Abstract P162: Has LDL Cholesterol (LDL-C) and Non-HDL Cholesterol (Non-HDL-C) Goal Attainment Improved 7 Years After Adult Treatment Panel III (ATP III) Guidelines Were Published?

Abstract

Background In coronary heart disease (CHD) patients, ATP III guidelines (2001) recommended LDL-C goal of <100 mg/dl, with optional goal of <70 in a 2004 update, and in patients with triglycerides (TG) ≥ 200mg/dl, non-HDL-C goal of <130 mg/dl with optional goal of <100. In a 2003 survey (NEPTUNE II), 62% of CHD patients achieved LDL-C goal of < 100 mg/dl but only 33% achieved both LDL-C and non-HDL-C goals. Methods To assess whether goal attainment has improved, we analyzed data from 7 Veterans Affairs (VA) medical centers. In patients with ICD-9 codes for CHD and a primary care visit in 2008, we assessed LDL-C and (in patients with TG ≥200 mg/dl) non-HDL-C (calculated as total cholesterol - HDL-C), to compare goal attainment for LDL-C and non-HDL-C in the VA system with NEPTUNE II. Results We analyzed 24,769 CHD patients. Significantly more VA patients ( table ) attained LDL-C goals per ATP III guidelines. Attainment of optional LDL-C goals per the 2004 update was statistically better than NEPTUNE II, but still low (34%). A major treatment gap was noted in patients with TG ≥ 200, with poor attainment for both LDL-C (primary goal) and non-HDL-C (secondary goal) per both ATP III (51%) and the update (12%), although goal attainment was better in the VA patients compared to NEPTUNE II. Controlling for facility clustering and patient's illness severity, non-physician providers (p=0.07), care at a teaching facility (p=0.09), patient's age > 55 years (p= 0.001) and diabetes (p=0.005) were positively associated with goal attainment, whereas African American patients were less likely to achieve lipid goals (p=0.04). Conclusion LDL-C goal attainment per ATP III guidelines has improved, but attainment of <70 mg/dl in CHD patients remains low. CHD patients with elevated TG continue to have poor attainment of non-HDL-C goals, which recent data indicate is as important as LDL-C goal attainment. We also identify factors associated with goal attainment which have implications for future interventions.