PQS Quality Corner Show

An Overview of ASCVD Risk Assessment

January 31, 2023 PQS Season 4 Episode 2
PQS Quality Corner Show
An Overview of ASCVD Risk Assessment
Show Notes Transcript Chapter Markers

For this upcoming heart health month,  Emily Young, PharmD, BCPS, BCCP, Cardiology Clinical Pharmacist Practitioner joins the Quality Corner Show to talk about Atherosclerotic Cardiovascular Disease (ASCVD) Risk Assessment  with Podcast Host Nick Dorich, PharmD, PQS Associate Director of Pharmacy Accounts.

In this episode, Young explains a comprehensive approach to managing lipids and how that guides a treatment plan, and the typical medications involved.

To estimate risk for ASCVD, here's a link to the American College of Cardiology's Risk Estimator Plus. 

00:00:01:00 - 00:00:27:05
Speaker 1
I'm really pleased with the shift in our guideline recommendations away from targeting a specific cholesterol number towards focusing on the individual patient's risk like we were taught in pharmacy school. Treat the patient, not the number. So why should cholesterol management be any different? Because for me, improving outcomes for patients is all about the patients living longer, free of preventable cardiovascular events and free of unpleasant medication.

00:00:27:05 - 00:00:29:11
Speaker 1
Side effects.

00:00:31:19 - 00:00:56:13
Speaker 2
Welcome to the Pharmacy Quality Solutions Quality Corner show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medication use and health care. We will hit on trending health topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the equip platform can help you with your performance goals.

00:00:56:22 - 00:01:18:10
Speaker 2
We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of reporting. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on.

00:01:18:10 - 00:01:20:12
Speaker 2
The Quality Corner show starts now.

00:01:33:03 - 00:01:56:07
Speaker 3
Below Quality Corner Show listeners. Welcome to the PQS podcast, where we focus on medication use, quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dortch, and on this episode we are talking about cardiovascular health. Now February is Heart Health Month and of course February 14th is Valentine's Day, which is all about our heart.

00:01:56:14 - 00:02:14:12
Speaker 3
Now, quick reminder for our listening audience if you haven't already, by the time this episode comes out, you still have time to get a gift for your significant other. But also don't forget about your mother most important person in your life. Don't forget about Mom for Valentine's Day. So you still got time to place that order. Make sure it arrives to them.

00:02:15:03 - 00:02:43:09
Speaker 3
But as it goes to our topic today, the focus is going to be on a specific part of cardiovascular or heart health, and that's going to be related to cholesterol management, new medications. We're talking about hyper lipoedema and what we want to do for treatment to prevent bad events and bad outcomes for those patients. Now, our guest today is Dr. Emily Young, and Emily is a cardiology clinical pharmacist practitioner at the Department of Veterans Affairs.

00:02:43:20 - 00:02:47:06
Speaker 3
Emily, welcome to the show. And how are you doing today?

00:02:47:06 - 00:02:53:20
Speaker 1
Thanks so much for having me. I'm really excited to be here with you bright and early in the morning.

00:02:53:20 - 00:03:20:21
Speaker 3
Earlier morning than usual for myself as well, recording this episode. But that's what the schedules allow and excited to really get the blood flowing here for this conversation today. Now, Emily, before we get into the topic, we're going to be again talking about cholesterol management and managing patient outcomes. We need to know about you. So I provided your title at the Department of Veteran Affairs, but do you mind giving us a little bit more information about your career, your background in health care, and then what it is that you do today?

00:03:21:03 - 00:03:44:10
Speaker 1
Absolutely. And Nick, as you know, I graduated a year after you at the University of Rhode Island College of Pharmacy with my pharm.d. After that, I completed my PGI one pharmacy residency at the VA Tennessee Valley Health Care System in Nashville, Tennessee. Went on to my PGI two cardiology pharmacy residency at the VA in West Palm Beach, Florida.

