5 ways to help patients manage cholesterol

In this article:

• What is considered high cholesterol?
• How to support patients with high cholesterol
• Bottom line

In this article

• What is considered high cholesterol?
• How to support patients with high cholesterol
• Bottom line

Cholesterol is a waxy, fat-like substance found in the body. It’s involved with important bodily functions, such as making hormones and helping digest foods. However, when there’s too much cholesterol in the body, it can build up in the bloodstream and form plaque. This is known as atherosclerosis, and it can increase the risk of cardiovascular problems, such as heart disease and stroke.

From 2017 to 2020, 10% of people aged 20 years and older had cholesterol levels greater than 240 mg/dL. As frontline healthcare providers, pharmacists have an invaluable opportunity to help patients manage their condition. Let’s explore the various ways pharmacists can help patients navigate high cholesterol.

What is considered high cholesterol?

There are two types of cholesterol: low-density lipoprotein (LDL), which is known as the “bad” cholesterol, and high-density lipoprotein (HDL), which is known as the “good” kind of cholesterol. According to the American Heart Association, there is no ideal target level for LDL-C, but lower is better. Most experts agree the optimal total cholesterol level is 150 mg/dL, while the optimal LDL-C level is less than 100 mg/dL. HDL levels are considered low when they are less than 40 mg/dL.

How to support patients with high cholesterol

High cholesterol—or dyslipidemia—is often managed with a team-based approach. There’s evidence that pharmacist interventions can significantly help patients improve their LDL-C, total cholesterol, and HDL-C levels. As a pharmacist, here’s how you can help patients with high cholesterol.

1. Promote medication adherence

A key issue in managing high cholesterol is adherence to medications. Non-adherence can lead to failure or difficulty reaching treatment goals, increased morbidity, mortality, and hospitalizations, waste of medications, changes to medication dosages, and an increase in healthcare costs.

Pharmacists have a vital opportunity to promote medication adherence to optimize health outcomes. One way to do so is through patient counseling. When patients come to the pharmacy to pick up their cholesterol medications, pharmacists can take a moment to encourage adherence and explain its importance in the patient’s overall treatment plan. You can explain how high cholesterol typically doesn’t cause symptoms. However, if it’s unmanaged, it can lead to high blood pressure, heart disease, stroke, and heart attack.

2. Recommend lifestyle changes

A number of lifestyle changes can help patients improve their cholesterol and lower their risk of cardiovascular problems. These include:

• Eating a heart-healthy diet. Pharmacists can encourage patients to eat foods that are low in saturated and trans fats, such as fruits and vegetables, whole-grain foods, fat-free, 1%, or low-fat milk products, lean meats, fatty fish, and unsalted nuts, seeds, and legumes. You may also discuss which foods patients should limit, such as high-sodium foods, sweets, red and fatty meats, full-fat dairy products, baked goods, and fried foods.
• Reaching and maintaining a healthy weight. Obesity is linked to higher triglyceride levels, higher LDL-C levels, and lower HDL-C levels. It can also lead to heart disease, high blood pressure, and diabetes. Pharmacists can help by determining a patient’s ideal weight and discussing strategies for weight loss.
• Being physically active. Exercise supports weight loss and helps reduce LDL cholesterol and increase HDL cholesterol. Pharmacists can encourage patients to exercise for at least 30 minutes five to seven times weekly. Aerobic exercise is best for cholesterol management, and examples include brisk walks, jogging, cycling, swimming, and yoga.
• Quitting smoking. It’s well-documented that tobacco has a very negative effect on your health. In those with high cholesterol, the nicotine in tobacco can decrease HDL-C levels and increase LDL-C levels. This can lead to a higher risk of atherosclerosis for smokers. Pharmacists can support their patients in quitting smoking by discussing different strategies to do so and providing resources that can help. If appropriate, pharmacists can also educate patients about various smoking cessation drugs.

Other lifestyle modifications that can potentially help with dyslipidemia include getting adequate sleep, having a pet, and meditating.

3. Evaluate cardiovascular risk

The American College of Cardiology (ACC) atherosclerotic cardiovascular disease (ASCVD) risk calculator is a tool that healthcare providers use to estimate a patient’s 10-year risk of developing heart disease or stroke. It’s also used to guide statin recommendations. Pharmacists can use this tool to determine an individual patient’s risk and evaluate whether a patient is on the appropriate therapy given their results.

4. Offer point-of-care cholesterol testing

According to the National Heart, Lung, and Blood Institute, patients should have cholesterol screenings starting between ages 9 and 11 and repeated every five years. For older adults, screenings are recommended every 1 to 2 years, depending on the patient’s age. Offering cholesterol point-of-care tests (POCTs) assists with patient outcomes by providing a convenient screening option and referring patients for further evaluation.

5. Recommend ways to lower medication costs

High cholesterol is a medical condition that requires long-term treatment. Treatment expenses can easily add up, and in many cases, they can be a barrier to medication adherence. As a pharmacist, you can help patients lower the cost of their prescription by recommending drug coupons, patient assistance programs, and manufacturer discounts. You can also discuss less expensive alternatives.

Bottom line

High cholesterol is usually managed with a team-based approach, and pharmacist intervention has been shown to improve LDL-C, HDL-C, and total cholesterol levels. Pharmacists can support patients with high cholesterol by promoting medication adherence, recommending effective lifestyle changes, evaluating cardiovascular risk, offering point-of-care cholesterol testing, and recommending ways to lower medication costs.