Sara Levintow Analyzes 2013 ACC/AHA Cholesterol Guidelines in Relation to Trends in US Lipid Testing

November 18, 2019

The 2013 ACC/AHA cholesterol guidelines had no significant change in lipid testing behavior, which can be potentially attributed to the varying cholesterol treatment guidelines implemented by organizations, said Sara Levintow, PhD candidate, Department of Epidemiology at the University of North Carolina at Chapel Hill.

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines had no significant change in lipid testing behavior, which can be potentially attributed to the varying cholesterol treatment guidelines implemented by organizations, said Sara Levintow, PhD candidate, Department of Epidemiology at the University of North Carolina at Chapel Hill.

Transcript

There was considerable attention to the 2013 change in the ACC/AHA cholesterol guidelines, yet you found no real change in testing behavior. How can we account for this?

We studied the frequency of [low-density lipoprotein] cholesterol testing frequency from before to after the release of the 2013 guidelines and those revised guidelines did remove the recommendation of ongoing LDL testing in order to treat patients to blood cholesterol goals. As you noted, we found very little, if any impact of the guidelines on LDL testing frequency following the release of the guidelines. So, this could be due to lack of awareness or understanding among physicians. It’s also possible that given that physicians are faced with a multitude of cholesterol treatment guidelines from varying organizations, sometimes or historically there are conflicts between those guidelines. There could also be disagreement or perhaps confusion over which guideline to follow, therefore leading to unchanged rates of LDL testing as observed in our study.

Were there any distinct population subgroups that stood out in the study, such as less testing among seniors, or less testing among younger adults? Any regional differences?

We did overall find that rates of LDL testing were unchanged and we explored multiple diverse patient populations including patients who were initiating statins at varying intensities, patients who were starting acetamide, as well as patients who are at much higher cardiovascular risk—those who had recent hospitalizations for myocardial infarction or ischemic stroke. In general, our findings were consistent. I will say that overall over the course of the study period, generally adults who were older, who had more higher levels of risk for cardiovascular disease, did have lower rates of testing. That was in contrast to younger adults who are at lower risk of cardiovascular disease who in general had higher rates of testing.