Rates of Lipid Testing among Patients with Atherosclerotic Cardiovascular Disease within a Large Community-Based Health System

Abstract

Study Funding

This study was sponsored by Amgen, Inc., Thousand Oaks, California.

Background/Synopsis

Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines for blood cholesterol management recommend that patients on cholesterol lowering therapy undergo repeat lipid testing every 3 to 12 months to monitor medication adherence and therapeutic effect. Contemporary rates of testing are not well known.

Objective/Purpose

pending

Methods

We performed a retrospective cross-sectional analysis of patients with atherosclerotic cardiovascular disease (ASCVD) cared for within a large community-based health system within the western US between January 1, 2017, and December 31, 2022. Percentages of annual cohort snapshots were calculated by lipid testing rates using a 12-month look back, stratified by ASCVD risk status (very high-risk [VHR] vs not very high-risk [NVHR] per ACC/AHA guidelines). Additional analyses were performed to assess whether these percentages varied using 1) a 24-month look back (2018-2022) and 2) a 12-month look back plus 3-month look forward. Lipid tests performed outside of the health system were not available for review.

Results

A total of 855,258 unique patients with >1 encounter for ASCVD were identified (annual patient counts ranged between 184,860 in 2017 and 430,481 in 2022). The mean age was 71.7 years, 44.8% were female, and 78.6% were White. Using a 12-month look back, only 33.6% and 37.2% of patients underwent some lipid testing in 2017 and 2022, respectively. Consistently higher percentages had some lipid testing among those that were VHR (36.2% in 2017 and 39.8% in 2022) compared to NVHR (29.2% in 2017 and 33.5% in 2022). With a 24-month look back, percentages with some lipid testing rose for all groups over time (47.8% for all patients, 50.9% for VHR patients, and 42.0% for NVHR patients in 2018; 51.5% for all patients, 54.1% for VHR patients, and 46.6% for NVHR patients in 2022). A similar, but less pronounced pattern was observed using a 12-month look back plus 3-month look forward (42.9% for all patients, 44.9% for VHR patients, and 39.3% for NVHR patients in 2017; 47.5% for all patients, 49.3% for VHR patients, and 44.0% for NVHR patients in 2022).

Conclusions

Despite guideline recommendations, a large percentage of patients did not undergo any lipid testing in our health system within 12 or 24 months prior to an encounter involving ASCVD. While annual percentages trended toward categories of higher lipid testing rates over time and were consistently higher among VHR patients, further investigation is needed to identify factors associated with different rates of lipid testing.