00:03:45:06 - 00:04:23:21
Speaker 1
Since completing my training, I've worked at multiple VA medical centers, including the Durham, North Carolina, VA back to the Nashville VA, and most recently, I now serve in a role with the Pacific Sierra Network of Veteran Affairs medical centers in California, Nevada and Hawaii. My roles as a clinical pharmacist practitioner in cardiology at these facilities have varied from cardiac ICU transitions of care for cardiology patients, PGI two cardiology pharmacy residency program director and currently my role is in telehealth cardiology pharmacotherapy with an emphasis on those telehealth modalities.

00:04:23:21 - 00:04:42:23
Speaker 1
In my role, I work directly with patients under a scope of practice to optimize cardiovascular medications for conditions including heart failure, coronary artery disease, hyperlipidemia. And as a disclaimer before we go further, please note that all my opinions that I expressed today are my own and do not reflect the beliefs and opinions of my employer.

00:04:42:23 - 00:05:06:12
Speaker 3
All right, Emily, thanks for the introduction. And yes, excited to have you on the show today. We do have experience working together, as you had mentioned, have known each other for I'll say it's a long time and it's one of the fun things for me about the podcast. This is a topic that we wanted to focus on early in the year, and it was an area of us, a focus for us at the Quality Corner show to talk about heart, health, cardiology.

00:05:06:21 - 00:05:23:19
Speaker 3
So it was a real treat for me when doing my research on LinkedIn to find and reach out to some of get some of these guests that I saw. Your name was able to reach out and it was very excited that your interest to appear on the show was was genuine and that we could show up for this episode recording.

00:05:23:19 - 00:05:33:14
Speaker 3
So it's enough for the preamble. We're going to go into our episode, but before we do, we're going to hear a quick message from the PQS team.

00:05:33:14 - 00:05:57:14
Speaker 2
Now it's time for the breakdown as quality corner show host little as three main topic questions. Our guests will have a chance to respond and there will be some discussion to summarize the key points. This process worksheet for the second and third questions which will wrap up the primary content. So this the 14 after that, it's next in on the closing summary, usually containing a bonus question.

00:05:58:03 - 00:06:05:01
Speaker 2
Now that we have the start of the process, let's jump into the questions.

00:06:05:01 - 00:06:25:22
Speaker 3
All right, Emily, we're back and we're ready for the questions with today's episode. Now we know patients, we know health care providers. Everyone is focused on heart health. We know this. And in many cases for health care and patient treatment, we focus on guidelines, clinical guidelines. When do we start treatment? When do we change dosing? When do we stop a medication?

00:06:26:03 - 00:06:45:22
Speaker 3
All of those different things. And this is going to be how we look at a patient care for the duration of their treatment. But when it comes to managing cholesterol, when it comes to managing cardiovascular health, that's also not quite what we do anymore. You know, as we were prepping for this episode, we had some back and forth into how we wanted to present this topic.

00:06:45:22 - 00:06:58:14
Speaker 3
But I'd like to really just have you dive in. And can you help us explain the comprehensive approach to managing lipids, how we guide a treatment plan, and why it may not necessarily have to do with specific clinical guidelines?

00:06:59:11 - 00:07:35:00
Speaker 1
Absolutely. In the last decade, the guidelines have really moved away from treating just the cholesterol panel or the numbers of a patient's cholesterol. And we've really shifted our focus to specifically recommended therapies based on targets for an individual's comprehensive assessment of atherosclerotic cardiovascular disease risk, or sometimes you'll see that abbreviated as CVD risk. So this includes determining if the patient is primary or secondary prevention for one of those ascvd events that includes heart attacks.

00:07:35:01 - 00:08:02:01
Speaker 1
Strokes are symptomatic peripheral artery disease and whether or not the patient has had any of those in the past. And then looking forward over the next ten years, what is the patient's risk for developing one of those? So based on that initial risk assessment, that's what guides our treatment approach of what therapy is recommended. If therapy is recommended, and then what intensity of therapy is recommended.

