EPICORE Centre, University of Alberta, Edmonton, Alberta, Canada
Faculty of Pharmacy, University of Otago, Dunedin, New Zealand.
BMJ Open. 2021 Mar 24;11(3):e043612. doi: 10.1136/bmjopen-2020-043612.
Patients with inflammatory conditions are at high risk for cardiovascular (CV) disease. Despite such elevated risk, their CV risk factors are suboptimally managed.
To evaluate the effect of a pharmacist-led intervention on CV risk in patients with inflammatory conditions.
DESIGN: Prospective pre-postintervention.
17 community pharmacies across Alberta.
Adults with inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, systemic lupus erythematosus, psoriasis vulgaris) who had at least one uncontrolled risk factor (A1C, blood pressure, LDL-cholesterol or current tobacco users).
All patients enrolled in the study received: physical and laboratory assessment, individualised CV risk assessment and education regarding this risk, treatment recommendations, prescription adaptation and prescribing where necessary to meet treatment targets, regular communication with the patient's treating physician(s) and regular follow-up with all patients every month for 6 months.
Primary: change in estimated CV risk (risk of a major CV event in the next 10 years) after 6 months. Secondary: change in individual risk factors (blood pressure, LDL-cholesterol, A1C and tobacco cessation) over a 6-month period.
We enrolled 99 patients. The median age was 66.41 years (IQR 57.64-72.79), More than half of them (61%) were female and more than three-quarters (86%) were Caucasians. After adjusting for age, sex and ethnicity and centre effect, there was a reduction of 24.5% in CV risk (p<0.001); including a reduction of 0.3 mmol/L in LDL-c (p<0.001), 10.7 mm Hg in systolic blood pressure (p<0.001), 1.25% in A1C (p<0.001). There was a non-significant trend towards tobacco cessation.
This is the first study on CV risk reduction in patients with inflammatory conditions in a community pharmacy setting. RIALTA provides evidence for the benefit of pharmacist care on global cardiovascular risk reduction as well as the individual cardiovascular risk factors in patients with inflammatory conditions.
NCT03152396.
评估药剂师主导的干预措施对炎症性疾病患者心血管（CV）风险的影响。
设计：前瞻性前后干预。
艾伯塔省的 17 家社区药店。
患有炎症性疾病（类风湿关节炎、银屑病关节炎、强直性脊柱炎、痛风、系统性红斑狼疮、寻常型银屑病）且至少有一种未得到控制的危险因素（A1C、血压、LDL-胆固醇或当前吸烟者）的成年人。
所有参与研究的患者均接受：体格检查和实验室评估、个体 CV 风险评估和有关该风险的教育、治疗建议、处方调整和必要时开具处方以达到治疗目标、定期与患者的治疗医生沟通以及所有患者每月定期随访 6 个月。
6 个月后估计的 CV 风险（未来 10 年内发生主要 CV 事件的风险）变化。次要结局：6 个月期间个体风险因素（血压、LDL-胆固醇、A1C 和戒烟）的变化。
我们共纳入了 99 名患者。中位年龄为 66.41 岁（IQR 57.64-72.79），超过一半（61%）为女性，超过四分之三（86%）为白种人。在调整年龄、性别和种族以及中心效应后，CV 风险降低了 24.5%（p<0.001）；包括 LDL-c 降低 0.3mmol/L（p<0.001）、收缩压降低 10.7mmHg（p<0.001）、A1C 降低 1.25%（p<0.001）。有戒烟的趋势，但无统计学意义。
这是在社区药房环境中针对炎症性疾病患者降低 CV 风险的第一项研究。RIALTA 为药剂师护理在降低整体心血管风险以及降低炎症性疾病患者的个体心血管风险因素方面的益处提供了证据。
NCT03152396。
