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As people living with HIV age, the risk of cardiovascular disease becomes the greatest threat to their health and quality of life. Not only does inflammation from HIV infection contribute to atherosclerotic cardiovascular disease (ASCVD), but dyslipidemia from the antivirals commonly used to treat HIV further enhances that risk. But does statin therapy reduce ASCVD risk in patients living with HIV?  That's the question that the REPRIEVE study attempted to answer.

Guest Authors:  Laura Lerner, PharmD and Joseph Nardolillo, PharmD, BCACP

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Can supplements marketed for cardiovascular health be used in place of statin therapy? Health professionals have long been wary of nutraceuticals and dietary supplements due to the lack of safety and efficacy regulations. The SPORT trial attempts to provide robust data, to practitioners and patients, on how common supplements perform compared to statin therapy. 

Guest Authors: Kaitlyn Phillips, PharmD, Lindsey Pitt, PharmD, and Anna Love, PharmD, BCACP

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Pain and hypertension are two of the most prevalent conditions worldwide. Acetaminophen is often considered the “go-to” and the “safe” over-the-counter analgesic for patients with hypertension because it is not commonly believed to increase blood pressure or cardiovascular events. But is that assumption grounded in evidence?

Guest Authors: Lizzie Baumeister, PharmD and Austin Morgan, PharmD, BCACP, CDCES

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Unfortunately, many patients with CAD do not receive the influenza vaccine every year.  And many patients being discharged from hospital after an acute coronary event don't receive it either. The IAMI (Influenza Vaccination After Myocardial Infarction) study was the first, large, randomized, double-blind, placebo-controlled, multi-center trial to investigate whether influenza vaccination could reduce the rate of cardiovascular events in high-risk adults with CAD.

Guest Authors:  Noelle Cordova, PharmD and Laura McAuliffe, PharmD, BCACP, CDCES

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We now have “diabetes medications” to treat heart failure with reduced ejection practice (HFrEF). Many clinicians have not yet used a sodium-glucose transporter 2 inhibitor (SGLT2i) for the treatment of HF and are (rightfully) concerned about potential drug-drug interactions, particularly when using an SGTL2i with a mineralocorticoid (MRA). A recent secondary analysis using data from the EMPEROR-Reduced study may provide some reassurance.

Guest Authors:  B. Blake Miller, PharmD, BCPS and Jennifer Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

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In blinded clinical trials the percentage of patients who experience muscle symptoms while taking a statin is typically in the 3-5% range.  In practice, the percentage of patients who report muscle symptoms is 10-25%.  This disparity between what has been observed in blinded trials and what patients experience when treated with a statin is due, in part, to the nocebo effect — a belief that a medication may cause harm.  How many lives could be saved if we routinely used tiny randomized, controlled, blinded trials to determine when statin therapy can be safely continued?

Guest Panelists: Elizabeth Hearn, PharmD; Stuart T Haines PharmD, BCPS, BCACP; and Kathryn (Katie) Kiser, PharmD, BCACP

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We know gout is among the many comorbidities that increase the risk of cardiovascular disease (CVD). In 2018, the cardiovascular safety of febuxostat and allopurinol in patients with gout and cardiovascular morbidities (CARES) trial concluded that febuxostat was non-inferior to allopurinol. BUT, two of the secondary endpoints were very concerning. Febuxostat was inferior to allopurinol in terms of cardiovascular death and all-cause mortality. Many clinicians were left wondering whether febuxostat was cardiotoxic …. or conversely, perhaps allopurinol was cardioprotective. Will another cardiovascular outcome trial provide greater clarity to guide clinical practice?

Guest Authors: Sophia Dietrich, PharmD and Michael W. Nagy, PharmD, BCACP

Guest Panelist: Dawn Fuke, PharmD, BCPS

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Systemic inflammation appears to be an important contributor to atherosclerotic cardiovascular disease but, to date, no medications have been approved that specifically target systemic inflammation. Could colchicine, an anti-inflammatory drug that has been used for decades, move from “perhaps-do” to a “must-do” standard of care for patients with coronary artery disease (CAD)? Data from two previous trials have demonstrated colchicine’s positive impact on cardiovascular outcomes. The LoDoCo2 study asks us, again, to consider colchicine for patients with CAD.

Guest Authors:  Augustus (Rob) Hough, PharmD, BCCP and Taylor Huff, PharmD

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Hypertension is poorly managed in the United States with only 25% of patients achieving optimal blood pressure (BP) control (BP less than 130/80 mmHg).  To achieve optimal control, patients require close follow-up and BP-lowering medication regimens need to be titrated and periodically adjusted. Community pharmacists are in a unique position to manage patients who have poorly controlled hypertension. However, significant barriers exist to implementing hypertension management services by community pharmacists including a lack of reimbursement. Is chronic care management (CCM) a viable payment model to support these services?

Guest Authors:  Kimberly Zitko, PharmD, BCACP, BCGP and Brittany Schmidt, PharmD, BCACP

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Lipid management continues to be an essential component in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).  For the past decade, clinical practice guidelines have gone back and forth about optimal treatment goals but guidelines all agree that statins should be used as the preferred initial therapy. However, there is still a lack of clarity about the optimal add-on therapies. The newest LDL-lowering therapy is inclisiran, a small interfering RNA (siRNA) that targets the PCSK9 pathway.

Guest Authors:  Joshua O. Holmes, PharmD, MS and Amanda Schartel, PharmD, BCACP

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