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June 30, 2025 33 mins

Dyslipidemia remains a major contributor to cardiovascular disease, and pharmacists play a key role in optimizing therapy and improving outcomes. This episode reviews recent updates in guidelines, pharmacologic options, and practical counseling tips for supporting patients with lipid disorders. Tune in to strengthen your clinical impact and support long-term health for the patients you serve.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Janelle Ruisinger, PharmD, FAPhA
Clinical Professor
The University of Kansas School of Pharmacy

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe current guidelines and evidence-based pharmacologic options for managing dyslipidemia.
2. Identify key counseling strategies pharmacists can use to support adherence and improve lipid-related outcomes.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-226-H01-P
Initial release date: 6/30/2025
Expiration date: 6/30/2026
Additional CPE details can be found here.

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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, andas always, I'm excited about
our conversation today.
Dyslipidemia is a majorcontributor to cardiovascular
disease, yet gaps in treatmentand adherence remain common.
In this episode, we'll reviewcurrent guidelines, therapeutic

(00:25):
updates and how pharmacists canhelp patients achieve better
lipid control and betterlong-term cardiovascular health.
I am very, very excited to havea good friend and colleague
with us today, janelle Ruesinger.
Janelle, thank you, it's sogood to see you.

Speaker 2 (00:41):
My pleasure.
I'm happy to be here.

Speaker 1 (00:43):
So Janelle and I go back.
Gosh, been almost five yearsnow, right, or more, yeah.
So I had the great pleasure ofgetting to know Janelle when we
lived in Kansas recently and gotto work with her for a few
months and just stayed friendsand colleagues and just super
excited.
As soon as this topic came up,I knew she was who I wanted to

(01:04):
speak on this.
This is her passion, her love.
So again, thank you.
I know it's busy time.
I remember from academia peoplealways said oh, it's the summer
, it's easy peasy and it'sactually harder most of the time
.
So I know it's a busy, busytime.
So thanks for giving us yourafternoon.
So, janelle, for our listeners.
So, janelle for our listeners,since they're not as privileged
as I, they don't know you thatwell maybe.

(01:29):
So go ahead and tell us alittle bit about yourself and
your practice side and all thatgood stuff.

Speaker 2 (01:31):
Sure.
So I am a clinical professor inthe Department of Pharmacy
Practice at the University ofKansas School of Pharmacy.
I'm also currently theAssociate Dean for Academic
Affairs within the school.
My practice site was theAtherosclerosis and lipid
apheresis center at theUniversity of Kansas Medical
Center.
So I did that for over 20 years, focused on lipids, was able to

(01:53):
have residents, pharmacyresidents in that clinic.
There were two of us pharmacistsin there and then we worked
under protocol with Dr PatrickMoriarty, who is a physician and
well-known in the lipid world.
So I was very fortunate to beable to learn a lot from him in
the 20 plus years of being there.
Our clinic at the medicalcenter we kind of saw the worst

(02:17):
of the worst.
It was a referral clinic, sopatients were sent to us if they
couldn't tolerate a statin orif they had multiple events on
statins or had familialhypercholesterolemia or had high
lipoprotein A, if they couldn'ttolerate a statin, or if they
had multiple events on statinsor had familial
hypercholesterolemia or had highlipoprotein A if they needed a
lipid apheresis, which is areally interesting topic in
itself.
So yeah, learned a lot and hada great time in there.

Speaker 1 (02:37):
That's great and the clinic name is such a mouthful.

Speaker 2 (02:41):
Did y'all ever?

Speaker 1 (02:42):
give it a quick little moniker that you could
use, or did you always say that?

Speaker 2 (02:47):
We always said that we never ended up giving it an
acronym or anything like that.
A lot of times we would just bereferred to as the Lipid Clinic
.

Speaker 1 (02:53):
Yeah, I was just going to say the clinic is
probably what I would have done.
So, yeah, it's funny because wepharmacists, people, we love
our acronyms, so it'sinteresting that you never gave
it a big acronym so well.
Again, thank you so much,chanel, so good to see you and
thrilled to have you on ourepisode today.
So, without further ado, let'sjump in, let's get started on
our topic for today.

