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

Luc Djousse1, Rachel E Ward2, Helen Marucci-Wellman2

  • 1MAVERIC, Boston VA Healthcare System, Boston, MA, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

JACC. Advances
|June 18, 2026
PubMed

Insights

Lipid optimization strategies improved low-density lipoprotein cholesterol (LDL-C) control in veterans with atherosclerotic cardiovascular disease (ASCVD). Tailored interventions increased LDL-C goal achievement and medication adherence.

Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Quality Improvement

Background:

  • Elevated low-density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerotic cardiovascular disease (ASCVD).
  • Despite available treatments, LDL-C goals are unmet in a majority of veterans with ASCVD.
  • Current lipid management strategies require optimization for improved patient outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of tailored lipid optimization strategies in improving LDL-C control among veterans.
  • To assess the impact of these strategies on the utilization and patient adherence to lipid-lowering therapy (LLT).
  • To identify site-specific barriers and implement targeted interventions for enhanced lipid management.

Main Methods:

  • A quality improvement program involving 167,505 veterans with prevalent ASCVD across 50 Veterans Affairs Medical Centers.
  • Collaboration between American Heart Association consultants and local providers to identify and address barriers to lipid management.
  • Primary outcome measured was the proportion of veterans achieving an LDL-C <70 mg/dL at 24 months.

Main Results:

  • 34.4% of veterans achieved the LDL-C goal (<70 mg/dL) at 24 months, a significant improvement (P < 0.001).
  • Mean LDL-C levels decreased by 16.6 mg/dL.
  • Use of LLT increased from 77.4% to 87.8%, and adherence to LLT rose from 56.3% to 65.1%.

Conclusions:

  • Addressing site-specific barriers to lipid management effectively improves LDL-C control in veterans with ASCVD.
  • Tailored interventions are crucial for enhancing lipid-lowering therapy utilization and adherence.
  • This quality improvement initiative demonstrates a successful model for optimizing cardiovascular risk management in a veteran population.
Abstract

Keywords:
atherosclerosiscardiovascular diseasedyslipidemiaepidemiologyquality improvementstatins

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