Community Pharmacists Decrease CVD Risk in Diabetics

The leading cause of death worldwide is preventable.

Cardiovascular disease (CVD) costs the United States $444 billion each year. Tobacco smoking, hypertension, dyslipidemia, diabetes, physical inactivity, high fat diet, and obesity increase CVD risk.

Only half of diabetic patients meet their HbA1C, cholesterol, or blood pressure goals, and only 13% meet all 3 goals. Past studies have shown that pharmacists favorably influence these goals individually, but no study has demonstrated their impact on aggregated goals.

Now, an article published ahead-of-print in the Journal of the American College of Cardiology indicates that community pharmacists can significantly reduce patient CVD risk and address all 3 goals well.

The RxEACH study was a randomized, controlled trial conducted in 56 community pharmacies.

The investigators enrolled adults at high risk for CVD. Patients had diabetes, chronic kidney disease (CKD), at least 1 uncontrolled risk factor, established atherosclerotic vascular disease, or Framingham risk scores >20%.

The researchers randomized patients to receive intervention—which consisted of a patient assessment, laboratory assessment of HbA1C, fasting cholesterol profile and estimated glomerular filtration rate, assessment of CVD risk, CVD education, prescription changes if warranted, and follow-up at least every 3 to 4 weeks for 3 months—and then compared them with those receiving usual care.

The patients in the pharmacist intervention group had a 21% decreased incidence of CVD events. This change reflected a 5.1% absolute risk reduction from 25.6% in the intervention group and a 0.7% absolute risk reduction from 26.6% in the usual care group.

Of note, 40% of the CVD patients were previously undiagnosed.

The investigators structured the study to use a short follow-up period because of concerns for patients in the usual care arm. Three months is barely enough time to manifest changes in cholesterol, blood pressure, and particularly HbA1C.

The RxEACH study shows that adding the 450,000 North American pharmacists to CVD care to complement physician’s efforts can decrease CVD risk strikingly.