00:08:02:01 - 00:08:36:12
Speaker 1
And when I say intensity, some of us who trained before this change might think, what's the LDL goal? But really that's not what we're focusing on anymore. It's about what intensity of statin therapy, statins, our first line therapy, which is a little bit jumping the gun, but what intensity of statin therapy we're expecting that patient to need. So unlike previous when you would look at their cholesterol and say, okay, let's start low and push the dose up to get them to a target, we're just going to start them right off on the intensity of therapy that's expected to be needed and give that benefit.

00:08:37:01 - 00:08:58:16
Speaker 1
Now, of course, that's not to put away our lifestyle recommendations, diet, exercise across the board, tobacco cessation. All of those things are also going to help reduce that risk. So we want to be including those in our treatment regimens. But depending on that level of risk, sometimes we'll start with primary or we'll start with lifestyle recommendations for a lower risk primary prevention patient.

00:08:59:07 - 00:09:07:11
Speaker 1
Otherwise, you know, if somebody had heart attacks or strokes in the past, we're going to incorporate starting the therapy right away along with those lifestyle recommendations.

00:09:07:22 - 00:09:29:16
Speaker 3
Excellent. And Emily, that really does check out to me and I'm sure that will also match the expectation of many of the listeners, folks that are familiar with quality measures related to cardiovascular health and lipids. You may see this in the forms of quality measures like statin use in persons with cardiovascular disease where a patient is going to be or you should be initiated on a moderate or high intensity statin therapy.

00:09:29:23 - 00:09:56:10
Speaker 3
Same thing with another measure like Statin use in persons with diabetes. That's another one where there are different levels of statin intensity therapy. But really any stat in there can be a good one. But depending upon the treatment plan, that may change. Now, Emily, before we go to the next question, quick follow up for you. Now these recommendations and the risk assessment, you know, that may change and we don't want to necessarily call out specific items to our audience.

00:09:56:16 - 00:10:09:19
Speaker 3
So where would you be looking for information or for our pharmacist, for our for our practitioners that are out in the field? You know, where would they go and find this information to find the latest recommendations on these risk assessments?

00:10:09:19 - 00:10:35:13
Speaker 1
Absolutely. That's a really important question because these guidelines do get updated every few years. The current iteration is the American Heart Association and American College of Cardiology is cholesterol management guidelines. The most recent version at the time of this recording is the 2018 guidelines for that. But like I said, they updated in 2013, again in 2018, so we could be getting another iteration here soon.

00:10:35:22 - 00:10:51:06
Speaker 1
There is also a newer guidance 2022 American College of Cardiology Expert consensus decision pathway for non statin therapy. So that could also be a helpful resource as we move into the newer therapies.

00:10:51:15 - 00:11:11:16
Speaker 3
Great. Thanks, Emily. So for folks that are wanting to read this, Emily gave you the gave us the rundown where we can look, but it sounds like we may have new information. It's probably due for an update. So definitely keep a look on that. Keep a look out for that, whether it be this year or next year. Emily, I'll move us to our next question for for for today.

00:11:11:16 - 00:11:36:14
Speaker 3
And when it comes to treating and managing patients, just like most disease states, there is going to be an approach for nonpharmacologic treatment and prevention. But at some point we may need to initiate therapy, right? This is where we're going to need to bring in the pharmacist. We're going to need to optimize. We'll start a medication therapy, optimize that therapy, mitigating any side effects, optimizing the clinical benefit, the therapeutic benefit for the patient.

00:11:36:21 - 00:11:57:11
Speaker 3
And this is an area where at least since you and I graduated from pharmacy school, there's been a number of updates you medications. So I will say for myself, this is an area where over the last decade plus, I've definitely had to do my own personal reading into what these new medications are. Are there a mechanism of action, how they're used, why they're used, etc.?

00:11:57:11 - 00:12:11:04
Speaker 3
So do you mind giving us a starting point, perhaps a quick overview when it comes to treating patients and managing lipids, what medications are typically amended, what may be new to the market?

00:12:11:09 - 00:12:43:01
Speaker 1
Absolutely. So standards are definitely our cornerstone of therapy. And you'll notice in the last two iterations of the cholesterol guidelines, I mentioned that there's that focus on the intensity of statin. And just to give you a rundown of what that intensity relates to, there's low, moderate and high intensity statins and what classifies a particular statin and the dose into one of those intensities is the percent reduction of LDL that's expected with that therapy.

