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Pharmacist-led standardized intervention framework improves LDL-C goal attainment in lipid-lowering therapy: A
Dong-Yan Chai1, Hong-Ye Han2, Chengyang Xu3
1Department of Pharmacy, Henan provincial people's hospital, Zhengzhou University People's Hospital; Henan University People's Hospital, Zhengzhou, Henan, China (Chai, Han, and Wang); International Medical Center of Henan Province, Henan provincial people's hospital, Zhengzhou, Henan, China (Chai, Xu, and Liu).
Background:
Despite guideline recommendations, low-density lipoprotein cholesterol (LDL-C) target attainment remains suboptimal, particularly in China, where only 26.6% of high-risk patients attain goals. Given the established role of pharmacists in lipid management and the current lack of a standardized intervention, we developed a comprehensive pharmacist-led intervention framework to improve patients' LDL-C goal attainment.
Objective:
To evaluate the effectiveness of a pharmacist-led intervention framework in improving LDL-C target attainment compared with usual care.
Methods:
An open-label, randomized controlled trial (RCT, January 2024-June 2025) was conducted. A total of 123 adults with above-target LDL-C were randomly assigned 1:1 to a 4-step pharmacist-led intervention or usual care. The primary endpoint was LDL-C target achievement at 12 months.
Results:
Of 123 randomized participants, 109 (88.6%) completed follow-up. The intervention group achieved higher LDL-C goal attainment [45.5% vs. 25.9%; relative risk (RR) = 2.381, 95% confidence interval (CI) 1.062-5.339, P = 0.033] and greater LDL-C reduction (-0.67 mmol/L [IQR: -1.21 to -0.12] vs. -0.08 mmol/L [IQR: -0.53 to 0.29], P < 0.001) than the control group. At 1-year follow-up, the adoption rate of lipid-lowering drugs showed significant differences between the two groups (80.0% vs. 59.3%, RR = 2.750, 95% CI 1.169-6.467, P = 0.018); especially, the nonstatin agent adoption rate was 5-fold higher with shared decision-making (20.0% vs. 3.7%).
Conclusion:
The proposed pharmacist-led intervention framework significantly improved LDL-C target attainment and facilitated adoption of nonstatin therapies in high-risk patients. This intervention provides an immediately implementable, scalable template for integrating pharmacists into multidisciplinary cardiovascular care.
Trial Registration:
This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2300079223; Registration Date: December 27, 2023).
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