Scott Webb (Host): Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. And today, I'm joined by the manager of EvergreenHealth Ambulatory Services, Katie Brooks, and EvergreenHealth Pharmacist, Shilpa Korah. And they're here today to discuss the importance of managing our lipids and how EvergreenHealth can help us lower our cholesterol and just generally live healthier.

Host: So, I want to thank you both for joining me today. We're going to talk about lipid management. I'll start with you, Shilpa. You know, I think we're all fairly used to hearing that we need to manage our cholesterol, but we're not used to, you know, that word, lipid. So, how are lipids related to cholesterol? Why is it important to manage our high levels of cholesterol and so on?

Shilpa Korah: Absolutely. Lipid is just another word for fats or cholesterol that's in our blood. While our body needs these cholesterol to perform important jobs such as making hormones and building cells, high levels of these cholesterol can actually cause blockages in your arteries and increase your risk of heart diseases and stroke. Therefore, it is important to maintain healthy levels of cholesterols in our blood.

Host: Yeah, it is really important as somebody who takes his cholesterol pill, my statin every night, I sort of understand. Let's talk then, Shilpa, about the risk factors, you know, high cholesterol risk factors, what should we be on the lookout for, and how much of this is hereditary, that family history that we can't outrun versus particular lifestyle choices.

Shilpa Korah: Certain health conditions and your lifestyle and your family history can increase your risk of cholesterols, as you mentioned, and these are your risk factors. We can sort of divide them into two categories. First one being the non-modifiable risk factors, and these are the factors that you cannot change. So, an example would be your age. So, everyone's risk of high cholesterol goes up with age, and this is because your body may not be able to clear the cholesterol as well as they could when you were younger. For male, this is 45 years or older. And for females, this would be 55 years or older. Family history is another non-modifiable risk factor, as you mentioned, that hereditary factor. If you have high cholesterol or family history of high cholesterol, your heart diseases, you're more likely to have high cholesterol, you may need to get your cholesterol level checked more often than other people who may not have that family history.

The second category would be that modifiable risk factors. These are behaviors or lifestyle choices or healthcare conditions that can increase your risk of high cholesterol. Smoking is one of those modifiable risk factors, so are health conditions such as type 2 diabetes or high blood pressure. So, it is really important that we work towards controlling and managing these disease states as well. And diet and activity definitely is one of those modifiable risk factors, which is the cornerstone of managing your high cholesterol as well.

Host: Yeah. And Katie, let's talk about lipid management services that are offered, right? So, what typically leads someone, you know, to seek out those services? For example, if I have a family history that includes heart disease, would I be able to schedule an appointment with a pharmacist? Is there anything that would disqualify me, so to speak, from lipid management? Maybe you can take us through this.

Katie Brooks: Yeah. So in short, if cholesterol or lipids have been a conversation for you and your provider in the past, the EvergreenHealth management of lipids might be a really appropriate service for you. We see adults outside of pregnancy who are seeking in-depth discussion of their cholesterol, whether it be patients or folks who've never been on a medication before. They have a family history and they know this is an important conversation for them, or patients who are already on medications, ,maybe they've had side effects to medications in the past, and they're just not quite sure what the next step is. It all just starts with a referral. So on EvergreenHealth.com, we have a lipid management page and a referral attached there. And in that referral, you'll notice specific goals called out for your provider to note. And this is really just an opportunity for us to start getting an understanding of what you and your provider have already talked about, the goals that the two of you have already set or that team has already set, and allows us to become a part of that team to support that mission to improve your lipid control.

Host: Yeah. And it really does sound like a team effort. I'm wondering if you can tell us more generally what services are offered. You know, because when I think of a pharmacist and I actually have a really good friend who's a pharmacist, I normally think of just medications, that she puts pills and things and then we go and we get our pills because we need them. But it's more than that, right?

