Type-2 Diabetes
Don't use DIABETES as a CV risk equivalent
As a pharmacy doctor, you will see more consensus on using statins for diabetes patients. We all know the controversy about the ACC/AHA cholesterol guidelines that abandoned LDL goals and recommended specific statin doses instead. Now the American Diabetes Association is following suit and providing similar guidance on when to use a statin in diabetes patients. …
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Statins
Think "LOWER IS BETTER" for LDL in high CV risk patients
As a cardiovascular pharmacist, there is an ongoing debate regarding the necessity of aiming for a specific LDL goal. For over a decade, the focus has been on using target DOSES of statins shown to reduce CV risk , rather than titrating to an LDL goal. But there’s been a shift toward a blended approach in recent years. Data comparing specific LDL targets are limited.…
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Statins
Coenzyme Q10 for STATIN intolerance
As a community pharmacist, patients will ask you more about Coenzyme Q10 for STATIN intolerance. Statin intolerance is present in about 9% of statin-treated patients, according to a recent meta-analysis. This finding is getting a lot of attention and is likely to increase interest in supplements that might help limit statin-induced muscle pain and weakness . Be prepa…
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Statins
Are Fish Oil supplements safe?!
As a nutrition support pharmacist, patients are asking whether fish oil supplements are safe. Some fish contain contaminants like mercury, PCBs, or dioxins. But most fish oil supplements are mercury-free since mercury accumulates in the meat more than the oils. And a large amount of other toxins are removed during manufacturing. But to be safe, direct patients to pro…
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Statins
Be aware of the role of STATINS in children
As a clinical pharmacist, you should be familiar with the Role of statins in children. More children will be screened and treated for dyslipidemia, now that Canadian and american guidelines suggest expanded screening. About 1 in 300 children are born with familial hypercholesterolemia (FH), which can lead to heart disease , stroke , and early death in adulthood if n…
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Statins
Approach to STATIN intolerance
As a pharmacist, you should know how to deal with statin muscle pain . Mounting evidence suggests that statin-associated muscle pain is driven by a patient’s expectation of harm. In fact, statin-intolerant patients often rate muscle symptoms similarly with statin OR placebo. But it’s still how they feel, often leading to poor adherence. Consider this approach for pat…
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Statins
Focus on DIET and exercise for high triglycerides
As a nutrition pharmacy specialist, you will see more focus on diet and exercise for high triglycerides and less reliance on prescribed (Rx) medications. This is different from current practice... Fenofibrate ( Lipanthyl, Fenolip, etc) use is increasing, despite the fact that there's no proof it improves cardiovascular outcomes. Regu…
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Weight Loss
Insulin resistance is a BIG problem
Metabolic syndrome is a BIG problem and growing. It affects over 25% of adults and 4% of adolescents. It's also called "insulin resistance syndrome" or "syndrome X" or "dysmetabolic syndrome" and even has its own ICD-9 code (see table 1) . New treatment guidelines will focus even more attention on it... …
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Type-2 Diabetes
Ensure your DIABETIC patients are on statin
Many eligible adults with diabetes aren’t on a statin . We know that statins reduce cardiovascular (CV) risk in patients with type 1 or 2 diabetes , and guidelines recommend use. Plus statin use in patients with diabetes age 40 to 75 is a common quality measure. Follow these steps... Think of statins as "automatic" for most …
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Statins
Evaluate the need for NON-statins
As a hospital pharmacist, you will continue to see LESS use of non-statins (niacin, etc) for dyslipidemia due to limited evidence of CV benefit. Consider discontinuing non-statins when patients are admitted if there's no good reason for the patient to be on them. Use these tips to evaluate the need for non-statins... Save non-stati…
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Pioglitazone
Consider Actos for NASH patients
As a hospital pharmacist, you will see more nonalcoholic fatty liver disease (NAFLD) . According to studies, up to 100 million Americans have this buildup of fat in the liver. It often goes hand in hand with obesity , dyslipidemia , insulin resistance , and diabetes . About 20% of patients with NAFLD have nonalcoholic steatohepatitis (NASH) , the mo…
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Omega-3 Fatty Acids
Consider discontinuing fish oil in CV patients
What are omega-3 fatty acids? ─ Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids. They are found in fish and sometimes called "fish oil". Alpha-linolenic acid (ALA) is also an omega-3 fatty acid. It is found in soy, canola oil, flaxseed, and walnuts. Foods that have omega-3 fatty acids, mainly fish, MIGHT prevent hea…
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Statins
How to manage HYPERtriglyceridemia
Questions will come up about how to manage high triglycerides, due to recent guidance from the American College of Cardiology . We know that a fasting triglyceride level of 150 mg/dL or higher is a marker for cardiovascular (CV) disease. But using medications specifically to lower triglycerides isn’t proven to reduce CV events or to prevent pancreatitis, even in pati…
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Statins
How to handle statin muscle pain?
As a pharmacist, you may know that up to 30% of statin patients get muscle pain, cramps, or weakness, usually in the larger muscles such as the thighs. You should suggest these strategies to help patients stay on the statin... Lowering the dose is often enough to reduce symptoms. Changing the statin to fluvastatin, pravastatin, or …
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