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Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic

Lookup NU author(s): Emerita Professor Julia Newton, Professor Gerard Stansby



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2024Patients attending vascular or diabetic foot clinics commonly have atherosclerotic disease, are at increased risk of cardiovascular disease (CVD), merit high-intensity lipid-modifying therapy to maintain secondary prevention targets and are often sub optimally treated in primary care. We set out to assess the impact of a pharmacist led lipid optimisation clinic in these patients in an area with high levels of social deprivation. METHODS: We performed a clinical cohort study to assess the effectiveness of a pharmacist led clinic to optimise lipid lowering therapy by optimising of statin therapy and commencing additional lipid lowering therapy if applicable with monitoring of blood lipid profiles. Results: Of the 216 patients (166 (77%) on statins) triaged by the pharmacist, 175 (81%) had non-HDL cholesterol levels above the target value of 97 mg/dL (2.5 mmol/L) with a mean non-HDL cholesterol level of 135.73 mg/dL (3.51 mmol/L). Pre optimisation by the prescribing clinical pharmacist 41/216 (19%) patients were at target with a mean non-HDL cholesterol of 135.5 mg/dL improving to 92/137 (67%) patients achieving the target non-HDL cholesterol level with a mean post optimisation non-HDL cholesterol of 94.35 mg/dL (2.44 mmol/L), odds ratio for being at target 8.67 [95% CI 5.30–14.20]. The calculated LDL cholesterol levels (Friedewald) demonstrated a mean reduction of 35.19 [95% CI 29.23–41.38] mg/dL (0.91 [95% CI 0.76–1.07] mmol/l). Proportion on high intensity statin increased from 65 out of 166 (39%) to 129 of 170 (76%) at follow up O.R. 4.89 [3.06–7.82], equivalent to an NNT = 3. CONCLUSIONS: A pharmacist led service in undertreated and clinically challenging vascular and diabetic foot patients in an area of high social deprivation produced significant improvements in utilization of high intensity statin and other lipid lowering therapies and attainment of lipid goals.

Publication metadata

Author(s): Hart M, Rees J, Newton JL, Stansby G, Mackay K, Luvai A

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Lipidology

Year: 2024

Issue: ePub ahead of Print

Online publication date: 29/03/2024

Acceptance date: 26/03/2024

Date deposited: 17/06/2024

ISSN (print): 1933-2874

ISSN (electronic): 1876-4789

Publisher: Elsevier Ltd


DOI: 10.1016/j.jacl.2024.03.008


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Funder referenceFunder name
Heath Innovation North East and North Cumbria (HI NENC)