A Novel Approach to Manage Hypercholesterolemia: Veterans Affairs Lipid Optimization Reimagined Quality Improvement...

Elevated serum low-density lipoprotein cholesterol (LDL-C) is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). Despite the availability of effective drugs to lower LDL-C, only one-third of veterans with ASCVD have LDL-C treated to goal.

This study aimed to determine if a variety of lipid optimization strategies including a health coach tailored to unique barriers and needs can improve: 1) the percentage of veterans with LDL-C <70 mg/dL; and 2) the usage and patients' adherence to any lipid-lowering therapy (LLT).

Veterans Affairs Lipid Optimization Reimagined Quality Improvement was embedded in the usual clinical care of 167,505 veterans with prevalent ASCVD inclusive of 88,778 veterans with baseline LDL-C ≥70 mg/dL in 50 Veterans Affairs Medical Centers between December 2022 and September 2025. At each Veterans Affairs site, American Heart Association consultants worked with local providers to: 1) identify barriers to lipid management; and 2) implement strategies tailored to the identified barriers. The primary outcome was the proportion of veterans with LDL-C <70 mg/dL between baseline and follow-up LDL-C measurement at 24 months.

A total of 88,778 veterans were included in current analyses with mean age of 70.0 (SD: 10.5) years and 6,250 (7.0%) women. Overall, 32.9% of veterans achieved LDL-C <70 mg/dL and for 24,610 veterans with 24-month LDL-C data, 34.4% achieved LDL-C goal (all P < 0.001). The mean LDL-C decreased by 16.6 mg/dL; use of LLT increased from 77.4% to 87.8%; and adherence to any LLT increased from 56.3% to 65.1% between baseline and 24 months.

This program showed that addressing site-specific barriers to lipid management is associated with improved LDL-C among Veterans with ASCVD.