Effect of pharmacist interventions on reducing low-density lipoprotein cholesterol (LDL-C) levels: A systematic review and meta-analysis

• Published in: Journal of clinical lipidology 2020-05, Vol.14 (3), p.282-292.e4
• Main Authors: Dixon, Dave L., Khaddage, Sarah, Bhagat, Shailja, Koenig, Rachel A., Salgado, Teresa M., Baker, William L.
• Format: Article
• Language: English
• Subjects: Low-density lipoprotein cholesterol; Meta-analysis; Pharmacists; Statins
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2020.04.004

Clinical practice guidelines recommend team-based care as one strategy to improve dyslipidemia outcomes. Randomized controlled trials (RCTs) have demonstrated that pharmacist interventions reduce low-density lipoprotein cholesterol (LDL-C) levels. The objective of the study was to conduct a meta-analysis to determine the effectiveness of pharmacist interventions on reducing LDL-C levels. A literature search of RCTs published after January 1, 2000 was performed using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Included RCTs evaluated a pharmacist intervention compared with usual care, reported baseline and follow-up LDL-C levels, and enrolled at least 100 patients. Mean differences in LDL-C and other lipid parameters were calculated using a random effects model. Twenty-six RCTs (n = 22,095 patients) were included in the meta-analysis. Compared with usual care, pharmacist interventions significantly reduced LDL-C levels by −7.9 mg/dL (95% confidence interval (CI) −11.43 to −4.35; I2 = 94%). A subgroup analysis revealed a greater reduction in LDL-C (−13.73 mg/dL; 95% CI −24.07 to −3.40; I2 = 96%) when LDL-C was the sole primary outcome. Significant improvements in total cholesterol (−12.73 mg/dL, 95% CI −19.18 to −6.27), triglycerides (−13.25 mg/dL, 95% CI −26.10 to −0.41), and high-density lipoprotein cholesterol (1.75 mg/dL, 95% CI 0.03 to 3.46) were also found. Pharmacist interventions significantly reduced LDL-C levels compared with usual care. Further research is warranted to determine the optimal pharmacist intervention for reducing LDL-C levels and to evaluate the comprehensive role of pharmacists in lipid management. •Pharmacist interventions significantly reduce LDL-C when compared with usual care.•Pharmacist interventions also improve total cholesterol, triglycerides, and HDL-C.•The optimal pharmacist intervention remains unknown and warrants further study.