(03:13):
So again, our topic for todayis dyslipidemia and, as always,
I like to just kind of set thegroundwork and make sure
everybody's on the same page.
So, if you want to take just aminute or two to kind of remind
us what dyslipidemia means, whatit involves and just kind of
how it plays a role incardiovascular risk and health,

(03:34):
Sure, sure.

Speaker 2 (03:35):
So dyslipidemia is kind of a broad term that can
encompass a lot of differenttypes of changes or issues in
cholesterol.
So you can have mixeddysplidemia, where you have high
LDL and high triglycerides.
You can have only high LDL, youmay have low HDL, you may have
familial hypercholesterolemia,which means you have very high

(03:58):
levels of LDL, that you becauseof a genetic mutation and so
kind of a broad term.
And so one of the reasons why,or you know a reason why that's
a problem is cardiovasculardisease is still the number one
cause of death in the UnitedStates and a big contributor of
that is the cholesterol or thehigh cholesterol levels.

(04:20):
So where that plaque formationthen can lead to heart attack,
to stroke, to needing a bypass,to stents and a whole host of
problems, and so addressing that, staying on top of it, being
involved, educating our patients, is really important and
hopefully we can knock that downfrom the leading cause one of

(04:44):
these days, but it has beenthere for a long time.

Speaker 1 (04:48):
Yeah, I know you would think, I mean you would
think cancer would haveeventually taken it over, but I
think it's just.
I mean, like you said, it'sjust such a juggernaut.
So, remind us again, just Ialways, like I said, like to
just lay the foundation.
The big three that we think ofare LDL, hdl and triglycerides.
And just to remind us again,ldl is considered the bad one,

(05:09):
so we want that, we don't wantthat to be high.
Hdl is the good one and we wantto be sure that we're getting
that as high as possible, right.
And then our triglycerides arealso another one of the bad ones
that we want to try to keep onthe lower end of things as well.
And triglycerides everythingcan be affected by diet, but
correct me if I'm wrongtriglycerides are more of one of
those that are really affectedby the diet, correct?

Speaker 2 (05:32):
Yes, definitely.
So a couple of things I alwayslike to tell patients.
Ldl is the lousy cholesterol.
You want low.
Hdl is the helper cholesterol.
You want high, right.
And then the triglyceridesyou're right, can largely be
affected by diet and exercise.
A few instances where, again,is a genetic component to it,
but for the majority of thepopulation, exercise and diet

(05:55):
and weight loss can certainlybring those down.

Speaker 1 (05:57):
Help out with those.
Yep, okay, and another one youmentioned.
Well, before we get into that,I'll segue.
Well, no, let's segue into itnow.
So you mentioned lipoprotein A.
So that's gotten a lot of pressrecently, so let's talk briefly
about that really quick, andthen we'll jump back to the
other prevalence of dyslipidemiaand everything.
So, while we're on that subject, let's talk about lipoprotein A

(06:18):
real quick, okay.

Speaker 2 (06:20):
Well, I could talk about that, probably the entire
podcast alone, so you can giveme the signal that I need to
wrap it up here pretty soon.
Lipoprotein A has been apassion of Dr Moriarty, so the
physician I worked under in the20 plus years that we worked
with him he has workedtirelessly to try to get it more
attention, to get people to payattention to it.

(06:42):
It's another component of yourcholesterol but it's hereditary,
so by the time you're about agefive your level is stable and
so it's not routinely checked.
So when you do a lipid profileit doesn't come along with the
LDL, hdl triglycerides, it's aseparate test.