00:12:43:11 - 00:13:04:19
Speaker 1
So depending on like we talked about the patient's risk for any CVD event, they get assigned to a category or an intensity of statin that would be expected to give them the optimal balance of benefit and side effects. So statin therapy overall very well-tolerated. You do hear some people talking about they should just put it in the water.

00:13:04:19 - 00:13:33:07
Speaker 1
But we do know that there are some patients who don't tolerate it as well. The most common thing would be muscle aches or myopathy. These are generally mild and can be addressed by adjusting the dose or even the frequency of longer acting statins. You could even consider every other day dosing for some patients. But when we do make those dose reductions, that's when we need to consider are we achieving that percent reduction that we're expecting to see based on that person's risk?

00:13:33:22 - 00:14:01:08
Speaker 1
And once we get to that point that the patient is on their maximally tolerated stand, that's when we need to consider if additional nonstandard therapies might be beneficial. So without those goals, we're looking first at the percent reduction achieved in their LDL. And then if we're not achieving that ideal percent reduction, we're going to consider compliance. Did we need to make a dose reduction before we think about adding on a second medication?

00:14:01:21 - 00:14:20:05
Speaker 3
Excellent. Emily Well, now, since we've covered the statins as that primary treatment item, what about new medications? So there's a number of new medications. My big question, as I wrote it, was, are they first line options or are they first line options yet? We already know the answer to that is no. But they are another tool in the toolbox.

00:14:20:05 - 00:14:25:02
Speaker 3
So when are they considered and how how do they work? How do they help these patients?

00:14:25:08 - 00:14:57:13
Speaker 1
Perfect. So the first line option of the non standard therapies is not really a new medication as Ed Imbibers that has been on the market for some time. And the guidelines do recommend that usually as our first line option for a non standard therapy just because of the value based benefit that it gives. However, when we look for a more robust LDL reduction, if it's needed for adding on to the statin therapies, the PCSK9 inhibitors are still considered the new kids on the block for lipid therapy.

00:14:57:13 - 00:15:31:19
Speaker 1
For many providers with Alirocumab or Praluent being the first in class to be FDA approved in 2015, followed not long after by Evolocumab or REPATHA. But there continue to be advancements. The two latest additions are Inclisiran or Leqvio and Bempedoic acid or Nexletol. To summarize about these agents, PCSK9 inhibitors interfere with LDL receptor binding, which ultimately leads to an increased availability of LDL receptors, and that dramatically lowers LDL cholesterol levels in the body.

00:15:32:06 - 00:16:04:10
Speaker 1
So Alirocumab and Evolocumab are fully humanized monoclonal antibody PCSK9 inhibitors, and they're dosed subcutaneously injected injection by the patient every 2 to 4 weeks. But the new additions include Syrian uses the same PCSK9 inhibitors mechanism, but it's formulated as a small interfering RNA therapy, allowing for subcutaneous injection usually by the provider in their office initially every three months, but then it's quickly extended to every six months for a long term therapy.

00:16:04:18 - 00:16:38:01
Speaker 1
And so for patients who might struggle with compliance or giving the injection to themself at home, this may be a great advancement in terms of options for their therapy. The PCSK9 inhibitors are expected to get an additional 60% reduction on LDL on top of a statin therapy. So when we look at if this impacts major adverse cardiovascular events, we do know that the monoclonal antibody PCSK9 inhibitors do give a significant reduction, but they don't independently reduce mortality.

00:16:38:14 - 00:17:05:12
Speaker 1
INCLISIRAN does have some data demonstrating its significant LDL cholesterol reduction, but the outcome trials are still ongoing. So that one we'll have to wait to see when we think about them. Piddock Acid, the other new agent on the block. This is a first in class ATP citrate inhibitor which the FDA approved based on modest LDL cholesterol reduction. When combined with maximally tolerated statins with or without is atomized.

