Secular Trends in Lipid Management Among U.S. Veterans With Atherosclerotic Cardiovascular Disease, 2003 to 2020

BACKGROUND: Current 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. OBJECTIVES: The 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: We 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.