Clinical Edge

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Lipid Guideline Adoption & Observed Implementation

Am Heart J; ePub 2018 Mar 26; Lowenstern, et al

While the majority of clinicians report adoption of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guideline recommendations, observed lipid management decisions in practice are frequently discordant, a recent study suggests. The Patient and Provider Assessment of Lipid Management (PALM) Registry asked 774 clinicians how they would treat 4 hypothetical scenarios of primary prevention patients with: 1) diabetes; 2) high 10-year ASCVD risk with high low-density lipoprotein cholesterol (LDL-C; ≥130 mg/dL); 3) low 10-year ASCVD RISK with high LDL-C (130-189 mg/ dL); or 4) primary and secondary prevention patients with persistently elevated LDL-C despite high-density statin use. Among the findings:

  • 85% of clinicians reported they would prescribe a statin to a patient with diabetes and 93% to a high-risk/high LDL-C patient (both indicated by guidelines), while 40% would prescribe statins to a low-risk/high LDL-C patient.
  • In clinical practice, statin prescription rates were 68% for patients with diabetes, 40% for high-risk/high LDL-C patients, and 50% for low-risk/high LDL-C patients.
  • Agreement between hypothetical and observed practice was 64%, 39%, and 52% for patients with diabetes, high-risk/high LDL-C, and low-risk/high LDL-C, respectively.
  • 55% of providers reported they would add a non-statin lipid-lowering medication among patients with persistently high LDL-C despite high-intensity statin treatment, while only 22% of patients were treated as such.


Lowenstern A. Li S, Navar AM, et al. Does clinician-reported lipid guideline adoption translate to guideline-adherent care? An evaluation of the PALM registry. [Published online ahead of print March 26, 2018]. Am Heart J. doi:10.1016/j.ahj.2018.03.011.