Association of Low-Density Lipoprotein Testing After an Atherosclerotic Cardiovascular Event with Subsequent Statin Adherence and Intensification
Open accessAbstract
Purpose This study aimed to evaluate associations between outpatient low-density lipoprotein cholesterol (LDL-C) testing and subsequent statin adherence and intensification in patients after an atherosclerotic cardiovascular (ASCVD) event. Methods This was a longitudinal study of adult members of Kaiser Permanente Northern California hospitalized with an ASCVD event (myocardial infarction or stroke) during January 01, 2016, to December 31, 2017, with follow-up through December 31, 2019. Outcomes were statin adherence (estimated using continuous medication gap [CMG]) and intensification (defined by an increased dose or switch to a higher-intensity statin) based on pharmacy dispensing. The exposure of interest was first outpatient LDL-C test after an ASCVD event. Baseline for follow-up was LDL-C test date or a date assigned using incidence density sampling. Multivariate logistic regression models were specified to estimate the odds ratios for statin adherence or intensification among those with vs without an LDL-C test, with adjustment for age, sex, race/ethnicity, smoking, hypertension, diabetes, body mass index, and estimated glomerular filtration rate. Results There were 19,604 adults hospitalized with ASCVD, including 7054 adults not on high-intensity statins. The mean age was 69.5 years and 33.0% were female. Prevalence of good adherence (continuous medication gap ≤20%) was significantly higher (80.2% vs 75.9%; odds ratio 1.38; 95% confidence interval, 1.28-1.49; P <.001) among participants who had an LDL-C test compared with participants who did not. LDL-C testing was associated with significantly higher rates of treatment intensification (16.1% vs 10.7%; odds ratio 1.51; 95% confidence interval,1.29-1.76; P <0.001). Conclusions Low-density lipoprotein cholesterol testing is recommended for patients with a history of ASCVD and may be a high-value and low-cost intervention to improve adherence and statin management.
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Monitoring lipid profiles after initiation of statin therapy and during therapy increases the likelihood of dose titration and following the statin treatment plan.
“Monitoring lipid profiles after initiation of statin therapy and during therapy increases the likelihood of dose titration and following the statin treatment plan (94)(95)(96).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [95]
The Results report that LDL-C testing after an ASCVD event was associated with higher statin adherence and treatment intensification. However, the claim generalizes this finding to lipid-profile monitoring during statin therapy more broadly and implies that monitoring increases these outcomes. The Discussion states that the observational design cannot establish a causal relationship. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMonitoring lipid profiles after initiation of statin therapy and during therapy increases the likelihood of dose titration and following the statin treatment plan.
“Monitoring lipid profiles after initiation of statin therapy and during therapy increases the likelihood of dose titration and following the statin treatment plan (88–90).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [89]
The Results report that LDL-C testing after an ASCVD event was associated with higher statin adherence and treatment intensification. But the Discussion says the observational design cannot establish causation, and the study does not establish this effect for statin users generally after initiation or throughout therapy. (LLM, conf=0.88)
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- Authors
- Rana, J. S., Virani, S. S., Moffet, H. H., Liu, J. Y., Coghlan, L. A., Vasadia, J., Ballantyne, C. M., & Karter, A. J.
- Affiliations
- Kaiser Permanente (US)
- Michael E. DeBakey VA Medical Center (US)
- Kaiser Permanente Santa Clara Medical Center (US)
- Kaiser Permanente Santa Rosa Medical Center (US)
- Corresponding author
- Rana, Jamal S.
- ORCID
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 135
- Issue
- 5
- Pages
- 603-606
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC9081243
- OpenAlex
- W3217074882
- Cited by
- 35
- References
- 19
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 4 · 2023: 10 · 2022: 4
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Kaiser Permanente
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- LDL cholesterol testing, statin adherence, atherosclerotic cardiovascular disease, myocardial infarction, stroke, secondary prevention, high-intensity statins, medication management
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Female, Humans, Cholesterol, LDL, Longitudinal Studies, Male, Myocardial Infarction, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke, Atherosclerosis, Medication Adherence
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