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

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: Among 9098 patients with ASCVD (median age 71.0 years, 61.6% male, 70.5% White) seen across 77 cardiology clinicians (56 physicians, 21 APPs), 52.8% were on a high-intensity statin, 17.1% were on ezetimibe, 7.8% were on novel LLT (proprotein convertase subtilisin/kexin type 9 monoclonal antibody, inclisiran, or bempedoic acid). Of those with an available lipid panel in the past year ( 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.