Trends in cholesterol testing during the COVID-19 pandemic

Abstract

Objective To characterize trends in cholesterol testing since the start of the COVID-19 pandemic. Methods We extracted testing for total cholesterol performed in adults ≥40 years old within the Mass General Brigham healthcare system between March and September 2020, as well those performed between March and September 2019 (reference period). Weekly cholesterol testing rates during the 2020 vs. 2019 study periods were compared using the paired samples t -test. Secondary analyses compared testing volumes and patient characteristics during the first vs. second half of the 2020 study period. Results The study sample included 296,599 tests for total cholesterol performed in 220,215 individuals. The mean (SD) weekly cholesterol tests performed were 6,361 (682) in 2019 vs. 3,867 (2,373) in 2020 ( P = 2.6 × 10 −5 ), representing an overall decline of 39.2%. However, weekly testing rates in 2020 were not uniform. Greatest reductions coincided with the “first wave” of the pandemic (March-May 2020), with up to 92% reductions in testing observed. In the first 14 weeks of each study period (March to mid-June), weekly testing rates were 71.8% lower in 2020. Among individuals tested in 2020, those tested between March and mid-June had substantially lower total cholesterol compared with individuals tested after mid-June (174.2 vs. 181.5 mg/dL, P <2.2 × 10 −16 ). Conclusions In a large integrated healthcare system, cholesterol testing rates were 39% lower between March-September 2020 compared with the same time period in 2019. Mechanisms for safely facilitating cholesterol testing and management for high-risk patients will be important as COVID-19 re-surges across the U.S. until widespread vaccination and population immunity allow resumption of routine preventive care.

Israeli COVID lockdowns mildly reduced overall use of preventive health services, but exacerbated some disparities

“…Another report documented decreases in cholesterol testing during COVID lockdowns [ 14 ]—similar to our findings. And, the World Health Organization published a report about the impact of COVID on care for noncommunicable diseases—which includes, but is not limited to, cancer screening [ 15 ].…”

Did Australia's COVID-19 Restrictions Impact Statin Incidence, Prevalence or Adherence?

“…International data demonstrate that COVID-19 infection was associated with a decline in the number of people receiving cholesterol tests. 4 Statin initiation is primarily dictated by either atherosclerotic events or cholesterol testing. 3 However, despite the relatively low number of infections, Australia implemented stringent lock-downs.…”

“…There was a 92% reduction in number of cholesterol tests in the United States from March to May 2020. 4 Cholesterol testing often precedes and informs prescribing of cardiovascular medications. Additionally, COVID-19 coincided with reduced cardiovascular-related hospital presentations but increased in-hospital mortality, possibly attributable to redirection and restrictions on available care.…”

Control of Atherosclerotic Risk Factors During the COVID-19 Pandemic in the U.S.

“…1 Telemedicine visits were associated with lower new medication prescriptions and less frequent assessments of blood pressure and cholesterol levels. 2,3 Lockdown restrictions coincided with an observed reduction in physical activity, weight gain, and increased rates of depression and anxiety. [4][5][6][7][8][9] Pandemic-related changes in cardiovascular risk factors and the 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) were evaluated in adults within an integrated healthcare system in the U.S.…”