00:17:06:12 - 00:17:33:14
Speaker 1
You can also see that the clear outcomes trial has been completed. If you look for it, and the manufacturer announced in December of 2022 that the primary end point for major adverse cardiac events did demonstrate statistically significant benefit. But the presentation and publication of those outcomes are expected early this year in 2023. So again, we'll have to wait to see the full benefit that we're going to see with this new agent.

00:17:33:23 - 00:17:53:20
Speaker 3
Excellent. Well, thank you, Emily, for the response there. And again, the key part here, new medications. There are definitely options or other treatment parts that can be considered. But when it comes to lipid management, still primary place to go, statins. So the way I think the way this is described in a lot of ways, like the more things change, the more some things stay the same.

00:17:54:01 - 00:18:24:17
Speaker 3
We're still wanting to use and optimize that statin therapy as that first building block for patient management. Now, Emily, at the quality Corner Show, our focus is on medication use and it's on quality improvement in health care. And this episode happens to really feature both of those aspects. So our final question in our conversation with each guest, it's the big question and we're going to frame it today in in a way that is appropriate for what we've talked about here, lipid health or lipids, cardiovascular health.

00:18:24:24 - 00:18:33:03
Speaker 3
So for patients, when we're treating hyperlipidemia and for you as a clinician, what does improving patient outcomes mean to you?

00:18:33:18 - 00:18:56:03
Speaker 1
That's a great question. I love that. That's the big question. And really from everything that we've talked about, I'm really pleased with the shift in our guideline recommendations away from targeting a specific cholesterol number towards focusing on the individual patients risk. Like we were talking pharmacy school treat the patient, not the number. So why should cholesterol management be any different?

00:18:56:10 - 00:19:25:21
Speaker 1
Because for me, improving outcomes for patients is all about the patients living longer, free of preventable cardiovascular events and free of unpleasant medication side effects. So sharing not just how the medication will impact a patient's cholesterol panel, but also what they can expect in terms of the benefits for actual things that the patients care about in their lives empowers the patient to be engaged in their care, contribute to making their medication decisions.

00:19:26:03 - 00:19:48:12
Speaker 1
So an example of this, I had a patient who had had multiple heart attacks in the past, but none in the last several years. And so when we talked about, you know, his LDL control, he was right above that 70 mark that we hear and see in the current guidelines on his high intensity statin. So he was like 71 or 72 milligrams per deciliter.

00:19:49:00 - 00:20:13:02
Speaker 1
So we sat down and we talked about, you know, this is where your LDL is, this is your level of risk. We can add on an additional medication to get a little more LDL lowering. This is the types of benefits that you can expect. These are the potential side effects. And he was able to process that information and contribute to his own decision making and say, you know, right now that's totally worth it for me.

00:20:13:02 - 00:20:37:13
Speaker 1
Let's go ahead and add on that additional medication. But he could have just as easily said, you know, I don't want to add another medication or another copay might be a big burden for me. So empowering the patient to be a part of their own care and guide some of those decisions when it's appropriate. So I like being able to, you know, get a patient thoughtfully considering their medications and contributing to the decision.

00:20:37:15 - 00:20:39:06
Speaker 1
That's really the best thing for me.

00:20:40:04 - 00:21:12:01
Speaker 3
Yeah, it is the patient's health, right. And I do appreciate that that is a change in the thought process that starts with us as the health care practitioner, as the provider, But it's a collaborative decision making with the patient. What do they want from their health? What are they expecting and when it does come to the Ascvd risk score, there are some elements that the patient is is not going to be able to change right where we have not yet reached a part where we can reverse the aging process or change someone's A's.

00:21:12:01 - 00:21:32:02
Speaker 3
Right. That that cannot be done. And there are going to be some other elements that have a role in this. But things like the blood pressure, cholesterol levels, what is their status with management of diabetes if they have if they are a patient that do have other comorbidities, what's the smoking status? So it goes really through that process and you can have that conversation with the patient.

00:21:32:02 - 00:21:51:14
Speaker 3
Well, if you're able to do X, Y or Z or maybe some of those items in combination, how does that go to reducing their risk? And when we look at their risk, it's typically presented as what's the what is that risk of having an event within X period of time. So really being able to have that conversation, what are their priorities in life?

