Impact of Lipid Monitoring on Treatment Intensification of Cholesterol Lowering Therapies (from the Veterans Affairs Healthcare System)

Xiaoming Jia, David J. Ramsey, Mahmoud Al Rifai, Sarah T. Ahmed, Julia M. Akeroyd, Dave L. Dixon, Ty J. Gluckman, Vijay Nambi, Christie M. Ballantyne, Laura A. Petersen, Neil J. Stone, Salim S. Virani*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Treatment guidelines recommend monitoring of lipids to assess efficacy and adherence to lipid lowering therapy. We assessed whether lipid profile monitoring is associated with intensification of cholesterol lowering therapy. Patients from the Veterans Affairs (VA) healthcare system with atherosclerotic cardiovascular disease and at least one primary care visit between October 2013 and September 2014 were included (n = 1,061,753). Treatment intensification was defined as the initiation of a statin, an increase in the intensity or dose of statin therapy and/or the addition of ezetimibe. An association between the number of lipid panels and treatment intensification was assessed with adjusted regression models. During the study period, 87.1% of included patients had ≥1 lipid panel. Patients with ≥1 lipid panel were more likely to undergo treatment intensification compared with individuals with 0 lipid panels (9.3% vs 5.4%, respectively, p <0.001). Among individuals not on statin therapy at the index date (n = 287,636), those with ≥1 lipid panel were more likely to have a statin initiated compared those who without a lipid panel (21.5% vs 8.7%, p <0.001). On regression analysis (odds ratio [OR] [95% confidence interval {CI}]), patients with 1 lipid panel (1.55 [1.50 to 1.59]), 2 to 3 lipid panels (1.76 [1.71 to 1.81]) and >3 lipid panels (3.02 [2.90 to 3.14]) showed greater odds of treatment intensification compared with individuals without a lipid panel. In conclusion, lipid monitoring is associated with higher rates of treatment intensification in patients with atherosclerotic cardiovascular disease. This has important clinical implications as higher intensity regimens with statins and in combination with select nonstatin therapies is associated with improved cardiovascular outcomes.

Original languageEnglish (US)
Pages (from-to)874-879
Number of pages6
JournalAmerican Journal of Cardiology
Volume125
Issue number6
DOIs
StatePublished - Mar 15 2020

Funding

Dr. Virani: Research support: Department of Veterans Affairs, World Heart Federation; Honorarium: American College of Cardiology (Associate Editor for Innovations, ACC.org); Steering Committee member for the PALM registry at the Duke Clinical Research Institute (No financial remuneration). Dr. Ballantyne: Grant/Research Support- All significant. (All paid to institution, not individual): Abbott Diagnostic, Akcea, Amgen, Esperion, Novartis, Regeneron, Roche Diagnostic, NIH, AHA, ADA. Consultant- Abbott Diagnostics, Akcea, Amarin, Amgen, Astra Zeneca, Boehringer Ingelheim, Corvidia, Denka Seiken, Esperion, Intercept, Janssen, Matinas BioPharma Inc, Merck, Novartis, Novo Nordisk, Regeneron, Roche Diagnostic, Sanofi-Synthelabo. Dr. Nambi: Site PI study sponsored by Merck, Investigator on a provisional patent “Biomarkers in the prediction of heart failure” along with Roche, supported by VA merit grant. All Others: None.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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