New Cholesterol Management Guidelines Not Fully Implemented in Medical Practice

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Interview with:
Thomas M. Maddox MD MSc
Cardiology, VA Eastern Colorado Health Care System
Associate Director, VA CART Program
Associate Professor, Department of Medicine
University of Colorado School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Maddox: With the release of the updated cholesterol guidelines last year and their significant changes in recommendations, we wanted to see what the potential impact would be on U.S. cardiovascular practices.  Specifically, we were interested in present cholesterol treatment and testing patterns, and how they would potentially need to change under the new guidelines.

We used the PINNACLE registry to conduct our investigation.  Under the sponsorship of the American College of Cardiology, the registry collects EMR data from 111 cardiovascular practices around the U.S.  We analyzed cholesterol treatment and testing patterns in approximately 1.2 million patients.  We found that most patients qualified for cholesterol treatment with statins, but 32.4% weren’t currently prescribed them.  We also found that 22.6% of patients were being treated with non-statin lipid-lowering therapies which, under the new guidelines, aren’t currently recommended for cholesterol treatment.  Finally, we found that 20.8% of patients underwent repeated LDL-C testing, which may not be necessary under the new guidelines.

Medical Research: What should clinicians and patients take away from your report?

Dr. Maddox: Clinicians should examine their own practice, and ensure that the cholesterol management of their patients hews to the latest evidence.  Doing so will maximally reduce our patients’ collective risk for myocardial infarction and death.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Maddox: Quality improvement initiatives are needed to examine the reasons behind these gaps in treatment and, where possible, close them.  The recent release of the IMPROVE-IT trial, which demonstrated that ezetimibe may have a role in cholesterol management, needs to be incorporated into our evidence.  In addition,  results of ongoing research in newer cholesterol agents, such as PCSK9 inhibitors and anti-inflammatories, will need incorporation, where relevant, into our management decisions.


Maddox TM, Borden WB, Tang F, et al. Implications of the 2013 ACC/AHA Cholesterol Guidelines for Adults in Contemporary Cardiovascular Practice: Insights From the NCDR PINNACLE Registry. J Am Coll Cardiol. 2014;():. doi:10.1016/j.jacc.2014.08.041.