Measurement of low-density lipoprotein cholesterol levels in primary and secondary prevention patients: Insights from the PALM registry

Angela M. Lowenstern, Shuang Li, Ann Marie Navar, Veronique Lee 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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere009251
JournalJournal of the American Heart Association
Volume7
Issue number18
DOIs
StatePublished - Sep 1 2018

Fingerprint

Primary Prevention
Secondary Prevention
LDL Cholesterol
Registries
Lipids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Therapeutics
Guidelines
Endocrinology
Cardiology
HDL Cholesterol
Primary Health Care
History
Cholesterol
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Measurement of low-density lipoprotein cholesterol levels in primary and secondary prevention patients : Insights from the PALM registry. / Lowenstern, Angela M.; Li, Shuang; Navar, Ann Marie; Roger, Veronique Lee; Robinson, Jennifer G.; Goldberg, Anne C.; Virani, Salim S.; Lee, L. Veronica; Wilson, Peter W.F.; Louie, Michael J.; Peterson, Eric D.; Wang, Tracy Y.

In: Journal of the American Heart Association, Vol. 7, No. 18, e009251, 01.09.2018.

Research output: Contribution to journalArticle

Lowenstern, AM, Li, S, Navar, AM, Roger, VL, Robinson, JG, Goldberg, AC, Virani, SS, Lee, LV, Wilson, PWF, Louie, MJ, Peterson, ED & Wang, TY 2018, 'Measurement of low-density lipoprotein cholesterol levels in primary and secondary prevention patients: Insights from the PALM registry', Journal of the American Heart Association, vol. 7, no. 18, e009251. https://doi.org/10.1161/JAHA.118.009251
Lowenstern, Angela M. ; Li, Shuang ; Navar, Ann Marie ; Roger, Veronique Lee ; Robinson, Jennifer G. ; Goldberg, Anne C. ; Virani, Salim S. ; Lee, L. Veronica ; Wilson, Peter W.F. ; Louie, Michael J. ; Peterson, Eric D. ; Wang, Tracy Y. / Measurement of low-density lipoprotein cholesterol levels in primary and secondary prevention patients : Insights from the PALM registry. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 18.
@article{2330f00df12f45d1ac39d3bd439d24a9,
title = "Measurement of low-density lipoprotein cholesterol levels in primary and secondary prevention patients: Insights from the PALM registry",
abstract = "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.",
author = "Lowenstern, {Angela M.} and Shuang Li and Navar, {Ann Marie} and Roger, {Veronique Lee} and Robinson, {Jennifer G.} and Goldberg, {Anne C.} and Virani, {Salim S.} and Lee, {L. Veronica} and Wilson, {Peter W.F.} and Louie, {Michael J.} and Peterson, {Eric D.} and Wang, {Tracy Y.}",
year = "2018",
month = "9",
day = "1",
doi = "10.1161/JAHA.118.009251",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "18",

}

TY - JOUR

T1 - Measurement of low-density lipoprotein cholesterol levels in primary and secondary prevention patients

T2 - Insights from the PALM registry

AU - Lowenstern, Angela M.

AU - Li, Shuang

AU - Navar, Ann Marie

AU - Roger, Veronique Lee

AU - Robinson, Jennifer G.

AU - Goldberg, Anne C.

AU - Virani, Salim S.

AU - Lee, L. Veronica

AU - Wilson, Peter W.F.

AU - Louie, Michael J.

AU - Peterson, Eric D.

AU - Wang, Tracy Y.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85055612492&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055612492&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.009251

DO - 10.1161/JAHA.118.009251

M3 - Article

C2 - 30371214

AN - SCOPUS:85055612492

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 18

M1 - e009251

ER -