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January 11, 2026American Journal of Preventive CardiologyOpen Access

Clinician-level variation in lipid management for secondary prevention of atherosclerotic cardiovascular disease: Opportunities for practice improvement

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Key result

Clinician variation is linked to ~44% higher odds of high-intensity statin use in ASCVD.

aMOR 1.44
95% CI 1.34-1.59
n=9,098

Figures

Why the study?

The degree of variability in lipid-lowering therapy practice patterns between clinicians treating patients with ASCVD is less well described.

Study Design

Type

Cohort (n=9,098)

Multicenter

No

Structured PICO

P

Population

9,098 adults with atherosclerotic cardiovascular disease seen by cardiology clinicians at a single academic medical center were evaluated for inter-clinician variation in lipid management.

O

Outcome

Clinician-level variation in lipid-lowering therapy (LLT) utilization and achievement of LDL-C <70 mg/dL, measured by adjusted median odds ratios (aMORs)surrogate

Main Result

Odds Ratio: 1.44 (95% CI 1.34–1.59)

There is substantial, measurable variation in lipid-lowering therapy prescribing patterns among individual cardiology clinicians within the same academic medical center, suggesting a targetable opportunity to standardize care and improve guideline-concordant LDL-C goal attainment in ASCVD secondary prevention.

Limitations

Single-center experience at an academic medical center may not generalize to other practice settings.
Differences in patient willingness to take lipid-lowering therapies may account for some observed variability.
Attribution of patients to their most recently seen cardiologist may not accurately reflect the clinician primarily responsible for lipid management decisions.
Exclusion of patients without recent lipid measurements may underestimate true clinician-level variation in LDL-C control due to selection bias.
Single-center experience at an academic medical center may not generalize to other practice settings
Differences in patient willingness to take LLT or statin intolerance may account for some variability
Attribution to the most recently seen cardiologist may not accurately reflect the clinician primarily responsible for lipid management decisions
Data captured prevalent rather than incident ASCVD, preventing analysis of clinician-patient relationship duration
Potential selection bias because only 78.3% of patients had lipid measurements available for analysis

Implication

Clinician variation in lipid-lowering therapy persists among ASCVD patients; leaves open whether standardizing prescribing improves LDL-C goal attainment.

Abstract

Introduction: While prior studies have documented suboptimal lipid management and low rates of low-density lipoprotein cholesterol (LDL-C) goal achievement in patients with atherosclerotic cardiovascular disease (ASCVD), the degree of variability in lipid-lowering therapy (LLT) practice patterns between clinicians is less well described. Methods: In this cohort study, we evaluated the use of LLTs and achievement of LDL-C <70 mg/dL among adults with ASCVD (coronary artery disease, peripheral arterial disease, or ischemic cerebrovascular disease) followed by a cardiology physician or advanced practice provider (APP) at a large academic medical center in north Texas from 01/01/22-06/30/24. LLT utilization and LDL-C goal achievement were modeled using mixed-effects logistic regression with clustering at the clinician level, adjusting for patient age, insurance, ASCVD type, and diabetes. We quantified clinician-level variability using the adjusted median odds ratios (aMORs) from these models. Results: = 7122), 48.5% achieved an LDL-C <70 mg/dL. Lipid management strategies varied substantially across clinicians. In mixed-effects models adjusting for patient-level factors, significant clinician-level variation was observed in the use of high-intensity statins (aMOR 1.44, 95% CI 1.34-1.59), ezetimibe (aMOR 1.68, 95% CI 1.52-1.91), and novel LLT (aMOR 2.21, 95% CI 1.90-2.68). Variation in achieving LDL-C <70 mg/dL was more modest (aMOR 1.31, 95% CI 1.23-1.42). Sequential adjustment for clinician prescribing patterns explained nearly half of the observed variability in LDL-C goal achievement, reducing the aMOR to 1.16 (95% CI 1.09-1.27). Conclusion: We found suboptimal rates of high-intensity statin and LDL-C control among patients with ASCVD. Even among cardiology clinicians at the same academic medical center, practice patterns varied widely in using LLT and achieving LDL-C goals for secondary prevention. Understanding the reasons for this variability and standardizing lipid management across the specialty may improve quality of care for patients with ASCVD.

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Cite This Study

Nguyen et al. (2026) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=9,098). Care by different individual cardiology clinicians vs. Randomly selected identical clinician (measured by aMOR) was evaluated on Clinician-level variation in the use of high-intensity statins (aMOR 1.44, 95% CI 1.34-1.59). Among adults with ASCVD, significant clinician-level variation was observed in the use of high-intensity statins (aMOR 1.44), novel lipid-lowering therapies (aMOR 2.21), and achievement of LDL-C <70 mg/dL (aMOR 1.31).

synapsesocial.com/papers/6a9306f7c9cc64515e7f5146 https://doi.org/10.1016/j.ajpc.2026.101421

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