00:21:51:14 - 00:22:13:11
Speaker 3
What do they want to achieve? And then I would explain it. It's almost like one of those choose your own adventure books, but for the patient, right? Which path did they want to go down? What do they want to commit to? So, Emily, from your experience and those of the providers that you work with, I would have to imagine, even for you as a health care practitioner, it's also in its way, in its own way, a more fulfilling experience for providing patient care, correct?

00:22:13:19 - 00:22:34:09
Speaker 1
Absolutely. Nobody wants to be the provider who just sits there and doles out pills all day that that a patient doesn't really want to take. So, you know, being able to engage the patient and talk with them about, you know, what their goals for their care are and helping them understand the expectations of what this medicine could do for them.

00:22:34:16 - 00:22:39:24
Speaker 1
That's really, you know, empowering to the patient and that gives that satisfaction back to me.

00:22:40:07 - 00:23:04:12
Speaker 3
Excellent. Well, Emily, that wraps up our questions for the key content of today's episode. And when we came into this episode and when our team of us was planning, it was originally well, let's talk about lipids, let's talk about lipid treatment. But in setting up this episode with you as our guest, it very quickly tuned. It changed the tune to becoming what we need to talk about risk assessment, how we're treating the patient.

00:23:04:12 - 00:23:36:20
Speaker 3
And that was even better for me as a topic because it really thinks about what we focus on here at the USDA. So real quick, as far as summary for all the listeners that are out there, I just items that we discussed treatment guidelines for for lipids, cardiovascular health aren't necessarily the way that we go anymore. What we're specifically looking at is the ascvd risk, and that's going to be looking at the patient's risk of a cardiac events such as a heart attack or stroke, and trying to find the right treatment plan to help that patient reduce that risk.

00:23:36:20 - 00:24:07:06
Speaker 3
That can be done in a number of ways, both through treatment but also lifestyle modifications. As Emily had noted, our statins are going to still be the primary form of treatment, although there are additional medications that can be considered. And then the big item that I really love to reiterate here, and in closing from this episode, is that this really does become a collaborative treatment plan between the provider and the patient onto how and why they are making those changes to the patient can live their life to the fullest.

00:24:07:14 - 00:24:33:22
Speaker 3
So great content, great episode that's here. As in addition, as Emily noted, for more information on guidelines, you can check out those guidelines and information from the HRA and the American College of Cardiology. Fingers crossed. I think maybe that there's going to be updated guidelines here that are that are imminent. So the information may be changing. We always recommend our folks to look at the latest information, latest treatment guidelines.

00:24:34:04 - 00:24:47:21
Speaker 3
But Emily, before we go, we do have to end with a couple of fun questions for you to help get to know you as the person and not just as the pharmacist that's here today. So are you ready to go with our quick fire questions?

00:24:48:03 - 00:24:49:08
Speaker 1
Ready as I'll ever be.

00:24:49:22 - 00:24:59:03
Speaker 3
All right. Well, this one is a good one, and I'll be interested in the answer given that we are recording this basically first thing on a monday morning, is it better to be a morning person or a night owl?

00:24:59:13 - 00:25:20:06
Speaker 1
Well, since I selected the time, I'll admit that I used to be more of a night owl. But in the last several years, especially growing my family, I have been forced into shifting to being a morning person. So after that first cup of coffee, I'm generally pretty ready to go hit the ground running. And at the end of the day, I can take it easy.

00:25:20:16 - 00:25:25:17
Speaker 3
Excellent. Next question. Do you prefer to read the book or watch the movie?

00:25:25:22 - 00:25:37:10
Speaker 1
Well, the book is generally better, so I often opt for the audiobook as a first line to save time. And then eventually I'll get around to watching the movie.

00:25:38:04 - 00:25:58:19
Speaker 3
Got it. The audiobook does count as a book. Just for the record, I may have to adjust my my question or how it's presented to allow for that, since that is a becoming a more frequent mode of enjoying the book. Next question What is your recommendation for living a healthy life? And Emily, I'll clarify your answer does not need to be specifically related to cardiovascular health.

