The Right Prescription for Lowering Cholesterol

April D. Abdoo, PharmD Candidate 2007
Shenandoah University
Prepared during Consumer Health Information Corporation Clerkship

McLean VA

This year about 1.2 million Americans will have a heart attack. ¹ Each year about 700,000 people have a stroke.¹ As a result, everyone is looking for a miracle cure. There are many prescription drugs that help to lower the risk by lowering cholesterol. However, the right prescription for lowering cholesterol requires more than a drug. This prescription involves a change in lifestyle. Pharmacies are exploring new roles and offering patients more than medication. Pharmacies are starting to offer specialized services including cholesterol screening. ²

Cholesterol screening is very important as more patients suffer from heart attack and stroke. In many people, excess cholesterol builds up inside the walls of the arteries, narrowing them and making it more difficult for blood to pass through. This narrowing of the blood vessels can lead to circulation problems as well as heart attack and stroke. The danger in having high cholesterol is that there are no symptoms.³

Do you know your cholesterol levels?
Pharmacists are helping patients by offering cholesterol screening at the pharmacy. Here are some things that a person can do:

• Be aware of high blood cholesterol to start reducing the risks for heart attack or stroke.
  It has been estimated that only 50% of the general population have had their cholesterol level checked, 29% reported having been told their results, and only 13% remembered their results.⁴
• Keep track of your cholesterol
  The National Cholesterol Education Program states that the first step in risk management is that all adults aged 20 years or older should have a fasting lipid profile done once every 5 years. ⁵ At the end of this article there is a chart to help you keep track of your cholesterol numbers for 1 year if you test as often as every 3 months.
• Ask your pharmacist if they have the lab test to test your complete lipid profile.
  Many pharmacies use the Cholestech LDX test. Cholestech LDX measures the amount of cholesterol in the blood. Before using Cholestech LDX, pharmacists ask patients not to eat any food for at least 12 hours to avoid causing inaccurate results. A simple blood sample can be obtained by pricking the finger, and results are available within minutes. ⁶ The machine prints out the lab test results for all components of a lipid profile.

Why do I need a complete lipid profile test?
A complete lipid profile lets the patient know more than total cholesterol. Total cholesterol is further separated into three categories:

• Low-density lipoprotein (LDL or "bad cholesterol")
• High-density lipoprotein (HDL or "good cholesterol")
• Triglycerides

It is very important to know these numbers in addition to total cholesterol. Total cholesterol and triglycerides are linked to increased risk for heart disease. ⁷ HDL or "good cholesterol" helps to regulate LDL, "bad cholesterol, and will reduce the risk for heart disease. ⁷ The National Cholesterol Education program now recommends significant lowering of LDL cholesterol to decrease the risk for heart disease. ⁵ Recent clinical trials show that lowering LDL cholesterol alone reduces the need for certain hospital procedures, major events like stroke, and death in people who have heart disease. ⁵ One type of drug works by lowering LDL cholesterol. These drugs are known as "statins". The statins include:

• Lipitor® (atorvastatin)
• Zocor® (simvastatin)
• Pravachol® (pravastatin)
• Crestor® (rosuvastatin)
• Mevacor® (lovastatin)
• Lescol® (fluvastatin)

If you are taking a statin, it is important to continue monitoring your lipid profile at least every 4 to 6 months even when your LDL cholesterol becomes under control.⁵ In the United States it is estimated that half of patients who are prescribed statins stop taking the drug after six months.⁸ Testing on a regular basis will help patients know their numbers and be more likely to take medications.⁹ Some patients who come into the pharmacy for cholesterol screening may already be taking one of these medications. These patients have the advantage of asking their pharmacist more specific questions. Cholesterol screening by a pharmacist gives all patients immediate contact with a healthcare professional¹⁰

What should I tell my doctor?
Cholesterol tests at the pharmacy are not meant to replace laboratory tests from your primary care doctor. They allow patients the ability to participate in their own healthcare management. Patients should also discuss these results with their doctor as testing may not be done as often in the doctor's office. For patients who do not have high cholesterol, this type of screening can be helpful in alerting them before having to take prescription medication. Making certain lifestyle changes can lower cholesterol. Pharmacists are also available to counsel patients on adjustments that can be made regarding diet and exercise to improve cholesterol.

Remember that your pharmacist can work with you to help decrease the risks associated with heart attack and stroke. Not all pharmacies offer specialized services. When you pick up your next prescription, take the opportunity to ask your local pharmacist if they offer any specialized services. Let your pharmacist help you write your own prescription for a healthier lifestyle in 2007.

*Detach this chart or design your own to keep track of cholesterol tests done in the pharmacy.

References

1. Anonymous. Know The Facts, Get The Stats 2007. American Heart Association. Accessed 12 Mar 2007.
   
2. Calis KA, Hutchison LC, Elliott ME, Ives TJ, Zillich AJ, Poirier T, et al. Healthy People 2010: Challenges, Opportunities, and a Call to Action for America's Pharmacists. Pharmacotherapy. 2004;24(9):1241-94.
   
3. Anonymous. High Cholesterol. Aetna. Accessed 6 Mar 2007.
   
4. Taylor JR, Lopez LM. Cholesterol: Point-of-Care Testing. The Annals of Pharmacotherapy. 2004;38:1252-7
   
5. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497
   
6. Santee J. Accuracy and precision of the Cholestech LDX System in monitoring blood lipid levels. American Journal of Health-Systems Pharmacist. 2002;59:1774-9.
   
7. Anon. Cholesterol Test. Accessed 12 Mar 2007.
   
8. Third Report on National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. IX Adherence. Circulation. 2002;106:3359-66.
   
9. Lee JK, Grace KA, Taylor AJ. Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol: A Randomized Controlled Trial. (reprinted) JAMA. 2006;296:2563-71.
   
10. Jafari M, Masih M, Emerson JF. The Value of Pharmacist Involvement in a Point-of-Care Service, Walk-In Lipid Screening Program. Pharmacotherapy. 2001;21(11):1403-06.

© 2007 Consumer Health Information Corporation. All rights reserved.