iForumRx.org

Should We Be Good SPORTs About Supplements for Cholesterol?

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

Music by Good Talk

Beyond Statins: Approaches to Lipid Lowering in 2023

This episode is a collaboration between the ACCP Ambulatory Care Practice and Research Network (PRN) ... and iForumRx.org.

The treatment of dyslipidemia has gotten a lot more complex in recent years as we now have several non-statins that can substantially lower LDL cholesterol and reduce cardiovascular event rates - including PCSK9 monoclonal antibodies, ezetimibe, bempedoic acid, and inclisiran. When and how should we be using these agents?

Panelists:  David Dixon, PharmD, BCACP, CDCES, CLS; Kathryn Litten, PharmD, BCACP; and Tomasz Jurga, PharmD, BCPS, BCACP, BCCP, CDCES

Produced by Jonathan Hughes, PharmD, BCPS, BCACP and Anna Love, PharmD, BCACP

Music by lemonmusicstudio from Pixabay

Fixed Dose or Treat-to-Target: Does LODESTAR Guide Us on Statin Management?

There has been a long-standing debate about the optimal approach to statin use, including whether we should initiate therapy using a “fixed-dose”, high-potency statin, or whether we should “start low and go slow” by titrating the dose to a specific LDL-C target. The LODESTAR study was designed to determine if treating LDL-C to a target level produces similar cardiovascular outcomes when compared to a fixed-dose approach.

Guest Authors: Dawn Fuke, PharmD, BCPS and Catherine Behret, PharmD, BCACP

Music by Good Talk

Is There a CLEAR Role for Bempedoic Acid in Cardiovascular Risk Reduction?

There are a variety of non-statin lipid-lowering medications with proven cardiovascular benefits; however, most of the evidence supporting their use has been as an adjunct with a statin. Bempedoic acid offers a novel mechanism of action to treat hypercholesterolemia. But is there a CLEAR role for bempedoic acid in the treatment and prevention of ASCVD in statin-intolerant patients?

Guest Authors: Sarah B. Edwards, PharmD and Briana Williams, PharmD, BCPS, BCACP

Special Guest: Joseph Saseen, PharmD, BCPS, BCACP

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How VITAL is Vitamin D in Preventing Statin Associated Muscle Symptoms (SAMS)?

You’ve probably encountered many patients who have experienced muscle symptoms after starting a statin.  Statin-associated muscle symptoms (SAMS) contribute to treatment discontinuation and significantly increase cardiovascular (CV) adverse events and mortality. What strategies do you recommend to increase statin tolerance? 

Guest Author:  Rick Hess, PharmD, CDCES, BCACP

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Tiny (n-of-1) Trials to Overcome Statin-Associated Muscle Pain

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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I Screen, You Screen, We Should All Screen for Unhealthy Drug Use

Nearly 1 in 8 Americans older than 12 used illicit substances in 2018, including misuse of prescription medications. In addition, more than 80% of those who would benefit from substance use treatment in the past year did not receive it. Thus, the importance of identifying and offering treatment should be a priority — particularly in primary care settings. However, there are many barriers to implementing unhealthy substance use screening including pervasive stigma, lack of clinician comfort, logistics, and limited knowledge of or avenues for treatment when unhealthy drug use is uncovered. The US Preventative Services Task Force (USPSTF) recently published updated recommendations on drug use screening.

Guest Authors: Melissa C. Palmer, PharmD, BCPS, BCPP; Jordan Cooler, PharmD, BCPP; and Amanda Stahnke, PharmD, BCACP

Music by Good Talk

Are Statins ALL THAT for Primary Prevention in Older Adults? A Second Look at ALLHAT-LLT

Statins reduce atherosclerotic cardiovascular disease (ASCVD) risk. However, the utility of statin therapy in older adults — particularly in those age 75 years and older — remains controversial. The need for additional evidence to guide clinical practice is underscored by the fact that one-in-three older Americans report taking a statin.  Given the paucity of prospective data, a post-hoc analysis of the ALLHAT-LLT (Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial - Lipid Lowering Trial) was recently published.  Does this new analysis really help inform the decision?

Guest Author:  Leo Buckley, Pharm.D.

Music by Good Talk

All for One and FOURIER for All!

Although statins have a proven benefit and are widely used, ASCVD continues to be the leading cause of death in the US.  In 2015, two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab (Praluent®) and evolocumab (Repatha®), were approved to treat elevated cholesterol when added to maximally-tolerated statin therapy in patients with familial hypercholesterolemia or history of ASCVD.  However, the lack of long-term CV outcomes data, high cost, and uncertainty regarding place in therapy have limited their wide-spread use. The recently published FOURIER Study provides compelling new evidence.

Guest Author:  Kelly Starman, Pharm.D., BCPS

Theme music by Good Talk.