T he risk of developing cardiovascular disease (CVD) can be greatly reduced through lifestyle and medical therapies that address diet, overweight and obesity, smoking, dysplipidemia, hypertension, and diabetes mellitus. Irrespective of which factors are contributing on an individual's risk for the development of CVD, treatment with statins safely and effectively reduces morbidity and mortality from CVD. 1,2The recent American College of Cardiology/American Heart Association cholesterol treatment guideline emphasizes identifying and treating individuals at risk for developing CVD. 3 However, fewer than half of high-risk individuals are treated with statins. 4,5 Statin use is lower among blacks, 4,6 Hispanics, 5,6 the uninsured, 7 and poorer individuals. 8,9 Reducing the population burden of CVD and decreasing disparities will require maximizing the use of preventive strategies among all individuals likely to benefit from them.Statins may be underused for primary prevention for several reasons. Clinicians and patients may not readily appreciate increased CVD risk, particularly when risk comes from factors other than elevated cholesterol. 10,11 Patients may also Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states.Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, [12][13][14] Outreach interventions focused on addressing this risk could increase the number of high-risk patients who seek out treatment. 15Implementing population health management strategies in settings that serve large numbers of patients from low income and minority populations may be an effective way to reduce disparities. 16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.We hypothesized that m...

Updated cholesterol guidelines emphasize multivariable cardiovascular disease (CVD) risk estimation to guide treatment decision-making in primary prevention. This study tested the preliminary feasibility, acceptability and efficacy of point-of-care testing (POCT) and quantitative CVD risk assessment in high-risk adults to increase guideline-recommended statin use in primary prevention. Participants were aged 40–75 years, without CVD or diabetes mellitus, and potentially-eligible for consideration of statins based on estimated 10-year CVD risk from last-measured risk factor levels in the electronic health record. We performed POCT to facilitate quantitative CVD risk assessment with the Pooled Cohort Equations immediately before a scheduled primary care provider (PCP) visit. Outcomes were: physician documentation of a CVD risk discussion and statin prescription on the study date. We also assessed acceptability of the intervention through structured questionnaire. We recruited 18 participants (8 from an academic practice and 10 from a federally-qualified health clinic). After the intervention, 83% of participants discussed CVD risk with their PCP, 47% received a statin recommendation from their PCP, and 29% received a new statin prescription during the PCP visit. Participants reported high levels of satisfaction with the intervention. This study demonstrates that in initial testing pre-visit POCT and quantitative CVD risk assessment appears to be a feasible and acceptable intervention that may promote guideline-recommended statin initiation in primary prevention. Future research with an adequately powered trial is warranted to determine the effectiveness of this approach in clinical practice.

This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.

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