LDL-C Testing Associated With Lower Achieved LDL-C Levels

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Endocrinologists had the highest rate of LDL-C testing followed by cardiologists and primary care providers.
Endocrinologists had the highest rate of LDL-C testing followed by cardiologists and primary care providers.

LDL-C testing is associated with achieving lower low-density lipoprotein cholesterol (LDL-C) levels in routine clinical practice, according to a study published in the Journal of the American Heart Association.

In 2013, the American College of Cardiology/American Heart Association recommended testing low-density lipoprotein cholesterol (LDL-C) to identify untreated patients with LDL-C ≥190mg/dL, assess lipid-lowering therapy adherence, and consider nonstatin therapy.  Investigators sought to determine whether clinician lipid testing practices were consistent with these guidelines.

      

This study used data was collected in the PALM registry (Patient and Provider Assessment of Lipid Management) which enrolled primary and secondary prevention patients from 140 cardiology, endocrinology, and primary care offices in the United States in 2015.

They then captured demographic data, lipid treatment history, and the highest LDL-C level in the past 2 years. Among the 7627 patients included in the data, 2787 or 36.5% had no LDL-C levels measured in the 2 years previous to enrollment.

Investigators found that patients without chart-documented levels of LDL-C were more likely to be non-white, women, uninsured, and non-college graduates (P<.01 for all).

Patients who did not have prior lipid testing were found to be less likely to receive statin treatment (P=.0034), high-intensity statin (P=.016), nonstatin lipid-lowering therapy (P=.0037), and had higher core laboratory LDL-C levels at enrollment (P=.0001) than patients with prior testing. 

Of the 166 patients with core laboratory LDL-C levels ≥190mg/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.

Investigators conclude, “more than one third of patients with or at risk for ASCVD are treated in contemporary practice without provider knowledge of LDL-C levels within the previous 2 years. Knowledge of LDL-C test results is associated with increased guideline adherence to statin therapy and better lipid control in both primary and secondary prevention populations.”

In addition, “within the context of the 2013 ACC/AHA guidelines, lipid testing may help to optimize guideline-recommended statin use and dosing as well as identify patients who are nonadherent to treatment or who need more intense lipid-lowering therapy.”

Reference 

Lowenstern AM, Li S, Navar AM, et al. Measurement of low‐density lipoprotein cholesterol levels in primary and secondary prevention patients: insights from the palm registry. J Am Heart Assoc. 2018;7(18):e009251.

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