(07:03):
But the problem is it isatherogenic in most instances,
so very similar to LDL in thatit can cause put you at
increased risk for heart attacks, for strokes, it can put you at
risk for valvular disease, andthe problem with it is that you
could literally eat twigs andberries and not change this

(07:25):
level again because of thegenetic component.
And the other challenge is wedon't really have any agents
right now that can lowerlipoprotein A.
The PCSK9 inhibitors can maybelower it about 25%.
I mentioned that lipidapheresis, so in extreme cases,
patients who use that it willlower lipoprotein A

(07:47):
significantly.
But right now we don't haveanything to lower that.
The good news is we've got acouple of agents that are in
trials right now, and so the oneagent can lower lipoprotein A
by about 94%, and so we're veryexcited about that.

(08:08):
Interestingly, the Europeanguidelines recommend the
European lipid guidelinesrecommend that every person get
that tested.
Once the US guidelines haven'tquite got there yet, we
recommend it more in patientsthat are high risk or have had
multiple events, have had familyhistory, significant family

(08:29):
history and things like that.
So, but I think you're going tobe hearing a lot more about
lipoprotein A in the near future.

Speaker 1 (08:35):
Yeah, and I think I mean it makes sense that if and
when those drugs come tofruition and they actually enter
the market and get approved, Ifeel like then if there's
something to treat it, hopefullythe attention it'll get the
attention it needs by beingtested, because then because I
mean I'm not on that side of whytest it, you're not going to be
able to do anything with it,but I'm sure that's what people

(08:55):
think is like, well, what's thepoint?
And if it's high or low wecan't do anything about it.
So hopefully with the newmedications in that class, that
would be beneficial.
Do you know and I may beputting you on the spot, sorry
Do you know if those newmedications also affect LDL?
Do they do anything else, orare they targeting solely
lipoprotein A?

Speaker 2 (09:16):
They're targeting solely lipoprotein A, from what
I'm understanding, but the goodnews is they're looking for
outcomes they want.
We have had agents in the pastthat lowered LDL levels and
things like that, but didn'timprove outcomes, and so they're
looking for some outcomes datafor these.
So it might be hopefully in thenext five years maybe we'll see

(09:40):
something come out for sure.

Speaker 1 (09:44):
Yeah, that'd be great .
Okay, well, thank you, that wasjust.
It seemed like a good seguewhen we were talking about the
components and I know that thatone has been in the news a lot
lately because of these studiesand just in general.
So hopefully Dr Morati is, he'sfinally getting his wish and
it's kind of yeah, it's kind ofcoming more mainstream.
So what let's let's back upjust real briefly and just talk

(10:05):
about the prevalence ofdyslipidemia and its impact on
public health in general,because I mean it can be a very
costly disease if it obviouslyfeeds into cardiovascular issues
and what's the importance ofearly detection.
So let's talk about that for alittle bit.

Speaker 2 (10:25):
Sure.
So it looks like about 11% ofadults that are age 20 or older
have high cholesterol levels,and so early identification is
important, because the sooneryou address it, hopefully you're
putting off any chance of anevent down the road.

(10:47):
Now dyslipidemia is a littlebit frustrating, right, because
it's a slow process and patientsdon't feel any different
whether their cholesterol levelsare high or whether they're low
, and so it's very easy forpeople to put off getting that
cholesterol checked, despitemaybe a significant family
history or maybe despitediabetes or, you know, being

(11:09):
overweight or anything like that.
But we know that the earlier wecan bring those cholesterol
levels down and address thoserisk factors, the better off we
are as far as preventing thoseevents down the road.

Speaker 1 (11:25):
Right, yeah, and that's a good point, because you
think about someone who hasdiabetes.
They usually they feeldifferent with low or high.
It's easy to say like, oh, Ineed to get that under control
because it makes me feelterrible or whatever.
So it's an interesting pointthat because we don't feel a
certain way with our levels oflipids, it's hard to say like,

(11:49):
well, you'd feel better if yougot it under control, because
it's not really the case.
So you'd feel better mentallyand emotionally, hopefully.
But, yeah, it's hard to kind ofrelay that to patients sometimes
.
What remind us about?
Like if you find out that youhave high levels and you getting
them under control, whether yougo on medication or whether you

(12:09):
lose weight or start exercisingwhatever, can any of the damage
that's been done so, likeplaque buildup or whatever?
Can that be reversed?
Are there?
Are there benefits for that aswell?

