How pharmacists can contribute to healthy hearts

February 1, 2023

Kate Mitchell

February is Heart Month, so this is a good time to shine a spotlight on actions we can all take to give our hearts some love – and how pharmacists can help us in those efforts.

In Canada, heart disease is second only to cancer as a cause of death¹. Every hour, about 14 people across the country who have been diagnosed with heart disease die. Meanwhile, about one in 12 Canadians (2.6 million people) who are age 20 or older live with a diagnosis of heart disease². Every year, more than 150,000 Canadians discover they have the most common kind of heart disease, ischemic heart disease, with more than 63,000 experiencing their first heart attack (acute myocardial infarction).³

Those most at risk for heart disease include men who are 45-plus and women who are 55-plus. Risks also rise for women who take birth control pills (especially those who also smoke, are over 35, have high blood pressure and/or have a blood clotting problem) and women in menopause. Certain ethnic groups are more at risk, too, including Aboriginal Canadians and Canadians whose origins are African, Chinese, Hispanic or South Asian. In addition, lower incomes correlate with heart disease because social disadvantage increases the probability of experiencing heart disease risk factors such as diabetes, smoking and high blood pressure.⁴

According to the Canadian Chronic Disease Surveillance System⁵, ischemic heart disease is:

The leading cause of life years lost because of premature mortality
The second leading cause of disability-adjusted life years lost because of ill health, disability or early death

It’s important to emphasize that there’s more to heart disease than ischemic heart disease. Other conditions that reduce blood flow to the heart include angina, arrhythmia, atrial fibrillation, heart failure and more. That said, there are many things individuals can do to reduce their risk of heart disease as a whole and to better manage their condition if heart disease does develop. Meanwhile, pharmacists can play an important role in both the prevention and management of chronic conditions such as heart disease.

Pharmacists are often certified in various strategies for disease prevention

Beyond serving as medication management experts, pharmacists have the opportunity to become certified in skills that more broadly support patient health, including smoking cessation, alcohol use disorders and diabetes education – all of which may help people avoid getting heart disease in the first place. When it comes to heart health specifically, pharmacists can earn a certification in cardiovascular health coaching. Let’s look at how each of those skills can help promote heart health.

Smoking cessation

According to the U.S. Centers for Disease Control and Prevention (CDC)⁶, smoking increases the risk of cardiovascular disease – specifically, acute myocardial infarction, atherosclerosis, peripheral arterial disease, abdominal aortic aneurysm and stroke. Smoking cession, the CDC emphasizes, is “one of the most important actions people who smoke can take” to reduce cardiovascular disease risk.

When people stop smoking, the results generally include less inflammation and hypercoagulability, improved high-density lipoprotein (HDL-C) levels, reduced development and slowed progression of subclinical atherosclerosis – and, critically, reduced risk of death from heart disease. Even among those who already have heart disease, smoking cessation lowers the risk of death from all causes, the risk of death from cardiac causes, and the risk of additional cardiac events.⁷ So, smoking cessation programs facilitated by pharmacists can have a significant impact on heart health.

Alcohol use disorders

The Canadian Centre on Substance Use and Addiction’s recently released alcohol drinking guidelines communicate the risk of just one alcoholic drink per day on nine conditions. Interestingly, risk is lowered for ischemic heart disease among people who consume up to four drinks daily, and is neutral for those who consume five or six drinks daily – but the increased risk is 31% among those who consume more than six drinks daily.⁸ Responsible consumption of alcohol is very important to overall health, as well as heart health, and pharmacists can play an important role coaching people towards that, too.

Diabetes education

With diabetes, high blood sugar can start to damage the heart’s blood vessels, leading to heart disease, and block blood vessels leading to the brain, resulting in a stroke. According to the CDC, more than two out of three people who have diabetes also have high blood pressure – a risk factor for heart disease. Overall, the CDC says, having diabetes doubles the risk of experiencing heart disease or a stroke.⁹ However, working with a pharmacist to learn about diabetes and achieve specific targets for the “ABCDEs” can lower those risks (note that these targets may vary from person to person and should be discussed with your healthcare team). General guidelines for the ABCDEs from Diabetes Canada are:¹⁰

A1C – 7% or less (targets are different for pregnant women, older adults and children 12 and under)
Blood pressure – lower than 130/80
Cholesterol – under 2.0 mmol/L for LDL (“bad” cholesterol)
Drugs – consider medication to protect the heart
Exercise and eating – maintain regular physical activity and a healthy diet
Screening for complications
Smoking cessation
Self-management, stress and other barriers

Cardiovascular health coaching

Directly zeroing in on heart health, training in cardiovascular health coaching can help pharmacists support people with hypertension and dyslipidemia – two significant risk factors for heart disease. Often, a combination of medication and living a healthier lifestyle can prevent progression to more serious cardiovascular medical conditions. Training for pharmacists may include learning how to apply motivational interviewing to facilitate changes in behaviour, as well as pharmacological and non-pharmacological options for treatment.

