Cardiovascular Risk Management

Deepak L. Bhatt, MD, MPH: Let me turn now to Dr Bress and ask his thoughts in terms of populations of patients. What do you think we should be doing in terms of identifying patients who are at risk and then monitoring them, especially when they’re at high risk of cardiovascular morbidity and mortality? A lot of health care systems have moved toward trying to do population health. And many times, pharmacists play a really important role in that process as well. What are your thoughts about the present and the future of that approach?

Adam Bress, PharmD, MS: I think that’s an important question. Kaiser Permanente has a cardiovascular risk management service in which patients at high risk for their first cardiovascular disease event or those with established cardiovascular disease can have their medication managed in a collaborative practice agreement with their provider. Medications for diabetes, cholesterol, and blood pressure are managed and optimized to get those risk factors to ideal levels.

I think establishing services like that to partner with other providers to help optimize the medication therapy to get these risk factors to ideal levels is important, given that there are numerous agents now, both for blood pressure and cholesterol levels, that need to be tailored individually to patients, which we know is a complex integration of efficacy, safety, cost, and convenience considerations as we have shared decision-making with patients around their preferences and acceptability of different therapies.

Deepak L. Bhatt, MD, MPH: That’s an insightful way of presenting things. This has been an interesting discussion, and I think it highlights the importance of identifying cardiovascular risk, practical steps to take, and at least an initial focus in terms of risk factors and LDL [low-density lipoprotein] reduction in its central importance to reducing overall atherothrombotic risk.