Abstract P454: Secular Trend in Cholesterol Management Among US Veterans With ASCVD

Background: Current guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) have explicitly highlighted the direct correlation of reduced LDL-C with a subsequent risk reduction in further ischemic events. Little is known about secular trends of LDL-cholesterol below 70 mg/ml among Veterans with ASCVD over the past two decades. Hypothesis: Among Veterans with ASCVD who are receiving lipid-lowering therapy, the proportion of those not treated to goal (LDL-C ≥70 mg/dL) has been declining between 2002 and 2020. Methods: We conducted a retrospective cohort study with an annual accounting of treatment information and LDL-C lab results between 2003 to 2020 for US Veterans with prevalent ASCVD who had at least one LDL-C lab value during the year prior to January 1st of the index year. Dyslipidemia was defined as LDL-C ≥70 mg/dL and ASCVD was defined as one inpatient or two outpatient diagnoses or one procedure diagnosis for MI, stroke, CAD, PAD, or angina. We investigated annual trends in proportion of Veterans with ASCVD who achieved LDL-C<70 mg/dL using lipid-lowering agents. Results: The study population consisted of 1,182,657 Veterans with a mean age of 72.5 years, 97% male, and a mean BMI of 29.8 kg/m 2 . The mean LDL-C in 2003 was 84.7 mg/dl and 739,295 (62.5%) participants had an LDL-C ≥70 mg/dl. We observed a steady increase in the proportion of Veterans achieving LDL below 70 mg/dl during the study period (Figure). Conclusion: Our data are consistent with a steady increase in proportion of US Veterans with ASCVD with LDL treated to goal between 2003 and 2020.