Pharmacists are well positioned to help people with heart disease manage their condition

Pharmacists are often very well connected within a community and can direct people towards healthcare groups that draw on multiple professionals’ expertise to look at all angles of a disease – a good example is endocrinology clinics for people with diabetes and thyroid conditions. They can also suggest resources in the community, from running groups to seniors clubs to reliable information sources such as the Heart and Stroke Foundation of Canada and Canada’s Food Guide.

Annual medication therapy reviews conducted by a pharmacist can help patients who are taking multiple prescription drugs – as well as over-the-counter drugs, supplements and vitamins – assess everything in their medicine cabinet. These reviews make sure everything’s still needed and that there aren’t any anticipated adverse interactions. If a pharmacist has questions, they can contact the patient’s doctor, discuss the situation, advocate for the patient, and then let the patient know if there’s a change in plans.

On a practical level, pharmacists can help increase medication adherence to improve heart health. According to one summary of research,¹¹ most patients with cardiovascular disease do not take their medications as prescribed. Self-reported medication adherence to a combination of aspirin, beta blockers and a lipid-lowering agent sits at just 39%. Even immediately following discharge after acute myocardial infarction, close to one-quarter of people didn’t fully fill their prescriptions. Yet, “Patients with high adherence rates have a significantly lower risk of cardiovascular events compared with those with low adherence rates.”

One of the ways pharmacists can help with medication adherence is “compliance packaging.” That may be blister packs, pre-filled plastic containers, or strip packaging that is a roll of individual pouches listing the medication and the time it should be taken. This can help people of all ages remember to take drugs as scheduled – and avoid the possibility of doubling up on doses if they forget they’re already taken their medications. This type of approach can be especially valuable to remind people to continue taking drugs for conditions such as high blood pressure that are asymptomatic until there’s a crisis.

Looking more broadly, whether someone has diagnosed heart disease or not, pharmacists can recommend the lifestyle changes proven to reduce the risk of poor heart outcomes, including healthy eating, proper sleep, physical activity, stress management and limited alcohol.¹²

Pharmacists are frequently the most accessible healthcare providers

Conversations with pharmacists about heart health often start when someone is prescribed their first medication for a heart-related risk factor. Many times, people are surprised to be suddenly taking a medication and want to know what they can do to make themselves healthier so they don’t have to take it forever. Picking up that first prescription is an opportunity to ask about lifestyle changes that may reverse unhealthy markers such as high blood pressure or high LDL levels.

Those conversations can sometimes be more honest and upfront with a pharmacist than with a doctor because people’s relationships with pharmacists tends to be less formal and interactions are often less rushed. In addition, doctors don’t have the very specific expertise pharmacists have to talk about dosing, side effects and drug interactions – and knowing, for example, what to expect in terms of health benefits and side effects from a drug can help with medication adherence.

Compared to an in-person pharmacy, discussions may be even fuller and deeper with a virtual pharmacy simply because people can speak with a pharmacist from the comfort and privacy of home and their medicine cabinet is nearby if they need to check something. That said, community pharmacies generally have private consultation rooms that enable one-on-one, quiet and undistracted conversations between a pharmacist and a patient.

Overall, pharmacists globally have earned a lot of trust from patients. In multiple countries, they regularly make the top five most trusted professionals lists. In Canada, they tend to hover around number four.¹³ And, recently, several trends have been reinforcing that trust. For example:

During the early period of the pandemic, pharmacies remained open as essential services and pharmacists were often the only healthcare providers accessible to people
Pharmacists have proven adept at helping Canadians manage supply chain issues that restricted access to certain medications, whether by proposing medication switches when shortages affected an active ingredient or compounding pediatric solutions of unavailable fever medications in late 2022
Family doctors are starting to incorporate a clinical pharmacist into their practices and delegate the choice of medication and dose to them
Provincial governments have been expanding pharmacists’ scope of practice – most recently, with the Ontario government allowing pharmacists to prescribe medications for 13 minor ailments

When people connect with someone they trust and with whom they can have discuss their health in an open and non-judgemental way, they stand the best chance of achieving lifestyle changes and following instructions to take appropriate medications that lead to positive outcomes. When that professional is also accessible – whether that’s by dropping by a pharmacy with no need for an appointment or through a phone or online connection – it can make them the first choice for follow-up and course correction when something goes wrong.

Pharmacists can be valuable members of everyone’s healthcare team, with established expertise in medications, as well as certifications related to health promotion and community connections that round out the service they can offer. This Heart Month, whether you have diagnosed heart disease or not, chat with your pharmacist about all the ways they can support your heart health.