High levels of low-density lipoprotein cholesterol (LDL-C) are associated with higher burden of atherosclerotic cardiovascular disease (CVD). Recent NICE recommendations provided more options for lipid-lowering therapies including bempedoic acid / ezetimibe and inclisiran. To improve lipid optimisation among patients with CVD, a pharmacy-led pilot was set up in two Primary Care Networks (PCNs) in collaboration with secondary care lipid experts to deliver a holistic lipid management pathway, address statin intolerance, and offer newer lipid lowering therapies (LLTs) in line with NICE recommendations.
Two PCN Senior Clinical Pharmacists offered the primary care service between May 2022 to April 2023. 238 patients with a history of CVD had an LDL-C ≥ 2.6 mmol/L or non-high-density lipoprotein cholesterol (non-HDL-C) ≥ 2.5 mmol/L were reviewed. We offered healthy lifestyle interventions and appropriate LLTs to reduce LDL-C to < 1.8 mmol/L. Patients were grouped according to CVD risk as follows: patients not on any LLT (Group 1); patients on ezetimibe only (Group 2); patients on high, medium, and low-intensity statins with ezetimibe (Group 3a, 4a and 5a respectively) and without ezetimibe (Group 3b, 4b and 5b respectively). The role of pharmacy technician in supporting with lipid reviews was developed. The PCNs collaborated with specialist cardiology pharmacists through bi-monthly virtual multidisciplinary team (MDT) sessions to manage more complex cases. Ethical approval was not required because this study would not be considered research by NHS using the HRA decision tool.
Pharmacy-led lipid optimisation in PCNs, supported by secondary care, was found to be a viable approach to better manage lipids among patients with CVD. The set up provided a conducive environment for peer support and upskilling PCN pharmacists for more complex cases of lipid optimisation. Of the 238 patients reviewed, 54 patients (23%) had LDL-C < 1.8mmol/L at the end of the project. 42 patients (18%) were re-challenged on a statin. 50 patients (21%) had LDL-reduction of at least 1mmol/L; and 1mmol/L LDL-C was associated with 25% relative reduction of risk of major vascular events (Silverman et al., 2016).
