Quality Improvement Program Shows Significant LDL Cholesterol Reduction Among Veterans

A quality improvement program significantly reduced LDL cholesterol levels among military veterans with heart and blood vessel disease, according to preliminary findings presented at the American Heart Association's Scientific Sessions 2025. The Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) program demonstrated that 34% of participants achieved LDL cholesterol levels below 70 mg/dL after 24 months, representing a critical milestone in cardiovascular risk management for this high-risk population.

The program addressed significant barriers to cholesterol management that have historically plagued veteran care, including poor medication adherence, gaps in health education, and staffing shortages at Veterans Affairs health care centers. Through a multipronged approach involving health care coaches, multidisciplinary teams, and improved medication prescribing practices, the program achieved a 32% increase in veterans reaching optimal LDL cholesterol targets. The analysis covered 83,232 veterans with atherosclerotic cardiovascular disease and baseline LDL cholesterol of 70 mg/dL or higher who had subsequent cholesterol measurements during the program.

Study results showed particularly promising outcomes across demographic groups. Among participants who remained in the program for at least two years and had follow-up LDL measurements, 33.5% achieved the target cholesterol goal. This benefit was consistent across both men and women, with veterans aged 75 and older showing especially notable results - 36% of this older cohort reached the LDL cholesterol goal of less than 70 mg/dL. The average LDL cholesterol reduction across all participants was 15.9 mg/dL, with the most substantial improvements occurring among veterans who initially had the highest cholesterol levels.

Medication management showed significant improvement throughout the program. The proportion of veterans prescribed cholesterol-lowering medications increased from 78% at baseline to 88%, while patient adherence to these medications improved from 65% to 77%. These enhancements in prescription practices and patient compliance contributed directly to the observed cholesterol reductions. The program's design emphasized simple, inexpensive approaches that could be sustained within the VA system and potentially adopted by non-VA health care systems.

The implications of these findings extend beyond veteran health care. As the largest integrated health care system in the United States, the Veterans Health Administration serves over 9.1 million veterans across 1,380 health care facilities. Successful implementation of cholesterol management strategies within this system could provide a model for broader cardiovascular care improvement nationwide. The program's collaborative nature between the Department of Veterans Affairs and the American Heart Association represents an important partnership in addressing cardiovascular disease, which remains the leading cause of death among veterans.

Researchers noted that the similar cholesterol reductions observed in older veterans were particularly significant, as fewer older adults have been included in previous clinical trials of LDL cholesterol medications. This finding, if confirmed by ongoing large trials among older adults, could influence clinical practice guidelines for cholesterol management in elderly populations. The study's large participant pool, including veterans of various ages, races, and both genders, suggests the results may have broad applicability to the general population.

While the program was not designed to evaluate impact on heart attacks or strokes, the substantial LDL cholesterol reductions achieved suggest potential for reduced cardiovascular events among participants. Lowering LDL cholesterol is well-established as reducing the risk of subsequent heart attacks and strokes, making these improvements in cholesterol management particularly meaningful for veteran populations who face elevated cardiovascular risks. The program continues through December 2025, with researchers evaluating additional outcomes including health care cost impacts.