Katie Brooks: Oh, yeah. Absolutely. In Washington state, the practice of pharmacy is really progressive. So, we've got those pharmacists in our retail pharmacy doing a great job keeping us safe and making sure we've got the right medications. But we've also got pharmacists in these clinical or ambulatory roles sitting in your primary care clinics or specialty clinics, and they're seeing patients on schedules right alongside your providers. At EvergreenHealth, we've really embraced that as well. We have pharmacists in our primary care clinics as well as specialty care with scheduled appointments to have dedicated time with you to focus on a specific chronic disease state like lipid management.

Host: Yeah. And Shilpa, let's talk about that first visit. How long does it take? What can folks expect? Maybe you can just sort of lay that out for us.

Shilpa Korah: So, that initial first appointment with the pharmacist typically takes about 45 to 60 minutes, and this is that dedicated time that Katie was talking about where we use it to really get to know you and your medical history. So, we'll perform a limited physical exam including measuring your weight, height, blood pressure and heart rate. We'll review your medication history, go over your current medications. And we'll also talk about any previous cholesterol medications you have taken and any side effects you may have experienced from these medications in the past. We'll also review your current nutrition and your physical activity. And we'll review our records and obtain any additional labs if needed to establish a baseline cholesterol level for you. Once all that review is done, we will look at your specific cardiovascular risk, your risk for heart attacks or strokes, and we'll come up with a treatment plan that includes lifestyle modifications and, in often cases, appropriate medications as well. Our goal during that first visit and the following visits is to work closely with you and your provider to come up with a treatment plan that balances your personal preference and your health goals.

Host: Yeah. And it's really interesting to me. It almost seems like sort of a one-stop shopping, right? If we can meet with someone like you and basically go through this physical, this, you know, lipid management visit, that first visit, 45 minutes to an hour, and I'm assuming that folks then, and you kind of touched on this, they'll come back for a second visit, third visit and so on. Maybe you could sort of take us through that, the various visits and what you're trying to accomplish.

Shilpa Korah: Sure. After that initial visit, the timing of the followup visit will vary based on the patient's specific goals and treatment, but it is typically about six to eight weeks after that first visit. So at each visit, we will discuss patient's progress towards the goal and labs and any adjustment to your treatment plan. At the end of the visit, we will make sure that we have outlined a plan for you that includes how to implement the lifestyle changes and any adjustments for the medications, as well as an appropriate timeline for labs and followup visits. We'll also help schedule that followup visit at that time as well.

We do have some patients that will follow up long-term to help maintain that lifestyle modifications, but patients typically will continue to follow up with the lipid clinic until those goals are met. And again, this is really up to you and your provider to decide.

Host: Yeah. This has been really enlightening today. Like I said, I have a friend who's a pharmacist, but I really had no idea what you guys are doing there and how you're helping folks in this sort of great team effort. And Katie, I'm sure it happens sometimes that despite the healthy lifestyle adjustments and medications, that some folks that are cholesterol just stays high. I don't know if that's family history, genetics, you know, whatever it is. What kind of strategies do you implement to help folks who are doing everything they can, fighting the good fight on their end, and yet their cholesterol's still high?

Katie Brooks: Yeah. You know, it's an exciting time for lipid management because there are a lot of new therapies out there now that weren't there 10 or 15 years ago. So, one of the things that our pharmacists do spend a lot of time on and work really hard on is keeping really up-to-date with the new medications, what's available now, and what's coming as well, so that we can be on top of the next opportunity. So today, we don't have a great solution. We can try something else when that next option is open.

We've also got pharmacists supporting other disease state management. As Shilpa mentioned, sometimes reducing the cardiovascular risk is more than just the lipids. So if we're not able to get the lipids exactly where we want, what else can we do to help reduce your risk? Maybe that's helping to manage diabetes or high blood pressure, or to get you referrals to see a specialist about nutrition or other needs that may help support reducing that risk in other ways.

Host: Yeah. Well, as I said, this has been really great today. Nice to meet you both, learn more about what you do, lipid management services there and so on. So, thank you both for your time. You both stay well.

Shilpa Korah: Thank you, Scott.

Katie Brooks: Yeah. Thanks much for having us.

Host: And learn more at evergreenhealth.com/lipid-management. Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.