CVRM diseases include cardiovascular diseases (CVDs), chronic kidney disease (CKD), and type 2 diabetes (T2D). These interlinked health conditions have the potential to negatively affect each other.^1,2,3

Together with general practitioners (GPs) and specialists, pharmacists play a key role in the management CVRM diseases. 

Pharmacists are uniquely positioned within the healthcare environment to educate patients about their condition/disease and interconnection in CVRM diseases, explaining the reasoning behind the different medications used, dispensing these medications, encouraging the patients to be compliant when it comes to taking their medications, and providing ‘add on’ services such as measuring blood pressure (CVS), screening for blood glucose (T2D) and cholesterol (CVS), and determining proteins in urine (CKD). 

While pharmacological management of CVRM diseases, should be initiated by a GP or specialist, the type of medications to be taken should be taken is important for a pharmacist to know and understand. 

Some guidelines to consider when interacting with CVRM disease patients: 

• Understand and explain the reasoning behind the use of medicine used for CVRM diseases 
• Understand and explain the underlying links between the heart, kidneys, and diabetes (pancreas), (‘Triangle of Risk’), for example: 
• Management of T2D is closely linked with the risk of heart and kidney disease, and that the risks of all three are interconnected 
• Management of heart and kidney conditions, and diabetes risks is crucial – requires a holistic approach 
• Understand the role of kidneys in filtering the blood of toxins. This filtering process is linked to the cardiovascular system (CVS)
• Explain to T2D patients that their risk of developing heart disease and CKD are increased and educate on how to improve the outcomes e.g.:^3,4 
• The importance of being compliant with taking their medication 
• Regular testing of their blood glucose is important to ensure optimal glucose levels 
• Emphasise and encourage patients about lifestyle management changes e.g. weight management, stop smoking, eat healthy, exercise regularly.² 

Pharmacists play an important role in the management of CVRM diseases and should always stay abreast of the latest information regarding the CVRM diseases. An understanding of the interlinks between the CVS, CKD and T2D can contribute to comprehensive patient care. 

REFERENCES 

1. Organs Talk. About the interconnectivity of organ systems. Available at: https://www.organs-talk.com/ - accessed: 23 May 2023
2. Sarafidis P., et al. SGLT-2 inhibitors and GLP-1 receptor agonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease. A consensus statement by the EURECA-m and the DIABESITY working groups of the ERA-EDTA. Nephrol Dial Transplant. 2019;1;34(2):208-30.
3. American Heart Association (AHA) and the American Diabetes Association (ADA). KnowDiabetesbyHeart. Diabetes, your Heart and Kidneys; a Triangle of Risk. https://www.knowdiabetesbyheart.org/articles/diabetes-your-heart-and-kidneys-triangle-of-risk/ - assessed: 23 May 2023
4. American Heart Association (AHA) and the American Diabetes Association (ADA). KnowDiabetesbyHeart. Heart Health: The link between Type 2 Diabetes and Chronic Kidney Disease. Available at: https://www.knowdiabetesbyheart.org/wp-content/uploads/2022/12/89159_KDBH_Kidney_HeartHealth.pdf - accessed: 24 May 2023