Speaker 2 (12:21):
Sure, sure.
And so what you're, once youknow that plaque is laid down,
sure, sure.
And so what you're, once youknow that plaque is laid down,
what you want to do is stabilizeit.
So you want it to basicallycalcify, and it will do that
over time if you bring down thatcholesterol level.
And so you, you may see alittle bit of regression, but

(12:42):
for it to completely go away isprobably not the case, and once
it's calcified, it's going tostay there.
One thing that we would look atis a carotid IMT kind of
getting off subject here, butit's where we were looking at.
It's an ultrasound where youlook at non-calcified plaque and
we could actually, if webrought levels down, we could
show regression in that noncalcified plaque.

(13:06):
And so, yeah, you, you can itmay not, you know, completely
clean out the right, thearteries, but you're, you're,
you're allowing it to stabilize,which then doesn't usually
rupture, and then you're keepingit from getting larger.

Speaker 1 (13:22):
Exactly exactly.
Just try and think of morebeneficial talking points to
convince a patient, you know, todo this or whatever.
So, yeah, okay, that's great.
So let's touch on reallybriefly.
I'll just kind of mention someof the things that we're going
to dig into deeper.
But lots of opportunities forpharmacists and I feel like I
say that with every subject thatwe tackle on this on this

(13:42):
podcast but there's just,there's so many opportunities.
So, because we're so accessibleand because we're knowledgeable
and we have this training.
But you know, some of the thingswe're going to talk about and
really dig into is medicationoptimization, lifestyle
counseling, and that includesdiet, exercise, you know,
supplements, things like that,and as well as just education in

(14:04):
general about the disease,about the fact that it's a
stepping stone to somethingbigger.
It's not just oh, okay, fine,I'll just have high LDL.
No, that could lead tocardiovascular disease, that
could lead to futurecomplications, heart attack, et
cetera, et cetera, so, yeah, soreally just touching on the fact
that education that we provideas pharmacists is also critical.
So with that, let's jump intoone of the first things, and

(14:28):
that is helping with medicationoptimization.
But that requires us to stayupdated on the medications and
the guidelines.
So if you'll tell us a littlebit about, maybe, how often the
guidelines come out and why it'simportant to stay up to date on
those and things like that,Sure, sure.

Speaker 2 (14:44):
So the current guidelines are from 2018, the
American Heart Association,american College of Cardiology
and the whole host of othergroups that endorsed them in
CUPE, including the AmericanPharmacists Association.
There, we are hoping that maybeanother guideline will come out
in the next few years.
We're kind of due, I think,especially looking at some of

(15:06):
the data that we're getting frommaybe some of these newer drugs
that might be coming out.
I'm hopeful that something willbe coming out before too long,
but I don't think anythingofficial has been actually
announced.
Yeah, I think kind of the maybeI don't know frustrating or
overwhelming piece of it is whenyou look at the guidelines
themselves.
They're what 40, 50 pages andthe average person is.

(15:30):
You know, I'm not going to readevery minute, every word of the
diabetes guidelines and thelipid guidelines and the
hypertension guidelines, and sosomething that they implemented
in the 2018 guidelines are thetop 10 take-home messages and so
yeah, and so I think, insteadof maybe being overwhelmed by
trying to look at that entiredocument, starting with simply
those top 10 take home messagesand ensuring that you are doing

(15:55):
that and utilizing those to, wekind of teach here is take away
some nuggets.

Speaker 1 (16:06):
Like we know that it's impossible to know every
single thing about every singlething, but you know taking home
some of those pearls and some ofthose little nuggets, so I love
that they did that with thatiteration.
I think that's just smart and Ireally hopefully others will
continue to kind of take note ofthat, because again, it's kind
of like what the CliffsNotesversion of it you know.

