2007 guidelines for the management of dyslipidemia and prevention of cardiovascular disease by pharmacists

Abstract

Introduction Despite the observation that age-specific mortality rates from coronary heart disease (CAD) have declined by nearly 40% in Canada over the past several decades, this disease continues to be the leading cause of death and morbidity for Canadians. Hyperlipidemia (especially an elevated low-density lipoprotein cholesterol [LDL-C] level and/or elevated total cholesterol to high-density lipoprotein cholesterol [TC:HDL-C] ratio) is recognized as a major independent risk factor for CAD. Recently, the large international case-controlled INTERHEART study demonstrated that an abnormal lipid profile was the most important modifiable risk factor associated with myocardial infarction. Consequently, national guidelines have been promulgated and regularly updated on the basis of accumulating clinical trial evidence to assist health care practitioners with diagnosis and treatment of patients with dyslipidemia. In Canada, these guidelines were updated and published in September 2006. Given advancements in pharmacy practice and current expectation that pharmacists take a more active role in and responsibility for medication management and patient health outcomes, pharmacists should be taking steps to identify and collaboratively manage patients with dyslipidemia. To emphasize where the knowledge and skills of pharmacists should be applied in the management of patients with dyslipidemia, the 2006 Canadian Cardiovascular Society [CCS] position statement (Recommendations for the Diagnosis and Treatment of Dyslipidemia and Prevention of Cardiovascular Disease) has been adapted and expanded. These Canadian pharmacist practice guidelines are a part of the continuing national effort to recognize and advance “the responsible and patient-centred role of the pharmacist” in chronic disease management. As key players in the health care system, pharmacists should use their knowledge, skills, and relationship with patients to improve the management of dyslipidemia and prevent cardiovascular disease. Consequently, these guidelines emphasize the role of the pharmacist in all aspects of managing the disease: • Identification and screening of patients • Individual cardiovascular (CV) risk assessment • Establishing appropriate lipid targets, based on CV risk • Lifestyle modification • Recommending and monitoring appropriate drug treatment • Ensuring patient adherence with treatment • Specialty clinic referral Readers interested in more detail or background on any of the above should refer to the full recommendations.