Cholesterol Management Evidence and Resources

People with elevated levels of cholesterol are at increased risk of having a heart attack or stroke. Substantial evidence shows that taking a statin medication each day to manage blood cholesterol can reduce the chance of having a heart attack for people at increased risk for heart attack and stroke, including those with diabetes; those with existing heart disease, especially those who have been treated for blocked arteries; and those with very high levels of cholesterol in their blood. People who have already had a heart attack or stroke have also been shown to benefit from statin use.

What PCOR Evidence Did EvidenceNOW Use?

Here are the PCOR findings used by EvidenceNOW for cholesterol management:

In 2016, the U.S. Preventive Services Task Force (USPSTF) released recommendations supporting statin use in adults at increased risk of cardiovascular disease.

Recommendation: The USPSTF recommended starting statin use for primary prevention of cardiovascular disease (CVD) in adults aged 40 to 75 years, with at least one CVD risk factor and an increased risk of a CVD event (>=10% in 10 years). The USPSTF recommended discussing statin use in similar patients with more moderate risk of a CVD event (7.5 percent to 10 percent in 10 years). More information can be found at the USPSTF Web site.

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) developed an evidence-based guideline on treating high blood cholesterol to reduce heart disease and stroke risk in adults. The guideline was the result of a collaboration with the National Heart, Lung, and Blood Institute (NHLBI), which conducted a systematic review of the evidence.

Recommendation: The panel recommended a combined approach of promoting healthy lifestyle behaviors and use of statins as the main treatment for managing blood cholesterol and decreasing the risk of heart attack or stroke.

• Prevention begins with a healthy lifestyle—following a heart-healthy diet, being physically active, avoiding tobacco, and maintaining a healthy weight.
• All patients at high risk should receive a high- or moderate-intensity statin unless contraindicated or not tolerated.

How Did EvidenceNOW Evaluate Whether Practices Followed This PCOR Evidence?

The measure used by EvidenceNOW reflects the proportion of people at high risk for heart disease (including those with known heart disease, those with high LDL cholesterol levels, and those with diabetes), who have been prescribed a statin medication.

This measure is used by the Centers for Medicare & Medicaid Services. (Measure ID: CMS 347)

The EvidenceNOW goal for primary care practices in the study is to have at least 70 percent of patients eligible to receive a statin be prescribed one.

Cholesterol Management Resources

Recommendations and Guidelines

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication: The U.S. Preventive Services Task Force Recommendation
This clinical recommendation summarizes the use of statins as a preventive measure for adults aged 40 to 75 years with no history of cardiovascular disease (CVD) and for those who have one or more CVD risk factors with a calculated 10-year CVD event risk of 7.5 percent or greater.

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
This clinical guideline, published in Circulation in 2011, outlines how to treat high blood cholesterol in adults to reduce the risk of cardiovascular disease. This guideline was a key PCOR finding disseminated to clinicians participating in EvidenceNOW.

Resources for Practices

EvidenceNOW PCOR Cholesterol Management Fact Sheet
This EvidenceNOW fact sheet provides an overview of PCOR findings and guidelines for managing cholesterol. It also provides links to related tools, resources, and PCOR evidence sources.

Cholesterol Management in Primary Care
This facts-at-a-glance handout for clinicians summarizes guidelines for prescribing statins for cholesterol management in high-risk groups, including patients with prior cardiovascular disease, diabetes, high LDL cholesterol, or elevated risk of heart disease.

Heart Health NOW! Lipid Algorithm
This decision tree summarizes recommendations for prescribing statins in primary and secondary treatment of cardiovascular disease.

Primary Prevention of Cardiovascular Disease (CVD) Events with Statins
This webinar slide deck and script reviews recommendations for lipid testing and CVD risk assessment, using assessment results and patient preferences to guide decisionmaking and improving adherence to statin therapy.

Kaiser Permanente National Cardiovascular Risk and Dyslipidemia Management Guideline
This clinical guide for primary care and other clinicians for the management of cholesterol was developed by Kaiser Permanente based on recommendations developed by the American College of Cardiology Foundation and the American Heart Association.

Cholesterol Management: Tasks for the Practice Facilitator
This two-page checklist and associated materials provide information on working with primary care practices to address cholesterol management.

Strategies to Better Manage Lipids—Statin Pearls
This slide deck and transcript of a 20-minute video with a family physician at Virginia Commonwealth University reviews current recommendations for the use of statins in lowering cholesterol and reducing CVD risk, as well as costs of the medication and common side effects.

Automated Outreach to Increase Primary Adherence to Cholesterol-Lowering Medications
This journal article summarizes findings from a randomized controlled trial that evaluated an automated system for improving adherence to statins for lowering cholesterol in patients who had received a prescription from their clinician but had not filled it.

Improving Medication Adherence Among Patients with Hypertension: A Tip Sheet for Health Care Professionals
This tip sheet for health care professionals outlines predictors of medication non-adherence and how to use the SIMPLE method to improve medication adherence among patients.

Resources for Practices To Use With Patients

How to Control Your Fat and Cholesterol: How to Control Your Cholesterol Numbers
This patient education booklet in the form of a fotonovela (an illustrated pamphlet popular in Mexico and Latin America) covers basics about cholesterol levels and diet and exercise guidelines for lowering cholesterol levels and heart disease risk.

How to Control Your Fat and Cholesterol: How to Control Your Cholesterol Numbers (Spanish)
This patient education booklet in Spanish and in the form of a fotonovela (an illustrated pamphlet popular in Mexico and Latin America) covers basics about cholesterol levels and diet and exercise guidelines for lowering cholesterol levels and heart disease risk.