Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry
Background The 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,...
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Wiley
2018-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009251 |
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| author | Angela M. Lowenstern Shuang Li Ann Marie Navar Veronique L. Roger Jennifer G. Robinson Anne C. Goldberg Salim S. Virani L. Veronica Lee Peter W. F. Wilson Michael J. Louie Eric D. Peterson Tracy Y. Wang |
| author_facet | Angela M. Lowenstern Shuang Li Ann Marie Navar Veronique L. Roger Jennifer G. Robinson Anne C. Goldberg Salim S. Virani L. Veronica Lee Peter W. F. Wilson Michael J. Louie Eric D. Peterson Tracy Y. Wang |
| author_sort | Angela M. Lowenstern |
| collection | DOAJ |
| description | Background The 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 Results The 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. Conclusions In routine clinical practice, LDL‐C testing is associated with higher‐intensity lipid‐lowering treatment and lower achieved LDL‐C levels. |
| format | Article |
| id | doaj-art-c063afaf2a5f435ca54cc34f96b1e3e9 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-c063afaf2a5f435ca54cc34f96b1e3e92025-08-20T02:02:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171810.1161/JAHA.118.009251Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM RegistryAngela M. Lowenstern0Shuang Li1Ann Marie Navar2Veronique L. Roger3Jennifer G. Robinson4Anne C. Goldberg5Salim S. Virani6L. Veronica Lee7Peter W. F. Wilson8Michael J. Louie9Eric D. Peterson10Tracy Y. Wang11Duke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCDepartment of Health Sciences Research and Division of Cardiovascular Diseases Mayo Clinic Rochester MNUniversity of Iowa Iowa City IAWashington University St. Louis MOBaylor College of Medicine Houston TXSanofi Bridgewater CTEmory University Atlanta GARegeneron Pharmaceuticals, Inc. Tarrytown NYDuke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCBackground The 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 Results The 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. Conclusions In routine clinical practice, LDL‐C testing is associated with higher‐intensity lipid‐lowering treatment and lower achieved LDL‐C levels.https://www.ahajournals.org/doi/10.1161/JAHA.118.009251clinician lipid testing practicesguideline adherencelow‐density lipoprotein cholesterol |
| spellingShingle | Angela M. Lowenstern Shuang Li Ann Marie Navar Veronique L. Roger Jennifer G. Robinson Anne C. Goldberg Salim S. Virani L. Veronica Lee Peter W. F. Wilson Michael J. Louie Eric D. Peterson Tracy Y. Wang Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease clinician lipid testing practices guideline adherence low‐density lipoprotein cholesterol |
| title | Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry |
| title_full | Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry |
| title_fullStr | Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry |
| title_full_unstemmed | Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry |
| title_short | Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry |
| title_sort | measurement of low density lipoprotein cholesterol levels in primary and secondary prevention patients insights from the palm registry |
| topic | clinician lipid testing practices guideline adherence low‐density lipoprotein cholesterol |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009251 |
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