Phone calls from a pharmacist could help people achieve healthy cholesterol

Regular follow-up calls from a pharmacist can help people lower their ‘bad’ (LDL) cholesterol by reminding them to take their medication, based on research presented at the British Cardiovascular Society conference in Manchester, and funded by us. 

When high-risk patients received  follow- up calls from a pharmacist, starting four to six weeks after a cardiovascular-related hospital admission like a heart attack, almost three-quarters – 70 per cent – managed to achieve a healthy level of ‘bad’ cholesterol, researchers led by Imperial College London found.  

People with high cholesterol are typically prescribed statins or other cholesterol-lowering medications. But many patients find it hard to stick to their medication schedule, and do not reach recommended cholesterol targets, leaving them at continued risk of heart attacks and strokes. Follow-up calls from a pharmacist could help. 

Fell by 42 per cent

The 204 people from west London in the study, who were called by the same pharmacist each time, so they could build a friendly relationship, started out with an average LDL cholesterol level of 3.39 mmol per litre. But this fell by 42 per cent to 1.97 mmol per litre on average after they received the pharmacist phone calls. 

If a single person reduced their bad cholesterol by the average achieved in this group, it would cut their odds of having a cardiovascular event by around 33 per cent, based on figures from previous research used by the researchers. 

The pharmacist calls, provided to more than 200 people in west London, were not simply reminders to take their medication. People were also provided with tips to support them taking their medications, from pill boxes to apps, and pharmacists explained their cholesterol targets and why treatment was important.  

Those concerned about reported statin side-effects, such as muscle pain and sleep disruption, were also informed of recent evidence that most suspected side-effects are not in fact linked to the drugs. While the study didn't compare the pharmacist approach to the usual NHS care, the researchers say a larger study could investigate this next, and that pharmacist calls could help reduce the workload of GPs. 

The current study involved 204 people who attended Chelsea and Westminster Hospital NHS Foundation Trust and had high ‘bad’ cholesterol and atherosclerotic cardiovascular disease (ASCVD) - cardiovascular disease caused by a build-up of fatty material in the blood vessels which can cause a blockage. The majority had previously had a heart attack. 

Approximately a quarter of deaths in people with ASCVD are due to high cholesterol. 

“No-one wants another heart attack or stroke"

Dr Sonya Babu-Narayan, our Clinical Director and a Consultant Cardiologist, said:

“No-one wants another heart attack or stroke. Yet many patients don’t get the help they need after these medical emergencies to reach their recommended reduction in cholesterol levels. The study showed that regular, continuing support from a pharmacist in the golden window soon after people go home from hospital can be powerful – because people can better understand their treatment, get onto their optimal dose of medication and stay on track with taking it.  

“Innovative service improvements like this could play a key role if they work across the nation. Importantly, the improvement worked regardless of sex, ethnicity and socioeconomic background, which means this kind of approach could improve access to healthcare for everyone.” 

Cholesterol is a kind of lipid – a fatty substance found in the blood – and is made in the liver. But there are two types of cholesterol – high-density lipoprotein (HDL) cholesterol, often known as ‘good’ cholesterol’, and low-density lipoprotein (LDL) cholesterol, or ‘bad’ cholesterol.  

HDL cholesterol picks up excess cholesterol in the blood, and helps the body get rid of it, but foods high in saturated fat, like red meat and butter, can trigger the body to make too much ‘bad’ LDL cholesterol which can get stuck to the walls of arteries. This can help to trigger a heart attack or stroke. 

People with high cholesterol are typically prescribed statins or similar medicines which reduce the amount of cholesterol the body makes. This medication is prescribed and overseen by a GP who will adjust it based on a patient’s progress. 

Patients in the study had follow-up blood tests at Chelsea and Westminster Hospital to see if their cholesterol was starting to come down, so their medications could be reviewed if needed. For those whose levels weren’t improving, or who were struggling with side-effects, extra support was offered, with more frequent reviews to help get things back on track. 

The researchers found 70 per cent of people reduced their level of LDL cholesterol to the recommended level of no more than 2 mmol per litre, typically after eight to 10 weeks. 

The researchers cite evidence that every 1 mmol/L reduction in LDL can cut the risk of a cardiovascular event by around 23 per cent after five years. Based on this statistic, the average cholesterol reduction seen across the 204 people in the study would equate to a 33 per cent reduction in the odds of having a cardiovascular event like a heart attack or stroke. 

"A simple change"

Hussein Alhakem, Specialist Cardiology Pharmacist at Chelsea and Westminster Hospital, said: 

“Our findings show that a simple change in how we support people in the community can have a powerful impact on reducing ‘bad’ cholesterol. Importantly, this approach was effective regardless of a person’s sex, ethnicity or socioeconomic background. This matters because we know some groups can face a higher risk of cardiovascular disease and often experience gaps in care. With further work to improve access, particularly in under-served communities, this model could be scaled up to help prevent thousands of future heart attacks and strokes in the UK.” 

The regular reminder calls would not be possible for everyone using cholesterol-lowering medications, because so many people take these medications, but researchers say the calls could make a real difference for high-risk people who have previously had a heart attack or stroke and are at risk of another.  

The team say giving patients across the UK access to pharmacist phone calls, particularly in areas where fewer people have regular contact with their GP, could help prevent thousands of repeat heart attacks and strokes. 

Find out more about our research