(16:28):
So it's, it's a good thing tokind of um, to also remind
yourself of often, you know liketo just look back at those and
be reminded of things.
So okay.
So then, along those same lines, another thing that we can do
as pharmacists is guide, therapyselection, dose optimization.
So tell us a little bit about,maybe, some of the ways that

(16:49):
that can kind of come into play,like when do we change the dose
of something you know, if it'snot responding or if they're
having side effects, or you knowthat kind of thing.
So if you can talk a little bitabout our role in that space,
that'd be great.

Speaker 2 (17:03):
Sure, sure.
And pharmacists, I think, havea really important role in that
space.
And so you know, if someone hasnot achieved that 50% reduction
with their current statin youknow, reduction of LDL with
their current statin, are theyon the maximum dose?
Do we need to bump that up alittle bit?
Do we need to switch them to astatin that's maybe a little bit

(17:25):
more potent?
You know right to be a littlebit.
Do we need to switch them to astatin that's maybe a little bit
more potent?
You know right to be a littlebit more aggressive with their
therapy.
Maybe they're already on themaximum dose of the current
statin.
Maybe we need to add a zetamide, but the patient doesn't want
to add another medication andthinking about that, or even if
they're on a zetamide and astatin, maybe it's time to have
that conversation about thePCSK9 inhibitor.

Speaker 1 (17:48):
Or maybe to have a conversation about adherence and
make sure that they're actuallytaking their medication Exactly
, exactly.

Speaker 2 (17:54):
Right, or that there's not some side effect
that's preventing them from, youknow, from taking it.
And so I think there are a lotof pieces.
You know, a pharmacist doesn'teven, I don't think, have to
spend 30 minutes with thepatient asking questions each
time they come in, you know, tomaybe glean some of that
information can then guide someconversation, maybe a little bit

(18:15):
longer conversations down theroad, absolutely, yeah.

Speaker 1 (18:18):
If there's one thing I'm learning with aging patients
and aging parents and you knowlearning that process with them
it's that you know sometimesthey like to just play with
their meds.
Like you know, today I don'tneed it because I feel great and
that's not really that's notreally what should be happening.
So again, yeah, when you'reseeing that the numbers are not
adding up, what, what are all?

(18:40):
I love that you laid out, likeall the different scenarios, and
then one of those also beingyou know, are you actually
taking your med and if not, why?
And if there's a reason why,can we also fix that you know?
So, yeah, that's great.
What about tell us what?
Obviously statins and tell mewe said this in the beginning,

(19:01):
before we got on record, so Iwant you to repeat it because
it's staggering Tell us thenumber of patients who never
fill their statin prescriptions.

Speaker 2 (19:10):
So about 50% of patients do not fill their
prescription for their statin orthey don't pick it up Right.

Speaker 1 (19:17):
Right, they never even drop it off or whatever.
Yeah, right, yeah.

Speaker 2 (19:21):
Right.
And so now, I think, withelectronic transmission of
prescriptions, pharmacists againare at a great point to say hey
, miss Jones, I have this timehere for you.
Yeah, why?
Why are you not picking thisone up?
Let's have a conversation aboutthat.

Speaker 1 (19:36):
You know what are your concerns.

Speaker 2 (19:37):
Where are you getting your information?
Are you getting it from Google?
Let's maybe look at some, youknow, point them in the
direction of a few places theycould get some good information,
that's such a great point,janelle.

Speaker 1 (19:50):
I love that because you know I think I've been in
that space I know it's busy, theworkflow is overwhelming and
you can't always take note ofeverything.
But when you see something likethat, don't just assume oh well
, they must have talked withtheir doctor and decided not to
take it, or, oh, they must.
Maybe they that particular onewent mail order for some reason,

(20:11):
or you know whatever.
Like don't assume I love the.
I love that because you're soright, like have that moment,
even if it's two minutes, to belike, hey, why did you never
pick this up?
Do you have concerns?
And I love your question ofwhere are you getting your
information?
Because have concerns.

