Key result
A multi-faceted implementation program did not significantly improve the 1-year composite lipid optimization endpoint compared to usual care (44.2% vs 48.2%, p=0.22).
Why the study?
Many patients with ASCVD have suboptimal longitudinal LDL-C control, necessitating new system-level implementation strategies to improve lipid optimization among high-risk adults.
Does a multi-faceted implementation program (online dashboard, peer-to-peer calls, educational resources) improve a composite lipid optimization endpoint in adults with established ASCVD and elevated LDL-C on statin therapy?
Does a multi-faceted implementation program (online dashboard, peer-to-peer calls, educational resources) improve a composite lipid optimization endpoint in adults with established ASCVD and elevated LDL-C on statin therapy?
A multi-faceted system-level intervention did not significantly improve 1-year composite lipid optimization overall, but exploratory analyses suggest a delayed benefit, highlighting the need for a lead-in period in implementation efforts.
Background Many patients with atherosclerotic cardiovascular disease (ASCVD) have suboptimal longitudinal low-density-lipoprotein cholesterol (LDL-C) control. New system-level implementation strategies are needed to improve lipid optimization among high-risk adults. Methods VICTORION-NOVEL was a prospective, multicenter implementation trial including 66 clinicians across ambulatory practices at 6 sites in the United States (09/05/2023-8/31/2024). Adults ≥18 years with established ASCVD, statin therapy and LDL-C ≥ 70 mg/dL were included. The intervention combined online dashboard for lipid management-related performance, peer-to-peer discussion calls and optional clinician resources and educational modules. Primary outcome was the probability of experiencing a composite endpoint defined as 1) achieving LDL-C<70 mg/dL, 2) achieving ≥20% reduction in LDL-C, or 3) experiencing intensification of lipid lowering therapy (LLT) within 1 year. Results Overall, 1,097 patients (364 at 3 intervention sites, 733 at 3 usual care sites) were included (mean age 68, 45% women). At 1-year, similar proportion of patients (intervention: 44.2%, control: 48.2%, P=0.22) experienced the composite endpoint. However, a significant time-varying effect on the primary outcome was observed with no benefit or lipid optimization favoring the control sites in the initial period (baseline to day 49 and day 50-218) with potentially late beneficial effects emerging thereafter (adjusted HR 1.34; 95% CI 1.07-1.68). At 1-year, a higher proportion of intervention patients achieved LDL-C<70 mg/dL than control patients (23% vs. 16%, p<0.01). Conclusions The multi-faceted intervention was associated with a higher proportion of patients achieving LDL-C goals. The delayed emergence of benefit suggests that a lead-in period may be required for full effectiveness of similar system-level implementation efforts.
No takes yet. Share an insight, caveat, or question.
Vaduganathan et al. (2026) studied Atherosclerotic cardiovascular disease with elevated LDL-C (n=1,097). Multi-faceted implementation program vs. Usual care was evaluated on Composite of achieving LDL-C < 70 mg/dL, ≥20% reduction in LDL-C, or intensification of lipid lowering therapy within 1 year (p=0.22). A multi-faceted implementation program did not significantly improve the 1-year composite lipid optimization endpoint compared to usual care (44.2% vs 48.2%, p=0.22).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: