{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T15:47:39Z","timestamp":1782143259854,"version":"3.54.5"},"reference-count":24,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"unspecified","delay-in-days":172,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,5,22]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in the UK, with raised cholesterol contributing to 25%\u201328% of ASCVD deaths. Despite well-established guidelines, cholesterol levels remain suboptimally managed and can vary based on ethnicity, sex and socioeconomic deprivation, potentially leading to disproportionate cardiovascular risk for those living at these intersections. Pharmacist-led lipid clinics may reduce variation through structured review and continuity of care. This study evaluates whether automating the detection and referral of high-risk patients to a pharmacist-led clinic is associated with improved attainment of low-density lipoprotein cholesterol (LDL-C) among post-acute coronary syndrome patients in a West London borough, and whether outcomes vary by sex, ethnicity and socioeconomic deprivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with established ASCVD and residual elevated lipid levels were identified using the International Classification of Diseases, 10th revision and Systematised Nomenclature of Medicine coding and referred to a pharmacist-led review. Sex, ethnicity, age and index of multiple deprivation (IMD) were automatically extracted. The review involved a structured consultation, treatment intensification where required, and follow-up at agreed intervals. The primary outcome was attainment of LDL-C \u22642.0\u2009mmol\/L in line with National Institute for Health and Care Excellence recommendations assessed using a pre-post design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 204 secondary prevention patients, 65% were from ethnically diverse backgrounds and 71% were male. Mean baseline LDL-C was 3.39\u2009mmol\/L and 13% were not actively receiving lipid-lowering therapy. Attendance by IMD quintile was 7.4% (most deprived), 34%, 33%, 13% and 12% (least deprived). Following the intervention, mean LDL-C reduced to 1.97\u2009mmol\/L with 70.6% achieving targets. Reductions were similar across sex, ethnicity and IMD quintile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A data-driven, pharmacist-led pathway was associated with significant LDL-C reduction. Among those who engaged, target attainment was similar across sex, ethnicity and IMD quintile, although low engagement from the most deprived quintile highlights that equitable reach has not yet been achieved. Further work is required to address upstream barriers and evaluate long-term sustainability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004089","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:55:37Z","timestamp":1782140137000},"page":"e004089","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Equitable lipid optimisation through a data-driven, pharmacist-led secondary prevention pathway"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7044-4802","authenticated-orcid":false,"given":"Joshua","family":"Xu","sequence":"first","affiliation":[{"name":"James Cook University Hospital, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasjit","family":"Syan","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"},{"name":"Imperial College London National Heart and Lung Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein","family":"Alhakem","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0292-7703","authenticated-orcid":false,"given":"John Michael","family":"Foster","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"McQueen","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadia","family":"Khan","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"},{"name":"Imperial College London National Heart and Lung Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"2026062207551294000_13.1.e004089.1","unstructured":"GOV.UK . Health matters: preventing cardiovascular disease. Available: https:\/\/www.gov.uk\/government\/publications\/health-matters-preventing-cardiovascular-disease\/health-matters-preventing-cardiovascular-disease [Accessed 27 Sep 2025]."},{"key":"2026062207551294000_13.1.e004089.2","unstructured":"Wilkins E , Wilson L , Wickramasinghe K , et al . European Cardiovascular Disease Statistics 2017. Brussels: European Heart Network 2017."},{"key":"2026062207551294000_13.1.e004089.3","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.121.008552","article-title":"Compounding Benefits of Cholesterol-Lowering Therapy for the Reduction of Major Cardiovascular Events: Systematic Review and Meta-Analysis","volume":"15","author":"Wang","year":"2022","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2026062207551294000_13.1.e004089.4","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1093\/eurheartj\/ehx450","article-title":"Reduction of low density lipoprotein-cholesterol and cardiovascular events with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors and statins: an analysis of FOURIER, SPIRE, and the Cholesterol Treatment Trialists Collaboration","volume":"39","author":"Ference","year":"2018","journal-title":"Eur Heart J"},{"key":"2026062207551294000_13.1.e004089.5","article-title":"Secondary prevention lipid management following ACS: a missed opportunity?","volume":"29","author":"Khan","year":"2022","journal-title":"Br J Cardiol"},{"key":"2026062207551294000_13.1.e004089.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaa047"},{"key":"2026062207551294000_13.1.e004089.