mridul C, Boccuzzi SJ, et al. Analysis of the degree of undertreatment of hyperlipidemia and congestive heart failure secondary to coronary artery disease. Am J Cardiol 1999; 83: 1303–7

    Article  PubMed  CAS  Google Scholar 

  19. Pearson TA, Laurora I, Chu A, et al. The Lipid Treatment Assessment Project (LTAP). A multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000; 160: 459–67

    Article  PubMed  CAS  Google Scholar 

  20. Fedder DO, Koro MS, L’Italien GJ. New National Cholesterol Education Program III guidelines for primary prevention lipid-lowering drug therapy: projected impact on the size, sex, and age distribution of the treatment-eligible population. Circulation 2002; 105: 152–6

    Article  PubMed  Google Scholar 

  21. Simons LA, Levis G, Simons J. Apparent discontinuation rates in patients prescribed lipid-lowering drugs. Med J Aust 1996; 164: 208–11

    PubMed  CAS  Google Scholar 

  22. Kiortsis DN, Giral P, Bruckert E, et al. Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients. J Clin Pharm Ther 2000; 25(6): 445–51

    Article  PubMed  CAS  Google Scholar 

  23. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462–7

    Article  PubMed  Google Scholar 

  24. Jacobson TA, Griffiths GG, Varas C, et al. Impact of evidence-based “clinicaljudgment” on the number of American adults requiring lipid-lowering therapy based on updated NHANES III data. National Health and Nutrition Examination Survey. Arch Intern Med 2000; 160(9): 1361–9

    Article  PubMed  CAS  Google Scholar 

  25. Madejski RM, Madejski TJ. Cholesterol screening in a community pharmacy. J Am Pharm Assoc 1996 Apr; NS36(4): 243–8

    CAS  Google Scholar 

  26. Jungnickel PW, Wisehart DA. Evaluation of community pharmacists’ experiences with cholesterol screening programs. J Am Pharm Assoc 1997 Nov/Dec; NS37(6): 640–6

    CAS  Google Scholar 

  27. Munroe WP, Kunz K, Dalmady-Israel C, et al. Economic evaluation of pharmacist involvement in disease management in a community pharmacy setting. Clin Ther 1997; 19(1): 113–23

    Article  PubMed  CAS  Google Scholar 

  28. Smith DH, Fassett WE, Christensen DB. Washington State CARE project: downstream cost changes associated with the provision of cognitive services by pharmacists. J Am Pharm Assoc 1999; 39: 650–7

    CAS  Google Scholar 

  29. Cranor CW, Bunting BA, Christensen CB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc 2003; 43(2): 173–84

    Article  Google Scholar 

  30. Nau DP, Ponte CD. Effects of a community pharmacist-based diabetes patientmanagement program on intermediate clinical outcome measures. J Manage Care Pharm 2002; 8(1): 48–53

    Google Scholar 

  31. Shibley MCH, Pugh CB. Implementation of pharmaceutical care services for patients with hyperlipidemias by independent community pharmacy practitioners. Ann Pharmacother 1997 Jun; 31: 713–9

    PubMed  CAS  Google Scholar 

  32. Nola KM, Gourley DR, Portner TS, et al. Clinical and humanistic outcomes of a lipid management program in the community pharmacy setting. J Am Pharm Assoc 2000 Mar/Apr; 40(2): 167–73

    Google Scholar 

  33. Jafari M, Masih M, Emerson JF. The value of pharmacist involvement in a point-of-care service, walk-in lipid screening program. Pharmacotherapy 2001; 21(11): 1403–6

    Article  Google Scholar 

  34. Bluml BM, McKenney JM, Cziraky MJ. Pharmaceutical care services and results in project IMPACT: hyperlipidemia. J Am Pharm Assoc 2000 Mar/Apr; 40(2): 157–65

    CAS  Google Scholar 

  35. Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management. The study of cardiovascular risk intervention by pharmacists (SCRIP). Arch Intern Med 2002 May; 162: 1149–55

    Article  PubMed  Google Scholar 

  36. Simpson SH, Johnson JA, Tsuyuki RT. Economic impact of community pharmacist intervention in cholesterol risk management: an evaluation of the study of cardiovascular risk intervention by pharmacists. Pharmacotherapy 2001; 21(5): 627–35

