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Measurement of Low-Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry
Journal article   Open access

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 L Roger, Jennifer G Robinson, Anne C Goldberg, Salim S Virani, L Veronica Lee, Peter W F Wilson, Michael J Louie, …
Journal of the American Heart Association, Vol.7(18), pp.e009251-e009251
09/18/2018
DOI: 10.1161/JAHA.118.009251
PMCID: PMC6222939
PMID: 30371214
url
https://doi.org/10.1161/JAHA.118.009251View
Published (Version of record) Open Access

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.
 Registries United States - epidemiology Follow-Up Studies Cardiovascular Diseases - prevention & control Humans Male Treatment Outcome Biomarkers - blood Secondary Prevention - methods Incidence Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Primary Prevention - methods Cardiovascular Diseases - blood Cardiovascular Diseases - epidemiology Cholesterol, LDL - blood Female Aged Retrospective Studies Patient Compliance

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