title: Institutional, provider, and patient correlates of low-density lipoprotein and non-high-density lipoprotein cholesterol goal attainment according to the Adult Treatment Panel III guidelines.
abstract: BACKGROUND
  The aim of this analysis was to identify the proportion of coronary heart disease (CHD) patients achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goals and to identify correlates of dual goal attainment.
  
  
  METHODS
  We analyzed patient, provider, and facility characteristics for 21,801 CHD patients in one Veterans Affairs Hospitals Network.
  
  
  RESULTS
  Low-density lipoprotein cholesterol goal attainment was 80%, but optional LDL-C goal attainment was 41%. Of patients with triglycerides ≥200 mg/dL, 51% attained both LDL-C and non-HDL-C goals. Correlates of higher dual goal attainment included older age (65-74 years: odds ratio [OR] 1.47, 95% CI 1.28-1.69), diabetes (OR 1.33, 95% CI 1.16-1.53), obesity (OR 1.25, 95% CI 1.04-1.50), a higher number of primary care visits (OR 1.04, 95% CI 1.04-1.05), and mild increase in illness severity of patients in provider's panel (OR 1.20, 95% CI 1.0008-1.46), whereas African American patients were less likely to achieve dual lipid goals (OR 0.63, 95% CI 0.48-0.82). Receipt of care from physician (vs nonphysician) or specialist (vs primary care) provider, number of patients in provider's panel, and percentage of patients in provider's panel with diagnosis of hyperlipidemia were not associated with dual goal attainment.
  
  
  CONCLUSIONS
  A large proportion of CHD patients attained LDL-C goal, but optional LDL-C goal attainment was low. Patients with elevated triglycerides had poor attainment of dual LDL-C and non-HDL-C goals, suggesting a treatment gap. Factors associated with dual goal attainment may identify interventions needed to improve future guideline adherence.
authors.affiliation: Health Policy and Quality Program, Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence; and Section of Health Services Research, Baylor College of Medicine; Houston, TX 77030, USA. salim.virani@va.gov
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: Lechauncy D
authors.initials: LD
authors.lastname: Woodard
authors.forename: Cassie R
authors.initials: CR
authors.lastname: Landrum
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pietz
authors.forename: Degang
authors.initials: D
authors.lastname: Wang
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
mesh_terms: D000367:Age Factors; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic
chemical_list: D008078:Cholesterol, LDL; D008074:Lipoproteins