(20:32):
And I love your question ofwhere are you getting your
information, because that's sucha good one Because, again,
they're probably gettingmisinformation, you know.
So, yeah, that's such a greatpoint.
Remind us what I was going forthere.
I wanted to share that becauseI think that that's just such I
mean, it's just such astaggering number the percentage
of people who actually justdon't ever follow through, so
that, in and of itself, if weget that under control, you know
, that can help a lot.
But remind us what medicationsare currently out Like.

(20:52):
What are?
What are some of the ones thatwe're going to see a lot of when
we're treating dyslipidemia?
What?
are the most common Sure.

Speaker 2 (20:58):
So still kind of the foundation right are the statins
, that entire class there.
Then we have the phenofibric orthe fibric acid derivatives.
Not used as much, maybe becausesome of the data for some of
the patients isn't as good, butyou'll see that azetamide- is

(21:21):
another one I think you're goingto see.
You probably see a lot ofBambidoic acid is another one
that came out a couple years agoand probably seeing it to some
extent, and then the PCSK9inhibitors.
Those injectables are probablywhat you're going to be seeing
as well are probably what you'regoing to be seeing as well.

Speaker 1 (21:41):
Okay, and with the latter there, those are more
reserved for severe cases,uncontrollable dyslipidemia Is
that kind of what we're lookingat with those Sure?

Speaker 2 (21:52):
Yeah, yeah, I think they also have a place for those
who are statin intolerant.
You know, if you have someonewho's high risk you know getting
the myalgias from the statins,then you may see them uh as well
.
But they, the pcsg9 inhibitors,can most certainly be used in
combination with the statinsazetamide, you know, and some
insurance companies are kind ofrequiring that that stuff.

(22:15):
But you can still keep them onum those, those other agents.

Speaker 1 (22:21):
Good to know.
So we talked, we touched onthis briefly, we talked about
how, we talked about adherenceand personal counseling and
making sure that they're gettingthe right information and that
they know what to do with thatinformation.
Medsync I think that's anotherthing that is important because
that can help with adherence andthat can make sure that they're
picking it up along with theirdiabetes meds or whatever and

(22:43):
just kind of keeping them onthat cycle.
But let's touch on briefly,before we kind of get into some
of the challenges that we face.
Let's talk about how we canpromote lifestyle interventions
and what should we be talkingabout and promoting in that
space to our patients?

Speaker 2 (22:56):
sure, sure, diet and exercise are foundational right
and every patient, regardless ofwhether it's genetic, whether
you know what the condition is,we should be promoting those
lifestyle modifications.
And you know, it kind ofdepends on the comfort level how
much pharmacists want to getinto that.
Certainly, walking, we're notgoing to tell our 70 year old

(23:19):
patient to start jogging right.
So simply walking work, youknow, working up slowly, because
the other thing we see is ifthey're put on a statin and
start exercising, they don'tknow if it's the exercise or the
medication that's causing theirmuscle aches right, and so, if
they haven't, exercised beforethey're going to have muscle
aches.
And so, talking to them aboutthat, the simple thing that we

(23:43):
would say we had a dietician.
We were fortunate to have adietician in our clinic and she
was absolutely fabulous,everyone saw her.
But the simple thing that wewould say to patients is it's
simply calories in, calories out.
Dr Moriarty would say if you'reeating, if you would eat half
of what you're eating right nowit's mcdonald's every day right,
if you ate half of that, you'regoing to lose weight, right,

(24:05):
right and right.
And so simply just beingmindful of um, what um calories
they're eating.
And then, if they can makethose small changes, right,
instead of getting the frenchfries with your hamburger, maybe
get a side salad or forego thefries all together and eat some
fruit later on, or somethinglike that.

(24:26):
So you don't have to make acomplete overhaul, but set some
goals, make some small changesand start that way.

Speaker 1 (24:35):
What about smoking and alcohol intake?
Do those come into play?
I mean, obviously they comeinto play everywhere, but are
they big factors in dyslipidemiacontrol?