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2023.100624","article-title":"Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study","volume":"29","author":"Ray","year":"2023","journal-title":"The Lancet Reg Health Eur"},{"key":"2026062207551294000_13.1.e004089.8","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/clc.23988","article-title":"Addressing current challenges in optimization of lipid management following an ACS event: Outcomes of the ACS EuroPath III initiative","volume":"46","author":"Catapano","year":"2023","journal-title":"Clin Cardiol"},{"key":"2026062207551294000_13.1.e004089.9","unstructured":"British Heart Foundation . Bridging hearts: Addressing inequalities in cardiovascular health and care. London: British Heart Foundation, 2025. Available: https:\/\/www.bhf.org.uk\/-\/media\/files\/what-we-do\/policy-and-public-affairs\/bridging-hearts-british-heart-foundation.pdf [accessed 25 Jan 2026]."},{"key":"2026062207551294000_13.1.e004089.10","doi-asserted-by":"crossref","first-page":"e572","DOI":"10.1016\/j.jacl.2024.03.008","article-title":"Lipid-lowering optimisation for secondary prevention vascular and diabetic foot patients in a pharmacist-led clinic","volume":"18","author":"Hart","year":"2024","journal-title":"J Clin Lipidol"},{"key":"2026062207551294000_13.1.e004089.11","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jacl.2020.04.004","article-title":"Effect of pharmacist interventions on reducing low-density lipoprotein cholesterol (LDL-C) levels: A systematic review and meta-analysis","volume":"14","author":"Dixon","year":"2020","journal-title":"J Clin Lipidol"},{"key":"2026062207551294000_13.1.e004089.12","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1007\/s11096-023-01562-4","article-title":"Optimising adherence to secondary prevention medications following acute coronary syndrome utilising telehealth cardiology pharmacist clinics: a matched cohort study","volume":"45","author":"Livori","year":"2023","journal-title":"Int J Clin Pharm"},{"key":"2026062207551294000_13.1.e004089.13","unstructured":"Collaborative NAA . NHS accelerated access collaborative\u202f\u00bb summary of national guidance for lipid management. 2020. Available: https:\/\/www.england.nhs.uk\/aac\/publication\/summary-of-national-guidance-for-lipid-management\/ [Accessed 26 Sep 2025]."},{"key":"2026062207551294000_13.1.e004089.14","unstructured":"GOV.UK . Health inequalities dashboard: statistical commentary. 2021. Available: https:\/\/www.gov.uk\/government\/statistics\/health-inequalities-dashboard-march-2021-data-update\/health-inequalities-dashboard-statistical-commentary-march-2021 [Accessed 29 Sep 2025]."},{"key":"2026062207551294000_13.1.e004089.15","unstructured":"CVDPREVENT. Available: https:\/\/www.cvdprevent.nhs.uk [Accessed 1 Oct 2025]."},{"key":"2026062207551294000_13.1.e004089.16","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313959"},{"key":"2026062207551294000_13.1.e004089.17","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s11883-022-01046-2","article-title":"Biology, Bias, or Both? The Contribution of Sex and Gender to the Disparity in Cardiovascular Outcomes Between Women and Men","volume":"24","author":"Gauci","year":"2022","journal-title":"Curr Atheroscler Rep"},{"key":"2026062207551294000_13.1.e004089.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2017.08.005"},{"key":"2026062207551294000_13.1.e004089.19","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jacl.2025.12.008","article-title":"Gender differences in lipid management, LDL-C goal attainment, and prescribing practices","volume":"20","author":"Vartak","year":"2026","journal-title":"J Clin Lipidol"},{"key":"2026062207551294000_13.1.e004089.20","unstructured":"Kings Fund . The health of people from ethnic minority groups in england. Available: https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/long-reads\/health-people-ethnic-minority-groups-england [Accessed 26 Jan 2026]."},{"key":"2026062207551294000_13.1.e004089.21","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1089\/met.2023.0009","article-title":"Machine Learning Applied to Cholesterol-Lowering Pharmacotherapy: Proof-of-Concept in High-Risk Patients Treated in Primary Care","volume":"21","author":"Krentz","year":"2023","journal-title":"Metab Syndr Relat Disord"},{"key":"2026062207551294000_13.1.e004089.22","doi-asserted-by":"crossref","first-page":"e463","DOI":"10.1016\/S2468-2667(23)00093-2","article-title":"Reducing health inequalities through general practice","volume":"8","author":"Gkiouleka","year":"2023","journal-title":"The Lancet Public Health"},{"key":"2026062207551294000_13.1.e004089.23","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.123.010335","article-title":"Pragmatic Trial of Messaging to Providers About Treatment of Hyperlipidemia (PROMPT-LIPID): A Randomized Clinical Trial","volume":"17","author":"Shah","year":"2024","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2026062207551294000_13.1.e004089.24","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1001\/jamacardio.2025.0244","article-title":"Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials","volume":"10","author":"Fanaroff","year":"2025","journal-title":"JAMA Cardiol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:55:49Z","timestamp":1782140149000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2026-004089"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004089","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}