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Secular Trends in Lipid Management Among U.S. Veterans With Atherosclerotic Cardiovascular Disease, 2003 to 2020
Patrick Benjamin1, Helen Marucci-Wellman2, Rachel Ward3
1VA Boston Healthcare System, Boston, Massachusetts, USA; Mass General Brigham, Boston, Massachusetts, USA.
Insights
Lipid management improved for U.S. Veterans with atherosclerotic cardiovascular disease (ASCVD), with more achieving low-density lipoprotein cholesterol (LDL-C) goals. However, most still need better lipid control to reduce cardiovascular risk.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Guidelines emphasize low-density lipoprotein cholesterol (LDL-C) reduction for atherosclerotic cardiovascular disease (ASCVD) risk management.
- Secular trends in lipid management for U.S. Veterans with ASCVD over two decades are not well-documented.
Purpose of the Study:
- To assess trends in lipid-lowering therapy and LDL-C goal attainment (<70 mg/dL) among U.S. Veterans with ASCVD from 2003 to 2020.
Main Methods:
- Retrospective cohort study analyzing annual treatment and LDL-C data from 2003-2020.
- Inclusion criteria: U.S. Veterans with prevalent ASCVD and at least one LDL-C lab value prior to the index year.
- Analysis focused on the proportion achieving LDL-C <70 mg/dL while on lipid-lowering agents.
Main Results:
- The study cohort expanded from 642,082 (2003) to 1.18 million (2020) Veterans, an older, high-risk group.
- Proportion achieving LDL-C <70 mg/dL increased from 14.5% to 41.6% over 17 years.
- Improvements were consistent across subgroups, including those over 75 years.
Conclusions:
- A significant upward trend in LDL-C control was observed among U.S. Veterans with ASCVD between 2003 and 2020.
- Despite progress, the majority of Veterans remain above recommended LDL-C targets.
- Continued optimization of lipid-lowering therapies is necessary for improved cardiovascular outcomes.
Background:
Current guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) have explicitly highlighted the direct correlation of reduced low-density lipoprotein cholesterol (LDL-C) with a subsequent risk reduction in further ischemic events. Little is known about secular trends of lipid management among U.S. Veterans with ASCVD over the past 2 decades.
Objectives:
The objective of the study was to determine the trend in the proportion of Veterans with ASCVD who are receiving lipid-lowering therapy treated to goal (LDL-C <70 mg/dL) between 2003 and 2020.
Methods:
We conducted a retrospective cohort study, with annual accounting of treatment information and LDL-C lab results from 2003 to 2020, among U.S. Veterans with prevalent ASCVD who had at least 1 LDL-C lab value in the year before January 1st of the index year. We investigated annual trends in the proportion of Veterans with ASCVD who achieved an LDL-C <70 mg/dL while taking lipid-lowering agents.
Results:
The cohort grew from 642,082 Veterans with ASCVD in 2003 to 1.18 million in 2020, representing an older, high-risk population with substantial comorbidity. At baseline, up to 85.4% of Veterans had LDL-C >70 mg/dL. Over the 17-year period, the proportion achieving LDL-C <70 mg/dL rose from 14.5% to 41.6%. These observations were consistent across subgroups, including Veterans >75 years, who experienced marked increases in LDL-C improvement.
Conclusions:
We observed a clear trend toward higher prevalence of LDL-C control among Veterans with ASCVD from 2003 to 2020. Despite this progress, most Veterans remain above guideline-recommended LDL-C targets, underscoring the need for continued optimization of lipid-lowering therapy.
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