Speaker 2 (24:47):
Absolutely.
So you know they say one drinka day, alcoholic drink a day is
probably okay, but for someonewith dyslipidemia, those again
simply more calories thatthey're drinking and not getting
a lot of nutritional value from, so being mindful of that.
But specifically, if someonehas high triglycerides, um
asking about you know how muchthey're drinking each day, and

(25:10):
and because alcohol cancertainly um contribute to that,
and again, you know reducingthe amount if they say I, I must
have um wine every night withdinner, that you know we can
work with that.
Just let's make sure it's nothalf a bottle, let's maybe do
one four ounce serving, or youknow something like that.

(25:31):
And then with the smoking, yeah, that the smoking, you know
they need to stop.
There are some differentresources, even if you don't
have a smoking cessation programat your pharmacy.
You know some of the help linesand things like that.
But the awesome thing too isthat pharmacists can recommend
you know some of the over thecounter.
You know nicotine replacementand so certainly options there.

(25:54):
But yeah, the smoking, thatthat's a big one.

Speaker 1 (25:59):
And I'll put a little shameless plug in here, because
every time that we have othereducation available to you,
there is a smoking cessationcourse that we have that you can
check out in your profile andthat can help you when you're
talking with your patients andgive guidance on recommendations
and things like that too.
So, yeah, great, call out.
Okay, let's jump into a littlebit of the challenges that we

(26:19):
may face as pharmacists in thisspace.
So one of the things and wetalked about this a little bit
and when we're looking at youknow optimization of the
medications and whatever, butpolypharmacy in general, because
, let's face it, I don't know apercentage, but I'm sure the
great number of percentage ofour patients who have
dyslipidemia also have somethingelse.
It's not usually going to bethe only thing they have, right.

(26:44):
So they're probably going tohave diabetes or they're going
to, you know, they're going tohave something else that's in
play that is going to also becausing a lot of medications to
be prescribed and to have to betaken.
So what are some of the tipsand tricks that you can share on
on that whole aspect ofmanaging the polypharmacy and
making sure that ourdyslipidemia medication is not
getting lost in the shufflebecause of something else.

Speaker 2 (27:05):
Yeah Right, I think a really important thing is to
empower the patients and getthem to have a current list of
their medications that theycarry with them all the time,
including supplements, includingvitamins.
It was amazing in our clinichow many times patients would
come in and just have no ideawhat they were on and maybe they

(27:26):
had been on a statin previouslyand we weren't sure if they
were still on it.
And then you add one, you know,and so encouraging them to take
charge of that and always havea current list.
I think another thing isensuring that we are using
medications when we can thatwork with the patient's
lifestyle.
So let's say, a patient says youknow, I cannot remember to take

(27:48):
simvastatin at night.
It's not going to happen.
I don't remember to take anymedications at night.
Okay, we can work with that.
Maybe we'll switch it toatorvastatin or rosuvastatin.
How long or how fast you cantake it in the morning, and
maybe that will help withadherence.
You had mentioned themedication synchronization.
That's huge that pharmacistscan do.

(28:08):
We would recommend pill boxes.
I know you know people wouldn'talways be on board with that,
but as soon as they realize thatit takes the guesswork, the
thinking, out of it.
You could work with them thatway as well.

Speaker 1 (28:23):
Yeah, I mean, I'm in my early 40s and I take no shame
in having a pillbox.

Speaker 2 (28:28):
I love my pillbox, I know I mean.

Speaker 1 (28:31):
I just I filled it up this morning and I love
organization, I love, you know,to keep it on track and I think
that that just that's alwayssomething that we can recommend
our patients.
It makes the most sense to me.
So yeah, sure, so we brieflytouched on this as well.
But obviously, statin hesitancy, statin misconceptions you know
there's a lot of unfortunatelynegative press that gets

(28:52):
associated with statins and andfor some reasons, rightfully so.
But but in general they're,they're great drugs and you know
patients should be on them,most patients should be on them,
most patients should be on themif they're prescribed them.
So any kind of things thatyou've learned over the years
that kind of helps with that.
I know, just education ingeneral and I love, again,
setting it up with where are yougetting your information from?

