Assessing lipid targets: A cross-sectional general internal medicine patient evaluation for optimal lipid-lowering outcomes

Background In 2022, heart disease and stroke caused nearly 875,000 deaths in the United States, with $216 billion in health care costs and $147 billion in lost productivity. Preventing and managing atherosclerotic cardiovascular disease (ASCVD) are crucial. Objectives This study evaluates the integration of lower low-density lipoprotein cholesterol (LDL-C) targets from the 2022 American College of Cardiology (ACC) and 2023 American Diabetes Association (ADA) guidelines into practice. Methods This retrospective chart review investigated adult patients with ASCVD receiving lipid-lowering therapy (LLT) seen at an internal medicine clinic between January 1 and July 31, 2023. LDL-C targets were assigned per the 2022 ACC and the 2023 ADA guidelines. The primary end point was assigned LDL-C target achievement. Secondary end points included analyzing whether LLT was assessed for efficacy, provider identification of LDL-C targets, and target-directed interventions. Data were analyzed using quantitative and qualitative statistics. Results Of 375 screened patients, 319 were included. Overall, 265 (83%) had a lipid panel drawn within a year of their provider visit, with 222 (70%) from January 1, 2023, or later. Only 91 (29%) met their assigned LDL-C target, leaving 228 (71%) suboptimally treated. Among these, only 18 (8%) had a provider-identified LDL-C target, with 11 of these targets (61%) being inappropriate. Providers intervened to improve lipid control in only 23 of the 228 patients (10%) not meeting their LDL-C target. Conclusions Most primary care patients (71%) did not meet newer LDL-C targets, highlighting gaps in guideline adoption. These findings will guide clinic pharmacists in enhancing practices and addressing patient care gaps.