From Prescription to Prevention: Pharmacists and ASCVD Prevention

Historically, there has been a discrepancy between individuals who are eligible for statin therapy and those who are being prescribed statins. In a study published by the Journal of Pharmacy Practice, a research team in New Mexico aimed to determine whether community pharmacists could perform atherosclerotic cardiovascular disease (ASCVD) risk assessments to identify patients eligible for statin therapy.

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The researchers sought 2 primary cohorts of patients not currently on statin therapy: those aged 40 to 79 with diabetes or individuals aged 50 to 70 with a history of hypertension or tobacco use. The study enrolled 57 participants in the ASCVD screenings, which consisted of a complete lipid panel, HbA1C screening, blood glucose monitoring, and blood pressure measurements.

Using the American College of Cardiology 10-year ASCVD risk assessment tool, 75% of patients were identified as statin eligible. On average, patients were willing to pay $50 out-of-pocket for the screening service and 84% of participants believed that ASCVD risk assessment was more convenient in a pharmacy than any other health setting. Furthermore, 77% of patients had confidence in the pharmacist’s ability to assess and prescribe statin therapy

The limitations of the study must be noted. Of 647 patients contacted, only 57 participated across 3 independent pharmacies in New Mexico. Having a small cohort could contribute to selection bias because those who chose to be in the study may have already had a favorable opinion on the pharmacist at baseline. Another limitation was that community pharmacies did not have access to all patient data needed to determine statin candidacy. For example, liver function tests and kidney function tests help pharmacists determine which statin is most appropriate. In the community pharmacy setting, access to labs and lab data is difficult, meaning all patients with borderline risk or greater had to be referred to their primary care provider for a final evaluation.

This study provided valuable information in relation to closing gaps in ASCVD care by expanding pharmacy’s scope. It also highlights the possibility of pharmacists expanding their responsibilities in the provision of other clinical services in community pharmacy practice. With this increase in clinical services provided by pharmacists, this study also advocates for the amendment of policy to give pharmacist prescriptive authority.

This study underscores insufficient prescription of statins for ASCVD risk, and the efficacy of pharmacist-led interventions. For implementation, the researchers propose using pharmacy students and interns to support these clinical services.

Reference

White A, Gonzalez LJ, Sarangarm P, et al. Community pharmacists' identification of gaps in care – statin utilization for primary prevention. J Pharm Pract. 2024. doi:10.1177/08971900241234567