ArticleJACC. Advances2026
Secular Trends in Lipid Management Among U.S. Veterans With Atherosclerotic Cardiovascular Disease, 2003 to 2020.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) have explicitly highlighted the direct correlation of reduced low-density lipoprotein cholesterol (LDL-C) with a subsequent risk reduction in further ischemic events. Little is known about secular trends of lipid management among U.S. Veterans with ASCVD over the past 2 decades.
objectivesThe objective of the study was to determine the trend in the proportion of Veterans with ASCVD who are receiving lipid-lowering therapy treated to goal (LDL-C <70 mg/dL) between 2003 and 2020.
methodsWe conducted a retrospective cohort study, with annual accounting of treatment information and LDL-C lab results from 2003 to 2020, among U.S. Veterans with prevalent ASCVD who had at least 1 LDL-C lab value in the year before January 1st of the index year. We investigated annual trends in the proportion of Veterans with ASCVD who achieved an LDL-C <70 mg/dL while taking lipid-lowering agents.
resultsThe cohort grew from 642,082 Veterans with ASCVD in 2003 to 1.18 million in 2020, representing an older, high-risk population with substantial comorbidity. At baseline, up to 85.4% of Veterans had LDL-C >70 mg/dL. Over the 17-year period, the proportion achieving LDL-C <70 mg/dL rose from 14.5% to 41.6%. These observations were consistent across subgroups, including Veterans >75 years, who experienced marked increases in LDL-C improvement.
conclusionsWe observed a clear trend toward higher prevalence of LDL-C control among Veterans with ASCVD from 2003 to 2020. Despite this progress, most Veterans remain above guideline-recommended LDL-C targets, underscoring the need for continued optimization of lipid-lowering therapy.
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