The importance of cholesterol follow-up testing under current statin treatment guidelines

Abstract

Under “treat to risk” goals, low-density (LDL)-cholesterol follow-up measurements monitor statin compliance rather than titration to target levels, however, there is little evidence showing that more-frequent monitoring reduces LDL-cholesterol. We therefore tested whether frequency of blood tests significantly predicted lipoprotein improvements in a large anonymized clinical laboratory database. Differences (∆ ± SE) in total cholesterol, triglycerides, and LDL-cholesterol between baseline and follow-up visits were calculated for 97,548 men and 110,424 women whose physicians sent blood to Boston Heart Diagnostics for analysis between 2010 and 2017. When adjusted for age and follow-up duration, plasma concentration changes per each follow-up measurement in men and women respectively were −2.84 ± 0.10 mg/dL and −3.03 ± 0.10 mg/dL for total cholesterol, −3.78 ± 0.30 mg/dL and −2.26 ± 0.19 mg/dL for triglycerides, and −2.54 ± 0.09 mg/dL and −3.06 ± 0.09 mg/dL for LDL-cholesterol (all P < 10−16). Relative to baseline, significant decreases (P < 10−16) were observed for the 1st, 2nd, and 3rd follow-up measurements for total cholesterol (mean ± SE, men: −9.4 ± 0.1, −11.9 ± 0.2, −13.7 ± 0.3; women: −8.0 ± 0.1, −10.5 ± 0.2, −12.6 ± 0.3 mg/dL, respectively), triglycerides (men: −10.3 ± 0.4, −12.8 ± 0.5, −13.4 ± 0.7; women: −6.4 ± 0.2, −8.8 ± 0.4, −10.1 ± 0.5 mg/dL, respectively) and LDL-cholesterol (men: −7.8 ± 0.1, −9.9 ± 0.2, −11.1 ± 0.2; women: −6.9 ± 0.1, −9.0 ± 0.2, −10.7 ± 0.2 mg/dL, respectively). When adjusted for regression to the mean, 6.9%, 9.9% and 11.8% of men, and 5.7%, 9.7% and 11.5% of women, went from having an LDL-cholesterol ≥160 to <160 mg/dL for their 1st, 2nd, and 3rd follow-up measurements, respectively. We conclude that under usual physician care, total cholesterol, triglyceride, and LDL-cholesterol concentrations decreased progressively with increased physician monitoring within a large patient population.