More than 2 million veterans are living with atherosclerotic cardiovascular disease (ASCVD) and require management of their high cholesterol, according to the Department of Veterans Affairs (VA). Left unaddressed, high cholesterol increases the chance of experiencing heart attack and stroke. To control high cholesterol among veterans, the American Heart Association, the world's leading nonprofit organization focused on heart and brain health for all, in collaboration with the VA, has launched a new VA Medical Center program to help former service members with ASCVD who are at high risk of cardiovascular events.
ASCVD is caused by plaque buildup in arterial walls and refers to conditions that include coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerotic disease. These conditions may lead to heart attacks, bypass surgeries, stenting procedures, amputations and strokes.
The Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) program aims to improve the treatment of high cholesterol in veterans whose ASCVD puts them at high risk of recurrent heart attack or stroke. It will be implemented in 50 selected VA medical center sites and reach up to 30,000 veterans over three years, specifically focusing on veterans whose low-density lipoprotein cholesterol (LDL-C) remains at or above 70 mg/dl despite standard care. The program will take a multi-pronged approach designed to enhance the VA health system's ability to identify high-risk patients, augment clinicians' understanding of ASCVD treatment guidelines and their importance and educate veterans on how to manage their high cholesterol and seek appropriate care.
Despite existing attempts to control cholesterol, there is still a significant population-level gap between what most ASCVD patients experience and what we believe is possible. Continuing variation by race, sex, ethnicity and socio-economic status compounds this gap. VALOR-QI aims not only to improve treatment for ASCVD, but also to redouble our efforts to find ways to overcome barriers to health equity for all veterans."
Carolyn Clancy, M.D., assistant under secretary for health for Discovery, Education and Affiliate Networks at the VA
The best methods of managing high cholesterol include modifying lifestyle factors such as diet and exercise, as well as using medication. The initiative seeks to provide a mixture of education, staff training, monitoring, health coaching, medication and other steps to achieve better compliance. Taking such a comprehensive approach will be the key to better managing cardiovascular disease and saving lives.
VALOR-QI builds off the American Heart Association's Integrated ASCVD Management Initiative. Both the VALOR-QI program and the American Heart Association's Integrated ASCVD Management Initiative are supported by Novartis Pharmaceuticals Corporation.
"We know elevated LDL-C is a major risk factor for atherosclerotic cardiovascular disease," said American Heart Association Chief Executive Officer Nancy Brown. "This new program will help identify strategies to reduce cholesterol levels and improve health outcomes. VALOR-QI and American Heart Association's overall Integrated ASCVD Management Initiative will ultimately help reduce the risk of heart disease and stroke for millions of people everywhere."
Program lead Michael Gaziano, M.D., MPH, cardiologist at VA Boston Healthcare System, noted that while the health impact from lowering cholesterol is well-known, finding the right way to align clinical support for veterans to achieve this has remained an enduring challenge, which VALOR-QI aims to address. Gaziano oversees the national leadership team coordinating the program's implementation at the 50 VA sites.
VALOR-QI participating sites will undergo rigorous evaluation using metrics designed to assess ASCVD management among patients. In addition, the VALOR-QI program will scrutinize existing disparities in ASCVD management, then develop and implement strategies to address health equity gaps by sex, race, ethnicity and other demographic variables.
"Cardiovascular disease is the No. 1 cause of death in the U.S., and it is also the leading cause of hospitalizations for our veterans in the Veterans Affairs health care system," said Victor Bulto, president of Novartis Innovative Medicines US. "Novartis is proud to support the American Heart Association and Veterans Health Administration in improving cardiovascular care and outcomes for veterans and building a foundation from which continued progress can be made."