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

BACKGROUND: 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. OBJECTIVE: The objective of the study was to conduct a meta-analysis to determine the effectiveness of pharmacist interventions on reducing LDL-C levels. METHODS: 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. RESULTS: 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; I-2 = 94%). A subgroup analysis revealed a greater reduction in LDL-C (-13.73 mg/dL; 95% CI -24.07 to -3.40; I-2 = 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. CONCLUSION: 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. (C) 2020 National Lipid Association. All rights reserved.