February is heart month, and what better way to love your heart than to learn more about it. Joseph Saseen, PharmD, is the Associate Dean for Clinical Affairs and a Professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. He is also a clinical pharmacist at the UC Health University of Colorado Hospital focusing on cardiovascular risk reduction. While at the American Society of Health-System Pharmacists conference, Dr. Saseen met with the team from Pharmacy Times to answer questions about heart health, patient education, and explained risks associated with high lipoprotein a (or Lp(a)) —an inherited condition that can increase the chance of heart disease. While current lipid-lowering medications may provide some minimal reduction in Lp(a) levels, the reduction is generally insignificant, and no drug is FDA-approved to specifically lower Lp(a).
What Patients Should Know
Saseen’s main take away? He emphasized that patients should know what their Lp(a) level is, as elevated values significantly increase cardiovascular risk. Raising awareness and educating patients on the importance of knowing their Lp(a) is crucial, as many are unaware of this risk factor. Additionally, providers should be on the lookout for new, more effective medications to reduce Lp(a) and potentially lower cardiovascular event rates. These should be available in a few years, but in the meantime, we are hearing a lot about Lp(a).
“Lp(a), or we also call it LP little a, is a factor for the development of cardiovascular disease," Saseen explained. “While we might not know everything about it, we know that patients with elevated Lp(a) values have an elevated risk of cardiovascular disease, and we know that 1 in 5 people in the United States have an elevated Lp(a) value. We also know that some patient populations have higher Lp(a) values than others, and hence higher cardiovascular risk.”
Saseen often prescribes a group of medicines, called statins, that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood. However, he cautioned that while current statins are great at reducing LDL and cardiovascular risk, they are not effective at lowering Lp(a). This highlights a need for new medications and more research to show that lowering Lp(a) makes a difference in reducing cardiovascular events.
What Patients Should Do
What can every patient do to understand their cardiovascular risk?
“Patients really need to know that Lp(a) should be measured in them. Period. It should be universally accepted that every patient should know what their Lp(a) level is,” he said. “We can accept that it doesn't change much throughout their life but knowing whether it's elevated is a risk-enhancing factor. It should trigger them to screen their relatives, or primary relatives for a similar type of elevation since it is inherited, and the bottom line is we should know to have it checked in ourselves and in our patients.”
Sassen says patients really need to be empowered with information.
“They need to know what's in it for them,” he said, “so that they can really buy into partnering up with their disease and their provider to treat their condition seriously.”
Saseen added that if patients have a high Lp(a), they should do everything within their control to reduce their cardiovascular risk. This starts with the basics; not smoking, managing blood pressure, managing high LDL cholesterol, achieving and maintaining a healthy weight, and following a healthy lifestyle.
“We must motivate patients and find what is important to them, and I think with that proper information, they're more inclined to take their medicines,” he said. “And then, as pharmacists, we need to make things easier and simplify regimens, determining the optimal treatment and the optimal doses for our patients.”
Patient education and patient buy-in are important, but Saseen says there are other factors at play when it comes to patients taking their medications.
Is More Expensive Better?
“Our treatments for lipid disorders fall into two buckets: cheap drugs and expensive drugs,” he said. “The cheap drugs are actually very good, and the barrier there is patient acceptance and patient understanding of long-term risk and benefit. Often, patients under-realize the benefits.”
According to Saseen, more expensive drugs, which can be very effective and helpful for some patients, frequently requite prior authorization and certain criteria to be met before they are covered by the patient’s insurance, which can cause many patients to forgo their medication.
His top tip to stay heart-healthy, for both patients and providers?
“I guess number one is know what your Lp(a) is,” he said. And as providers, “be aware of treatments that are going to get approved in the very near future. If they are approved, it's because they've been proven to reduce Lp(a) and reduce cardiovascular events.”
Saseen also advocates that patients should be motivated to take control and ownership of their health.
"They alone are the ones to decide whether to engage in healthy habits or not," he said.
