Magazine article Drug Topics

Cardiometabolic Disorders

Magazine article Drug Topics

Cardiometabolic Disorders

Article excerpt

The pharmacist's role

Action for Outcomes Series

CardioMetabolic Disorders & Weight

According to the National Heart Lung and Blood Institute (NHLBI) an estimated 47 million U.S. residents have an increased risk of heart disease because they suffer from cardiometabolic disorders.1 Cardiometabolic disorders and weight (CMD&W) represent a cluster of interrelated risk factors - primarily hypertension, elevated fasting glucose, dyslipidemia, abdominal obesity (waist circumference), and elevated triglycerides - that promote the development of atherosclerotic cardiovascular disease and type 2 diabetes.

Pharmacists have an essential role to play in managing CMD&W through teaching, counseling, and dispensing.


Mary Jane Osmick, MD, vice prèsident and medicai director, LifeMasters Supported SelfCare in Irvine, Calif., has extensively discussed2 the discrepancies between the various sets of guidelines developed for CMD&W (see Current Meta- bolic Syndrome Definitions). "Not only is there no consensus on the definition of cardiometabolic [disorders] and the guidelines for diagnosing [them]," Osmick told Drug Topics, "but the cluster of risk factors poses another issue: whether [this] should be treated as a single condi- tion or whether each underlying factor should be treated independently.

"One thing that most providers agree upon," she said, "is the need for prevention and early detection of the [associated] risk factors." This is where community pharmacists can help mitigate the causes and symptoms of CMD&W by engaging and coaching patients, in addition to imparting their knowledge about medications.

Role of pharmacists

With many drugs, adherence is a growing problem, and the medications associated with CMD&W - statins, antihypertensives, and diabetes drugs - are no exception. Nonadherent occurs in 21.3 percent of patients with diabetes, according to a retrospective cohort study of 1 1,532 patients.1 The study revealed that those who did not adhere to their prescribed antihypenensive, hypoglycemic, and lipid -lowering medications at least 80 percent of the time were significantly more likely to have elevated levels of HbAlf, blood pressure, and LDL than were those who adhered.

The American Pharmacists Association recommends that pharmacists collaborate with physicians to identify individuals who are not adherent and help to eliminate barriers by minimizing the number of daily doses, reducing dosing frequency, and selecting

the most efficacious and cost-effective medications.

Alan Vogenberg, RPh, a consultant pharmacist in Levittown, Perm., says that community pharmacists are at a loss, because they know what drugs patients are taking, but they don't necessarily know the diagnosis. This can make it difficult to counsel them. "The best-case scenario is developing a collaborative approach with a physician and creating a dialogue," lie told Drug Topics.

"The pharmacist can monitor patients and report back to the physician. We can serve as teachers and help patients manage side effects or facilitate compliance. Also, don't use jargon with patients; use open-ended questions and ask patients to repeat back information to ensure they understand what has been said."

Tracey H. Taveira, PharmD, associate professor of pharmacy at the University of Rhode Island in Kingston, agrees with Vogenberg that as patients take more drugs as part of increasingly complex regimens, pharmacists can play an important role in medication adherence. "We are also experts at knowing what's on formulary, helping to ensure that drugs are covered, and converting doses and medications if needed," she said.

Through an affiliation with the Veterans Affairs Medical Center in Providence, Taveira and her col- leagues conducted a study of 375 veterans, using the Cardiovascu- lar Risk Reduction Clinic model,4 a pharmacist-coordinated care model that incorporated cardio- metabolic risk factors under one umbrella for treatment by clinical pharmacists overseen by a cardi- ologist. …

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