MON-282 - Pharmacist-led Lipid Management for Patients with Diabetes and Atherosclerotic Cardiovascular Disease

Background
Patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD) are at an increased risk of secondary cardiovascular events, necessitating the intensification of lipid-lowering therapies. Clinical guidelines (AACE, ADA) have recently updated lipid goals for secondary ASCVD prevention in patients with DM to target a goal LDL-C < 55 mg/dL, as well as a ≥ 50% LDL-C reduction from baseline, with a level of evidence of Grade A and Grade B, respectively. Additionally, AACE recommends non-HDL-C < 80 mg/dL. Pharmacist-led interventions for lipid management have previously demonstrated a positive impact on achieving lipid goals; however, there is limited literature on pharmacist-led lipid management in patients with ASCVD and DM. This quality improvement study evaluated the impact of pharmacist interventions on achievement of lipid goals for secondary ASCVD prevention in patients with DM.

Methods
This is a retrospective-prospective, cohort study of adult patients with DM and history of ASCVD that have an LDL-C ≥ 65 mg/dL. Patients must have been seen by a provider within the Tufts Medical Center Division of Endocrinology, Diabetes and Metabolism within the last year. A patient list for referral to the pharmacist-led service was generated using an EHR report. The study team performed a manual chart review of patients to assess appropriateness of referral to the pharmacist-led lipid service. Lipid-optimization strategies were individualized based on guideline recommendations and patient-specific factors. The primary outcome was the percentage of patients achieving goal LDL-C < 55 mg/dL. Enrolled patients were followed for ≥ 3 months. IRB granted exemption for this study.

Results
Twenty-two patients qualified for study inclusion. Among these patients, 16 were on a high-intensity statin and 8 were on non-statin therapies at baseline. The average baseline LDL-C was 102 mg/dL, non-HDL-C 129 mg/dL, lipoprotein(a) 89 nmol/L, and HbA1c 8.1%. The most common interventions were initiating injectable lipid-lowering therapies and adherence counseling. Twenty post-intervention lipid panels were collected. The average post-intervention LDL-C and non-HDL-C was 67 mg/dL (IQR 50-70 mg/dL) and 90 mg/dL (IQR 70-96 mg/dL), respectively. Nearly half of patients (n=9) were able to achieve goal LDL-C. The average percentage change in LDL-C and non-HDL-C was –35% (± 42) and –33% (± 42), respectively.

Conclusion
Pharmacist-led lipid management resulted in improved achievement of lipid goals and reduction in lipid levels. These results support the role of pharmacists in lipid management as part of team-based care, which is an area of further research identified by the recent 2026 ACC/AHA Guidelines on the Management of Dyslipidemia. Future directions of this study include pharmacist expansion into cardiology and internal/family medicine clinics.

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