Key result
Health coach intervention lowers LDL-C by ~23 mg/dL from baseline in veterans.
Why the study?
The project aimed to develop and deploy a plan to achieve LDL-C <70 mg/dL in >30% of veterans with atherosclerotic cardiovascular disease and uncontrolled LDL-C, as well as meaningful LDL-C lowering.
Does a health coach-based personalized strategy improve LDL-C lowering and control in veterans with atherosclerotic cardiovascular disease?
Does a health coach-based personalized strategy improve LDL-C lowering and control in veterans with atherosclerotic cardiovascular disease?
A health coach-based personalized strategy significantly lowered LDL-C and enhanced lipid control in veterans with ASCVD.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Through the use of a health coach, we're able to provide that pharmacologic and non-pharmacologic interventions that patients need, some of the tools that the skill set that the health coach uses are providing that shared medical decision making, as well as utilizing motivational interviewing to get patients from point A to point B.”
“Despite existing attempts to control cholesterol, there is still a significant population-level gap between what most ASCVD patients experience and what we believe is possible. Continuing variation by race, sex, ethnicity and socio-economic status compounds this gap. VALOR-QI aims not only to improve treatment for ASCVD, but also to redouble our efforts to find ways to overcome barriers to health equity for all veterans.”
“For patients, our study results mean participation in the quality improvement program increased the likelihood of improvement in cardiovascular health. Many tools and strategies used in VALOR-QI were simple, inexpensive and accessible to clinicians and patients at each point of care. This is important for sustainability within the VA system and could lead to adoption of these strategies throughout the vast VA system and also non-VA health care systems.”
Supports health coach strategies for LDL-C control in veterans with ASCVD; leaves open confirmation in randomized trials before practice change.
Background The Veterans Affairs New York Harbor Healthcare System is 1 of 50 Veterans Affairs sites participating in the Veterans Affairs Lipid Optimization Reimagined Quality Improvement Project. Veterans Affairs sites worked with an American Heart Association quality improvement consultant to develop and deploy a plan to achieve low‐density lipoprotein cholesterol (LDL‐C) <70 mg/dL in >30% of veterans with atherosclerotic cardiovascular disease and uncontrolled LDL‐C (LDL‐C ≥70 mg/dL), and meaningful LDL‐C lowering. Methods In this pre‐post designed project, health coaches applied a root‐cause analysis framework, used medication possession ratio to assess adherence, and used motivational interviewing principles to improve medication adherence and lifestyle habits. Health coaches tailored interventions to address adherence barriers (if medication possession ratio <0.8) or facilitated medication intensification (if medication possession ratio ≥0.8). To evaluate the impact of health coaches on outcomes, we compared baseline and follow‐up data pre‐post to evaluate LDL‐C lowering and assess LDL‐C control. Results Among 152 engaged veterans, 57.9% had LDL‐C between 70 and 100 mg/dL at baseline, 41.4% had LDL‐C ≥100 mg/dL, and 0.7% had no data in the past year. Median (interquartile range) baseline LDL‐C was 92.0 (81.0–118.0) mg/dL, and follow‐up was 75.0 (54.5–98.0) mg/dL. Mean LDL‐C change from baseline was −22.7 mg/dL (Wilcoxon signed rank test, P <0.001). The proportion with controlled LDL‐C was 42.6% (binomial test, P =0.001). All specialties, except geriatrics, lowered LDL‐C significantly and exceeded the 30% goal. LDL‐C control rates did not statistically differ by specialty (Fisher exact test, P =0.091). Conclusions Health coach–delivered interventions to improve medication adherence and encourage lifestyle modifications led to significant LDL‐C reduction, with 42.6% achieving control, surpassing the 30% program benchmark, and lowered LDL‐C level.
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Chen et al. (2026) studied Atherosclerotic cardiovascular disease and uncontrolled LDL-C (n=152). Health coach-based multilevel personalized strategy vs. Baseline (pre-intervention) was evaluated on Mean LDL-C change from baseline (MD -22.7 mg/dL, p=<0.001). A health coach-delivered intervention significantly reduced LDL-C by a mean of 22.7 mg/dL from baseline (P<0.001), with 42.6% of veterans achieving LDL-C control.
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