Heart Month 2025: “It was the age of wisdom; it was the age of foolishness”

First, the 2025 American Heart Association Heart Disease and Stroke statistics were published on January 27 and once again they show rising cardiovascular mortality for both men and women – we are truly losing the battle against the leading cause of death in America!

Second, the National Committee for Quality Assurance (NCQA) recently published the 2022 update for their quality measure on the use of statins in patients with ASCVD:

Achievement of this statin-based quality measure is >80% across the various payer types, which is seemingly an excellent outcome. But is the mere prescription of a statin leading to optimal control of LDL-cholesterol in people with ASCVD? The answer is – not even close. Based on a recent analysis from the Family Heart Foundation, which was presented at the 2024 Family Heart Foundation Global Summit, only 39% of Americans with ASCVD are achieving an LDL-C of < 70 mg/dl.

If you’d like to learn more about this analysis, check out this podcast by Dr. Keith C Ferdinand onReachMD.

https://reachmd.com/programs/heart-matters/ldl-c-management-trends-in-ascvd-patients/29147/

In this “age of wisdom”, we now have 4 therapies which have been proven to both reduce LDL-C and subsequent cardiovascular events – statins, PCSK9 inhibitors, ezetimibe, and bempedoic acid. And yet this “age of foolishness” led us to abandon LDL-C goals in our national guidelines in 2013 and focus on the prescription of one class of medications (statins) in our performance measures to assess quality of care for lipids in people with ASCVD.

Related to the topic of LDL-C treatment goals, the field of prevention lost a giant recently with the passing of Dr. Scott Grundy. He was an author on the first National Cholesterol Education Program Adult Treatment Panel (ATP) guidelines in 1987 and for the next 25 years, Americans were encouraged to “know their numbers” and healthcare practitioners treated patients to increasingly lower LDL-cholesterol goals, from <130 mg/dl in 1987 for high-risk individuals to < 70mg/dl in 2004 for very high-risk. His perspective from a 2014 interview still rings true and will hopefully inspire future guideline writing committees:

“In my opinion, treatment goals have a lot of clinical utility. But recent guidelines have found it difficult to define a clinical goal for LDL. The available data suggest that the lower the better for LDL levels. For secondary prevention, this translates into a goal in the range of less than 70 mg/dL.”

https://www.lipidjournal.com/article/S1933-2874(13)00353-X/fulltext

With cardiovascular disease mortality on the rise once again for both men and women, we urgently need to return to a common sense approach for controlling a major modifiable risk factor for CVD by restoring specific LDL-C treatment goals to our national guidelines and ensuring that NCQA and CMS measure what matters in their quality measures.

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