John Foster

Ouch! (Just kidding). Three Trumpers sent letters (April 25-26 edition) to assail me for a recent column that was critical of the war in Iran. So much to write about […]

Introduction Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the UK, accounting for a quarter of all deaths annually. Many of these deaths can be prevented through better control of risk factors. Despite well-established evidence and treatment guidelines, cholesterol levels remain sub-optimally managed in many high-risk patients. The British Heart Foundation’s (BHF) Bridging Hearts report found that cardiovascular outcomes are strongly influenced by ethnicity, sex and socioeconomic deprivation due to differences in health care access, risk factor management and care delivery pathways. Without standardisation, treatment intensification and follow up can vary due to clinician biases, patient literacy and system pressures. Pharmacist led lipid clinics offer an opportunity to reduce variation in treatment delivery through structured education and continuity of care. This study evaluates whether a data driven pharmacist led pathway achieves equitable lipid optimisation for secondary prevention patients across a West London Borough. Methods Patients with established atherosclerotic cardiovascular disease and residual elevated lipid levels were identified using ICD-10 and SNOMED coding and referred to a pharmacist led review. Information regarding ethnicity, sex, age and index of multiple deprivation (IMD) were automatically extracted. The review involved a structured consultation with the pharmacist, intensification of medication if required and follow up at set agreed intervals. Outcomes were assessed using a pre-post design. Primary outcomes included LDL-C reduction and attainment of LDL-C targets. Secondary outcomes assessed equity of treatment goals by comparing outcomes across sex, ethnicity and IMD quintiles. Results Among 204 secondary prevention patients, 65% were from ethnically diverse backgrounds and 71% were male. The mean baseline LDL-C for the patients was 3.39 mmol/L and 13% were not actively receiving lipid lowering therapy ([table 1][1]). Attendance following referral by IMD quintile was 7.4% (most deprived), 34%, 33%, 13% and 12% (least deprived) ([figure 1A][2]). Following the intervention, mean LDL-C decreased to 1.97 mmol/L (41.8% reduction) with 70.6% achieving LDL-C targets. Absolute LDL-C reduction and target attainment were comparable with no significant differences observed across sex, ethnicity or IMD quintile ([figure 1B][3]). Among patients receiving high intensity statins, 66.3% met their target LDL-C levels and 89.4% of patients on high intensity statin combined with ezetimibe achieved targets. Patients who decided for non-pharmacological therapy also demonstrated a 46% reduction in LDL-C (n=46). Conclusion These results provide evidence that a pharmacist led lipid optimisation pathway achieved significant LDL-C reduction and target attainment among secondary patients without introducing or amplifying disparities across sex, ethnicity or deprivation. This suggests that consistent, proactive delivery of care can preserve equity that commonly diverges once patients enter care pathways. In addition, we found a meaningful reduction in LDL-C even in patients who decided for non-pharmacological therapies, which suggests that through behavioural reinforcements, structured education and continuity of care, this may reinforce the importance of adherence and lifestyle modification. However, attendance from the most deprived quintile remains low, which may be explained by upstream barriers to access and highlights the need for a more integrated and targeted approach within the community to achieve truly equitable prevention. We provide a scalable framework for potential expansion into primary prevention and cardio-reno-metabolic pathways. ![Abstract 97 Figure 1A][4] Abstract 97 Figure 1A ![Abstract 97 Figure 1B][4] Abstract 97 Figure 1B View this table: Abstract 97 Table 1 Baseline characteristics of the cohort attending the pharmacist-led lipid [1]: #T1 [2]: #F1 [3]: #F2 [4]: pending:yes

Any word that has “moron” in it catches my attention so you can understand why I was curious about “Oxymoron Day”.

Most days when I go to work, I pass two red and white signs that say, “Drive Like Your Children Live Here”.

Here’s a sobering thought for voters who go to the polls in November – U.S. senators elected for six-year terms will be in office when the trust fund of the […]

I’ve remained engaged because I get a kick out of some of the clever and cute things others post.

Well, President Trump has stirred up his “less-than-fans’ legions” with the renaming of Lake Ontario to Lake America.

I am deeply concerned for the future of software development now that the AI era has completely taken over how developers use the internet to seek answers to their questions

I grew up in a northern Ohio town where one of, if not the largest annual parades was on Labor Day.

Al McBride’s letter in the Aug. 29-30 edition challenged me to answer questions about several Democrats running for election in November.