Importance of Low-Density Lipoprotein Cholesterol Measurement and Control As Performance Measures

Achievement of LDL-C levels <100 mg/dL in individuals with ASCVD or equivalent risk has been associated with improvements in ASCVD event rates and mortality, making it a Class IA recommendation and an established quality measure in the well-respected HEDIS tool in the past. The transition by the NCQA to a HEDIS process measure focused on statin use in 2015 reflected new data in support of higher-intensity statin treatment but did not incentivize LDL-C monitoring and/or improvement. Many data now support the re-establishment of LDL-C testing in high-risk subsets as a performance measure, especially in patients with established ASCVD:

• Recent data from the NCQA and independent surveys show minimal improvement in statin use in individuals with ASCVD in recent years
• Significant heterogeneity in LDL-C response from statin therapy
• New evidence-based guidelines that support LDL-C monitoring to assess efficacy and adherence to statin therapy and assess the need for add-on therapies (e.g., if certain LDL-C thresholds are not met on statin therapy alone)
• New clinical trial evidence with nonstatin therapies that supports the benefits of additional LDL-C lowering in high-risk patients already on maximal statin therapy
• Advances in the use of advanced data analytics in the EHR that allow health systems and providers not only to monitor LDL-C levels but also to improve care quality and outcomes