This article is more than 5 years old. Information may no longer be current.

Most monitoring lipid tests do not result in changes in therapy

Results from a new study indicated that although there is a high frequency of obtaining monitoring lipid panels for patients receiving statin therapy, the findings from most of these tests resulted in no change in lipid-lowering treatment.

“Statins are among the most commonly prescribed medications in the United States and are effective for prevention of cardiovascular events,” Karen Stenehjem, MD, from the division of general internal medicine at the University of Colorado School of Medicine, and colleagues wrote in JAMA Internal Medicine. “Recent lipid management guidelines no longer recommend treating to a target low-density lipoprotein (LDL) level and instead favor a risk-assessment approach. Though there is insufficient data to show that monitoring lipids leads to meaningful improvements in clinical outcomes or adherence to pharmacologic treatment, U.S. guidelines recommend lipid monitoring every 3 to 12 months.”

Stenehjem and colleagues sought to determine the reasoning for ordering monitoring lipid panels for patients receiving statin therapy, as well as the rate of occurrence of treatment changes caused by testing. They recruited 4,945 patients from the University of Colorado Hospital between the ages of 40 and 79 years who visited a primary care physician in the past year and have been undergoing statin therapy for more than 3 years. The researchers took a random sample of the participants (n = 210; mean age, 64.7 years; 65% white; mean 10-year atherosclerotic cardiovascular disease risk, 14.2%) and reviewed their medical records from Nov. 1, 2012, through Nov. 1, 2015.

During the study period, 634 monitoring lipid panels were performed with a mean of 3.01 lipid panels per patient. Participants had comorbidities, including diabetes (37%), hypertension (71%) and current tobacco use (11%). For most patients (79%), statin therapy was initiated for primary prevention of CV events. Of the medical charts reviewed, 87% indicated a rationale for ordering lipid tests, with the most commonly reported rationales being monitoring (70%), follow-up statin dosage change (8%) and patient request (4%). Most (86%) monitoring of lipid profiles caused no change in therapy. There were infrequent changes after a lipid test regardless of lipid-lowering indication.

“The high frequency of testing may reflect adherence to current guidelines, practice habits stemming from the historic treat-to-target approach, patient expectations, and a perception that lipid testing may allow for monitoring adherence to therapy,” Stenehjem and colleagues concluded.

“We suspect that the rarity of treatment changes was owing to the dearth of data supporting LDL or triglyceride targets, as well as guidelines that now advocate a risk stratification approach though still recommend routine lipid monitoring,” they added. “Because the key clinical decision has shifted from treatment to an LDL goal to mitigating cardiovascular risk, the utility of lipid monitoring may be diminished.”

“Our study raises the question of the utility of routine lipid monitoring,” they added. “The appropriate frequency of lipid testing is uncertain. As attention to value-based care increases nationally, this may be a target for cost savings and warrants further study.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.