    Article  PubMed  CAS  Google Scholar 

  37. Konzem SL, Gray DR, Kashyap ML. Effect of pharmaceutical care on optimum colestipol treatment in elderly hypercholesterolemic veterans. Pharmacotherapy 1997; 17(3): 576–83

    PubMed  CAS  Google Scholar 

  38. O’Donnell DC, Chen NTW, Piziak VK. Goal attainment and maintenance of serum cholesterol level in a pharmacist-coordinated lipid clinic. Am J Health Syst Pharm 2001 Feb 15; 58: 325–30

    PubMed  Google Scholar 

  39. Carson JJ. Pharmacist-coordinated program to improve use of pharmacotherapies for reducing risk of coronary artery disease in low-income adults. Am J Health Syst Pharm 1999 Nov 15; 56: 2319–24

    PubMed  CAS  Google Scholar 

  40. Dunham DM, Stewart RD, Laucka PV. Low-density-lipoprotein cholesterol in patients treated by a lipid clinic versus a primary care clinic [letter]. Am J Health Syst Pharm 2000 Dec 15; 57: 2285–6

    PubMed  CAS  Google Scholar 

  41. Till LT, Voris JC, Horst JB. Assessment of clinical pharmacist management of lipid-lowering therapy in a primary care setting. J Managed Care Pharm 2003 May/Jun; 9(3): 269–73

    Google Scholar 

  42. Geber J, Parra D, Beckey NP, et al. Optimizing drug therapy in patients with cardiovascular disease: the impact of pharmacist-managed pharmacotherapy clinics in a primary care setting. Pharmacotherapy 2002; 22(6): 738–47

    Article  PubMed  Google Scholar 

  43. Cording MA, Engelbrecht-Zadvorny EB, Pettit BJ, et al. Development of a pharmacist-managed lipid clinic. Ann Pharmacother 2002 May; 36: 892–904

    Article  PubMed  Google Scholar 

  44. Bozovich M, Rubino CM, Edmunds J. Effect of a clinical pharmacist-managed lipid clinic on achieving national cholesterol education program low-density lipoprotein goals. Pharmacotherapy 2000; 20(11): 1375–83

    Article  PubMed  CAS  Google Scholar 

  45. Ellis SL, Carter BL, Malone DC, et al. Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Pharmacotherapy 2000; 20(12): 1508–16

    Article  PubMed  CAS  Google Scholar 

  46. Fonarow GC, Gawlinski A, Moughrabi S, et al. Improved treatment of coronary heart disease by implementation of a cardiac hospitalization atherosclerosis management program (CHAMP). Am J Cardiol 2001; 87: 819–22

    Article  PubMed  CAS  Google Scholar 

  47. Lacy CR, Suh DC, Barone JA, et al. Impact of a targeted intervention on lipidlowering therapy in patients with coronary artery disease in the hospital setting. Arch Intern Med 2002; 162: 468–73

    Article  PubMed  Google Scholar 

  48. Hilleman DE, Monaghan MS, Ashby CL, et al. Physician-prompting statin therapy intervention improves outcomes in patients with coronary heart disease. Pharmacotherapy 2001; 21(11): 1415–21

    Article  PubMed  CAS  Google Scholar 

  49. Hitchcock AM, Lousberg TF, Merenich J. The impact of clinical pharmacy management on cardiovascular risk reduction in patients with established heart disease in a group model health maintenance organization [abstract 135]. ACCP Spring Practice and Research Forum: Pharmacotherapy 2000; 20(3): 360–1

    Google Scholar 

  50. Ito MK. Role of the pharmacist in establishing lipid intervention programs. Pharmacotherapy 2003; 23(9 Pt 2): 41S–7S

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L. Brian Cross.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cross, L.B., Franks, A.S. Clinical Outcomes Associated with Pharmacist Involvement in Patients with Dyslipidemia. Dis-Manage-Health-Outcomes 13, 31–42 (2005). https://doi.org/10.2165/00115677-200513010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200513010-00004

Keywords

Navigation