Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry

Abstract

BackgroundThe 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low‐density lipoprotein cholesterol (LDL‐C) to identify untreated patients with LDL‐C ≥190 mg/dL, assess lipid‐lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines.Methods and ResultsThe PALM (Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest LDL‐C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no LDL‐C levels measured in the 2 years before enrollment. Patients without chart‐documented LDL‐C levels were more often women, nonwhite, uninsured, and non–college graduates (all P<0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%; P=0.0034), a high‐intensity statin (21.5% versus 24.3%; P=0.016), nonstatin lipid‐lowering therapy (24.8% versus 27.3%; P=0.037), and had higher core laboratory LDL‐C levels at enrollment (median 97 versus 92 mg/dL; P<0.0001) than patients with prior LDL‐C testing. Of 166 individuals with core laboratory LDL‐C levels ≥190 mg/dL, 36.1% had no LDL‐C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment.ConclusionsIn routine clinical practice, LDL‐C testing is associated with higher‐intensity lipid‐lowering treatment and lower achieved LDL‐C levels.

Low-Density Lipoprotein Cholesterol Testing Following Myocardial Infarction Hospitalization Among Medicare Beneficiaries

“…Prior studies have shown that LDL-C testing leads to improvements in lipid-lowering medication use and adherence. 11 , 12 , 13 , 14 , 15 , 16 , 17 This was not possible in the current analysis due to not having LDL-C values.…”

“…Lipid testing can overcome clinical inertia and is associated with lipid-lowering medication use and initiation, 11 , 12 , 13 higher adherence to lipid-lowering medication, 14 , 15 and lipid-lowering treatment intensification. 12 , 15 , 16 , 17 In a prior analysis of veterans with a history of ASCVD who had a primary care physician visit at the Veterans Health Administration (VA), those with a lipid panel had a higher likelihood of lipid-lowering treatment intensification within 90 days vs their counterparts without a lipid panel (9.3% vs 5.4%, respectively, P < 0.001).…”