00:25:58:23 - 00:26:01:08
Speaker 3
If you want to go beyond that topic, you are allowed to.

00:26:01:18 - 00:26:22:23
Speaker 1
Well, I'm glad you allowed me to expand beyond it, because I think for me, living a healthy life is about thinking about all of the ways that we can be healthy and then prioritizing them. There's so many ways to be healthy that's exercising, eating right, you know, meditating, having personal time, taking care of your family and your friends.

00:26:22:23 - 00:26:36:13
Speaker 1
And so for me, it's really important to reflect on my priorities and determine what's going to be that top priority so that when it comes to my health, I actually make, you know, the top priority a priority and make time for it.

00:26:36:20 - 00:26:52:02
Speaker 3
Emily, your response sounds in a lot of ways kind of like it's a modified version of an ascvd risk assessment and what step or what plan you're going to take. Right? We can't do everything in the world. There's not enough time to do all the things like that, especially like, as you said, you've got family. Other people need to take care of.

00:26:52:02 - 00:27:02:10
Speaker 3
And sometimes that means sacrificing one's health at points for for others. Right. And when you do have the time to focus on yourself, you know, what do you do? So you can do it, but you do it Well.

00:27:02:18 - 00:27:06:00
Speaker 1
Exactly. So high intensity meditation for me right now.

00:27:07:11 - 00:27:13:08
Speaker 3
All right. Last question here for this section. What is one goal that you are currently working towards?

00:27:13:16 - 00:27:34:12
Speaker 1
So it fits really nicely in with that last section. I recently started working remotely with my most recent job change, so I'm working on finding ways to be active while I work. So that includes using my standing desk to its fullest capacity and seeing if I can master the walking pad without falling on my face.

00:27:35:09 - 00:27:51:16
Speaker 3
As someone that does also work remotely, Emily, I can tell you that I've been through that experience standing desk, you know, just even trying to walk in place. It's a little bit different from when you and I work together in a in a pharmacy, in a community pharmacy setting. You were at the computer doing drug, you know, medication input, prescription input.

00:27:51:19 - 00:28:14:06
Speaker 3
Maybe you're at least walking around being at home. It's very easy to become sedentary. So best wishes to you for you to keep to that goal. And the next time we chat outlook to get an update from you. Sounds like Emily. Yeah thank you. Well, and I think thank you for being on the episode today. I really appreciate you coming on to talk about this topic and treatment risk assessment for for patients.

00:28:14:19 - 00:28:23:11
Speaker 3
Before we close, we may have folks that want to hear more from you or may want to get further information about the items that you discussed today. So how can folks contact you?

00:28:23:11 - 00:28:29:21
Speaker 1
Absolutely. The best option to reach out to me is on LinkedIn. I'm Emily Young, Pharm.d. On LinkedIn.

00:28:30:03 - 00:28:45:18
Speaker 3
Excellent. Well, folks, with that, we have wrapped up today's episode and we thank you for joining us on the Quality Corner Show. Thanks for listening. We'll be back with you for another episode in a couple of weeks. Until then, we have one final message from the PQS team.

00:28:46:14 - 00:29:07:10
Speaker 2
The Pharmacy Quality Solutions, Quality Corner Show has a request for you. Our goal is to spread the word about how quality measurement can help improve health outcomes. And we need your help in sharing this podcast to friends and colleagues in the health care industry. We also want you to provide feedback, ask those questions and suggest health topics you'd like to see covered.

00:29:08:04 - 00:29:30:09
Speaker 2
If you are a health expert and you want to contribute to the show or even talk on the show, please contact us. You can email info at pharmacy quality dot com. Let us know what is on your mind, what we can address so that you are fully informed. We want you to be able to provide the best care for your patients and members, and we wish all of you listeners out there well.


Introduction
What is the Approach to Managing Lipids and How Does that Guide Treatment?
Overview on Statin Medications
New Medications
Question for Guest: What Does Improving Outcomes Mean to You?
Closing