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Welcome to the Quick Consult podcast, brought to you by Metall. Before starting this podcast, please review the faculty information, disclosure statements, and learning objectives using the link in the episode description. To claim your CME credit, complete the evaluation using the link in the episode description. This podcast is a continuing education activity managed and accredited by Affinity CE in collaboration with META. This activity is supported by an independent medical education grant from MSD. Welcome back to the final episode of Lipid Talk. We've covered cumulative risk and identifying high-risk groups in our previous episodes. Today we focus on the most important partnership in care, the clinician-patient relationship. The goal of this episode is shared decision making, partnering for better outcomes. Specifically addressing the gap where the implementation of shared decision making remains limited in lipid care. I'm pleased to have Doctor Christopher Cannon back with us. Doctor Cannon, thank you for uh completing this series with us. Certainly, it's a delight to, to talk with you. Guidelines recommend shared decision making for initiating lipid lowering therapy, yet many clinicians report limited use. Often citing time constraints. In a busy practice, why is shared decision making so vital for a chronic, often asymptomatic condition like hyperlipidemia? Um, it is a key factor, I think, in this disease because we have to overcome a lot of misinformation that people have read about, oh, it's not that important, and um we know that we're worried about our higher risk patients and we have to really convey that to to the patient. Um, you know, this is a very good evolution in medicine to approach it as shared decision making, that it's not a paternalistic, the doctor says thou shalt take these three medicines and just do what I say, uh, to a discussion, to say, here's what I'm worried about, we have signs of atherosclerosis, or your LDL is sky high and Um, and that can lead to heart attack and stroke, and you don't want that. I don't want that for you. Um, and there are lots of ways that we can work together to, to avoid that. And so being very practical and. Open discussion, I think is a key component to engage because this is a lifelong commitment to taking medications often and often, you know, healthy lifestyle is a day to day, um, you know, commitment. So we have to spend time to to do that. We asked our patient advocate Julie Stevens for her view on this from a patient's perspective, what does a truly successful conversation about your lipid management look like? What specific things does a healthcare professional do or say that make you feel heard and like an active partner in your own care? Yeah, I think, I think to, to feel like it's a successful conversation, like you said, is, is really to be treated like a partner in. As a part of the care team, I really appreciate it when my healthcare provider explains things to me and like really teaches me about my condition and And tells me why treatment matters, why we're doing the course of treatment and the medication that we're doing. Um, it gives me confidence in our treatment plan and also when my healthcare provider really takes the time to ask me about my concerns, ask me how I'm doing, and treat me like a person, and that he actually cares about my well-being, I think that leads to successful talk about lipids and stuff like that. Doctor Cannon, what are some practical low time commitment techniques or tools that clinicians can use to foster genuine shared decision making in lipid care? For instance, how do you effectively balance guideline adherence like aiming for an LDLC that's less than 55 for very high risk patients, uh, with the patient's values. Well, I, I have grown up involved in trials and things and so evidence and showing the data to, to, I don't expect the patient to just do what I say because who am I, you know, that, that, uh, but if I can share with them, you know, we did a study and it showed this, or there have been 10 studies that each one shows the same benefit. Um, that, that's, I think, a powerful, useful way, um, to, uh, to share all of our knowledge with them, so they understand what we understand. The other practical thing is that I have printed out a set of picture from a colleague's article on atherosclerosis with a plaque, uh, and I pull it out and I say, OK, here's what we're talking about. Here's a normal artery. Here's one with a big plaque. That's sitting there with lots of cholesterol, and then here's one after a year and a half or so of intensive lowering of the cholesterol with much less cholesterol, and I explained, this is where you are now, this is where we want to get you, and we can get you there, and then share how it all relates to the LDL level, and so really walking them through the story so they can see it, um. And I think, you know, the last part of your question was with their values, um, you know, we, we sometimes as physicians get feedback the patients say after the visit, and the best one that, that I appreciate hearing, and, and I try to strive to get is that he listened. And that I thought, OK, that's what I want to do. I want to find what are the patients' values, what do, do they want, and what have they been thinking about, and how do they approach that. And so that's how to engage with the patients to further along the discussion. And so it becomes a really rewarding discussion to impart such good information, and, and it's helpful, it's a positive message, and And very often, after I've showed this picture of the patients, you know, no one's ever explained this to me before, um, and so if they can understand really the biology and the, and what we're doing, that I think is sort of an aha moment for patients to say, OK, I get this, I, I I've figured this out, I've, now we just got to do it. From the patient's side, starting a long-term therapy can be daunting. Uh, Julie, what are the biggest real world barriers to starting or staying on a therapy, whether it's concerns about side effects, cost, or just understanding why it's so important? Yeah, so some barriers for me that I've dealt with personally is I, I sometimes feel overwhelmed by how much medication I have to take. I do an injection every 2 weeks, I take 2. Cholesterol-lowering pills, a low-dose aspirin every night. And it just gets to be a lot having to, to remember to take them and then to get them refilled and take them, and it's just long-term, it just feels like a lot. Also, it cost, insurance was a big deal too. Insurance denied my injections a couple of times, so it took months of appeals to get Through to that. Luckily for me, I haven't had much issues with side effects. I do know that is a big barrier for some people. My sister, specifically, my son's had a couple issues. And then also, I know out there, there are some misconceptions about cholesterol and how to treat it and statins in general. And I think that can be a barrier for some people too. Doctor Cameron, statin intolerance is a major barrier to adherence and is often cited by patients. How should clinicians approach this issue, especially since a significant portion of muscle pain is often not actually related to the statin? What are the key steps in a statin intolerance workup and re-challenge? So this is definitely true that this is a major barrier. Um, and one thing is starting with acknowledging that this is real. It's not fake, you know, that there are, you know, 10% of people who do have statin-related muscle aches. I say, and I say, you know, I have them too, that I have non-statin related muscle aches. And uh so sorting out which is which is, is part of what we'll do. But then I walk through with patients that together, we're gonna do a test and see, you know, uh, have to take the statin, do you feel muscle aches, let's stop it for a month, see if they go away, and then we'll restart it and see if they come back. And if so, then you and I will know that the statins at whatever dose don't agree with you. And so, you know, I emphasize that it's not harmful and we have time, thankfully with cholesterol is a long-term issue, so take a month or two to figure this out together um is a, is a great way to try and work through the issue. The