Back to Journals » Clinical Epidemiology » Volume 12

Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines

Authors Levintow SN, Reading SR, Saul BC, Yu Y, Reams D, McGrath LJ, Philip K, Dluzniewski PJ, Brookhart MA

Received 1 May 2020

Accepted for publication 14 July 2020

Published 4 August 2020 Volume 2020:12 Pages 835—845


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Irene Petersen

Sara N Levintow,1,2 Stephanie R Reading,3 Bradley C Saul,1 Ying Yu,1 Diane Reams,1 Leah J McGrath,1 Kiran Philip,3 Paul J Dluzniewski,3 M Alan Brookhart1,4

1NoviSci, Inc, Durham, NC, USA; 2Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA; 3Center for Observational Research, Amgen, Thousand Oaks, CA, USA; 4Department of Population Health Sciences, Duke University, Durham, NC, USA

Correspondence: Sara N Levintow
NoviSci, Inc, PMB 218, 201 W Main St, Ste 200, Durham, NC 27701 Email

Background: The 2013 ACC/AHA cholesterol treatment guidelines removed the recommendation to treat adults at risk of cardiovascular disease to goal levels of low-density lipoprotein cholesterol (LDL-C). We anticipated that the frequency of LDL-C testing in clinical practice would decline as a result. To test this hypothesis, we evaluated the frequency of LDL-C testing before and after the guideline release.
Methods: We used the MarketScan® Commercial and Medicare Supplemental claims data (1/1/2007– 12/31/2016) to identify four cohorts: 1) statin initiators (any intensity), 2) high-intensity statin initiators, 3) ezetimibe initiators, and 4) patients at very high cardiovascular risk (≥ 2 hospitalizations for myocardial infarction or ischemic stroke, with prevalent statin use). Rates of LDL-C testing by calendar year quarter were estimated for each cohort. To estimate rates in the absence of a guideline change, we fit a time-series model to the pre-guideline rates and extrapolated to the post-guideline period, adjusting for covariates, seasonality, and time trend.
Results: Pre- and post-guideline rates (LDL-C tests per 1,000 persons per quarter) were 248 and 235, respectively, for 3.9 million statin initiators; 263 and 246 for 1.3 million high-intensity statin initiators; 277 and 261 for 323,544 ezetimibe initiators; and 180 and 158 for 42,108 very high-risk patients. For all cohorts, observed post-guideline rates were similar to model-predicted rates. On average, the difference between observed and predicted rates was 8.5 for patients initiating any statin; 2.6 for patients initiating a high-intensity statin; 11.4 for patients initiating ezetimibe, and − 0.5 for high-risk patients.
Conclusion: We observed no discernible impact of the release of the 2013 ACC/AHA guidelines on LDL-C testing rates. Rather, there was a gradual decline in testing rates starting prior to the guideline change and continuing throughout the study period. Our findings suggest that the guidelines had little to no impact on use of LDL-C testing.

Keywords: low-density lipoprotein cholesterol, statin, ezetimibe, cardiovascular disease, guideline adherence, database, epidemiology

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]