Equitable lipid optimisation through a data-driven, pharmacist-led secondary prevention pathway

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in the UK, with raised cholesterol contributing to 25%-28% of ASCVD deaths. Despite well-established guidelines, cholesterol levels remain suboptimally managed and can vary based on ethnicity, sex and socioeconomic deprivation, potentially leading to disproportionate cardiovascular risk for those living at these intersections. Pharmacist-led lipid clinics may reduce variation through structured review and continuity of care. This study evaluates whether automating the detection and referral of high-risk patients to a pharmacist-led clinic is associated with improved attainment of low-density lipoprotein cholesterol (LDL-C) among post-acute coronary syndrome patients in a West London borough, and whether outcomes vary by sex, ethnicity and socioeconomic deprivation.

Patients with established ASCVD and residual elevated lipid levels were identified using the International Classification of Diseases, 10th revision and Systematised Nomenclature of Medicine coding and referred to a pharmacist-led review. Sex, ethnicity, age and index of multiple deprivation (IMD) were automatically extracted. The review involved a structured consultation, treatment intensification where required, and follow-up at agreed intervals. The primary outcome was attainment of LDL-C ≤2.0 mmol/L in line with National Institute for Health and Care Excellence recommendations assessed using a pre-post design.

Among 204 secondary prevention patients, 65% were from ethnically diverse backgrounds and 71% were male. Mean baseline LDL-C was 3.39 mmol/L and 13% were not actively receiving lipid-lowering therapy. Attendance by IMD quintile was 7.4% (most deprived), 34%, 33%, 13% and 12% (least deprived). Following the intervention, mean LDL-C reduced to 1.97 mmol/L with 70.6% achieving targets. Reductions were similar across sex, ethnicity and IMD quintile.

A data-driven, pharmacist-led pathway was associated with significant LDL-C reduction. Among those who engaged, target attainment was similar across sex, ethnicity and IMD quintile, although low engagement from the most deprived quintile highlights that equitable reach has not yet been achieved. Further work is required to address upstream barriers and evaluate long-term sustainability.