Non–high-density lipoprotein cholesterol reporting and goal attainment in primary care

• Published in: Journal of clinical lipidology 2012-11, Vol.6 (6), p.545-552
• Main Authors: Virani, Salim S., MD, PhD, Wang, Degang, PhD, Woodard, LeChauncy D., MD, MPH, Chitwood, Supicha S., MPH, Landrum, Cassie R., MPH, Zieve, Franklin J., MD, PhD, Ballantyne, Christie M., MD, Petersen, Laura A., MD, MPH
• Format: Article
• Language: English
• Subjects: Aged; Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - pharmacology; Cardiovascular; Cholesterol - analysis; Coronary disease; Coronary Disease - pathology; Coronary Disease - prevention & control; Databases, Factual; Diabetes mellitus; Diabetes Mellitus - pathology; Female; Follow-Up Studies; Humans; Hyperlipidemias - drug therapy; Hyperlipidemias - pathology; Hypertension - pathology; Logistic Models; Male; Medication Adherence; Middle Aged; Non-HDL cholesterol; Practice Guidelines as Topic; Prevention; Primary Health Care - standards; Treatment goals; Triglycerides - metabolism; United States; United States Department of Veterans Affairs
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2012.04.080

Background The Adult Treatment Panel III guidelines established non–high-density lipoprotein cholesterol (non-HDL-C) as a secondary treatment target. However, non-HDL-C levels are not reported on standard lipid panels by many hospital-based and/or commercial biochemical laboratories. Objective We determined whether reporting non-HDL-C was associated with improved non-HDL-C goal attainment. Methods We identified patients with cardiovascular disease (CVD) and/or diabetes receiving care within the Veterans Health Administration. We matched a facility that reported non-HDL-C levels on lipid panels (3994 CVD and 5108 diabetes patients) to a facility with similar size, patient complexity, and academic mission that did not report non-HDL-C (4269 CVD and 6591 diabetes patients). We performed patient-level analysis to assess differences in non-HDL-C from baseline to the most recent lipid panel at these facilities. Results Baseline non-HDL-C levels for CVD patients were 114 mg/dL and 107 mg/dL at the reporting and nonreporting facilities, respectively. At 2.3-year follow-up, non-HDL-C levels decreased at both facilities but by a greater amount at the reporting facility (−11 mg/dL vs −3 mg/dL at the nonreporting facility, P < .001). Results remained significant ( P < .001) after we adjusted for patient's age, race, gender, illness burden, history of diabetes, hypertension, medication adherence, statin use, number of lipid panels, and number of primary care visits between baseline and follow-up. Reductions were greater among CVD patients with triglycerides ≥200 mg/dL (−25 mg/dL vs −16 mg/dL at the respective facilities, P  = .004). Results were similar in diabetes patients. Reporting was also associated with greater proportions of patients meeting non-HDL-C treatment goal of