(29:14):
I love that.
That's going to stick with me.
But, yeah, anything else inthat space that can kind of help
overcome that hesitancy or thereluctance, for that, sure.

Speaker 2 (29:23):
What we'd hear a lot of times is you know, my sister
was on a statin and had problemsso I can't take it, or you know
I'm not going to because myneighbor had problems and things
like that, and so you know,interestingly, you see a lot of
that.
But there are different statinsthat patients can try.
Some of the you know againatorvastatin or suvastatin are

(29:45):
pretty clean, have longerhalf-lives, you know, and so
patients may do well with them,and if they don't, we always
have options.
You know, we could try adifferent statin, we can try a
lower dose, we could tryalternative dosing.
Lots of data on once a week,twice a week, three times a week
, statins especially with thosethat have the longer half-lives

(30:05):
for certain.
Like you had mentioned, makingsure that you, if a patient is
getting their information fromGoogle or Reddit or you know
wherever they get it from,having some sources that you can
point them to.
You know, there's a great sitehere on the American Heart
Association, or here I justprinted out a handout from you
know, american heart associationor something like that.
So having some options so thatwe're not telling them where

(30:28):
you're going, isn't good, but,um, giving them some options to
go get that, that informationredirecting as opposed to right
getting on to them.

Speaker 1 (30:37):
Yeah, exactly exactly .

Speaker 2 (30:39):
And then I think some persistence to.
You know you're probably notgoing to get convince them the
first time, but what we wouldeven do is say you know, just
get take it a couple times thisweek, see how you feel, and then
you know we can maybe titrateup as as we go, but that kind of
helps them dip their toe in thewater and get a little bit of
confidence to give it, to giveit a go.

Speaker 1 (31:01):
Great feedback, great ideas and ways to kind of frame
that conversation with thepatient.
So that's good.
Well, I told you time's goingto run out before we realize it.
So we're already running out oftime.
But before we go, I want to besure is there anything else in
this space, chanel, that you'relike, oh, I was just dying to
tell everybody about this?

(31:22):
Is there anything else that youwant us to be sure we know
about this lipidemia or thetherapies associated with it,
before we head out?
And if not, then my final,final question to you is what's
the game changer here?
You know, what is the absolutetake home point here?
How can we really utilize theinformation that you've given us
to make a difference?
So sure.

Speaker 2 (31:43):
Well, we'll jump to the game changer, since we're
running out of time here.
But I think for me, from myperspective, the game changer is
that the pharmacists are thegame changers in this, in this
space, and the patients, whenthose prescriptions come in and
they're not picking them up, youknow, asking a few questions,
being kind of persistent,finding out why and being the

(32:07):
source of that good information,that reliable information we
mentioned earlier, staying up todate on that and helping the
patients be educated and helpingthem navigate this.
I think sometimes they'rescared, they're nervous, they're
getting all kinds ofinformation, so helping them
navigate that and lead throughall of it is important.

(32:30):
So, yeah, I think thepharmacists are the game
changers.
I love that.

Speaker 1 (32:34):
And I think it's great.
I think it's important that wealso don't dismiss their
concerns, and everything you'veshared is setting it up in that
same way, like, don't dismiss it.
They have valid concerns and,again, some of the evidence is
it is true, you know they arerough on, you know the body
sometimes, but, like you said,there are so many ways in which

(32:55):
we can approach that therapy andI think that is where you can
shine as the pharmacist andbeing like look, yes, I know, I
agree they can.
You know it can be difficult,you might have a side effect,
but I know all about how to makethis better for you and you
still get the outcome that youneed.
So, yeah, so I agree,pharmacists are the game changer
.
I agree 100%.

(33:16):
Well, janelle, this was lovely.
Thank you so much for your timetoday and for reminding us
about all things dyslipidemiaand for giving us some great
updates and great take-homenuggets.
Really appreciate your time.

Speaker 2 (33:29):
Well, thank you.
Thank you for having me.
I really enjoyed it and it wasa privilege to be here today.
Thank you.

Speaker 1 (33:35):
If you're a CE Plan subscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all again next week.
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