As a member of the multidisciplinary committee revamping dyslipidemia guidelines, pharmacist Joel Marrs saw his profession’s opportunity to help patients navigate a new era of long-term cardiovascular care.
“As pharmacists, we obviously brought our pharmacotherapy and pharmacology knowledge to the table,” said Marrs, who served with fellow ASHP member Joseph Saseen on the committee convened by the American College of Cardiology, the American Heart Association, and nine other medical organizations.
“But the big pieces were that pharmacists are part of team-based care and that we’re able to help educate patients,” Marrs said.
The updated guidelines call for earlier and more aggressive interventions to lower the lifetime — rather than 10-year — risk of cardiovascular disease. Key elements of that shift include the return of specific low-density lipoprotein cholesterol (LDL-C) targets, universal lipoprotein(a) testing, and the use of a new risk calculator, Predicting Risk of Cardiovascular Disease EVENTs (PREVENT).
These changes position pharmacists as key members of multidisciplinary care teams, according to Marrs, a cardiology ambulatory clinical pharmacist with the Cheyenne Regional Medical Group Heart and Vascular Institute, and other ASHP members who spoke with the ASHP News Center.
Often considered the most accessible healthcare providers, pharmacists can expect to serve as a critical source of patient information on the guidelines, which for many people could change how they manage their health.
Pharmacists can expect more involvement in interpreting expanded lipid panels, helping determine patient risk stratification, and intensifying therapies to meet LDL-C targets, said Patrick Gregory, assistant director of population health pharmacy services at Duke Pharmacy.
“Pharmacists now play a much earlier, more continuous, and more aggressive role in cardiovascular prevention,” said Gregory.
These expanded responsibilities span primary and secondary prevention, said Danielle Firkus, clinical cardiovascular pharmacist with the Mayo Clinic Health System in Eau Claire, Wisconsin. In secondary prevention, she explained, pharmacists are integral to sequencing and intensifying lipid-lowering therapy, including non-statin agents, to achieve and maintain LDL-C targets.
“Across both settings, the focus is on proactive, goal-directed lipid management to reduce lifetime cardiovascular risk,” said Firkus.
Where pharmacists add value
To implement the updated guidelines, pharmacies are embedding PREVENT calculators into electronic medical record workflows, adjusting algorithms to account for earlier interventions, and considering such initiatives as pharmacist-led lipid clinics, ASHP members said.
The guidelines don’t necessarily represent a major operational shift in all settings. Firkus, for instance, said the updates “largely reinforce and formalize strategies we were already incorporating into routine care” at her outpatient cardiac center.
For example, she said, her clinic routinely uses advanced lipid markers, including Lp(a). “This helps identify higher-risk patients earlier and supports more individualized decisions around therapy intensification,” she said.
Therapy intensification poses some challenging scenarios. Lauren Deal, manager of ambulatory care pharmacy at Community Health Network in Indianapolis, Indiana, noted that under the new guidelines, more patients are likely to receive combination therapies with non-statin drugs, if LDL-C goals are not met.
But, she said, those additional agents are often higher cost and come with more intensive prior authorization processes, “which may create workflow challenges for pharmacists and care team members.”
Clinical inertia has long been a challenge in intensifying lipid-lowering therapy when LDL-C targets are not met, said Firkus. That’s where pharmacist expertise comes in.
“This is where we add the most value,” said Firkus. “Identifying patients who are not at goal, supporting timely escalation, navigating prior authorization and access barriers, and helping patients understand why intensification is necessary based on cumulative ASCVD risk rather than a single lab value.”
Helping improve adherence and initiation
Sticking to long-term medication will also challenge many patients.
“Adherence is always a challenge with lifelong therapies,” said Sarah Spinler, a professor in Binghamton University School of Pharmacy and Pharmaceutical Sciences and a past recipient of the ASHP Foundation Literature Award for Sustained Contributions. “Even free statins have issues with adherence. Documenting intolerances to justify higher insurance tier medications is crucial.”
Pharmacists and other providers must also address a potential communication problem: Because the guidelines reflect lifetime, not just 10-year risk, many patients identified as high risk may feel fine.
Gregory said pharmacists will need to drive home a core concept: “It’s not just how high LDL is — it’s how long you’re exposed to it.”
Especially with younger patients, he said, the focus should remain on prevention, not disease. Pharmacists can frame it this way, he said: “Cholesterol works like plaque buildup over time. Starting earlier gives us a huge advantage.”
Spinler added that there are shared decision-making tools to help those conversations. “Using a risk score is becoming easier for patients, as they are used to answering questions or completing [an] online survey,” she said.
Pharmacists say the goals are realistic — with close monitoring and follow-up. The return of the LDL targets to the guidelines, last updated eight years ago, reflects recent research showing that lower is better for many patients.
Deal said the older guidelines may have meant some patients were undertreated due “to less aggressive non-statin add-on therapy.” Now pharmacists and other providers can help correct that.
Marrs called the guidelines an opportunity for pharmacists.
“Because patients see pharmacists frequently, it's an opportunity to help educate them that it’s not ‘Just go on this medication and you're good,’” he said. “We need to monitor things.
