VA Quality Improvement Program Shows Significant LDL Cholesterol Reductions Among Veterans

A quality improvement program helped reduce LDL cholesterol levels among military veterans with heart and blood vessel disease, according to preliminary findings presented at the American Heart Association's Scientific Sessions 2025. The Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) program demonstrated that 34% of veterans with heart disease and high cholesterol achieved improved cholesterol levels below 70 mg/dL after 24 months in the program.

Heart disease and stroke are the leading causes of death among veterans, and elevated low-density lipoprotein represents a major risk factor for both conditions. While effective cholesterol-lowering medications exist, two-thirds of veterans with heart disease do not have their cholesterol treated to goal levels, according to study author Luc Djousse, M.D., a research health scientist at Massachusetts Veterans Epidemiology Research and Information Collaborative (MAVERIC) and associate professor of medicine at Harvard Medical School.

The program addressed several barriers to cholesterol management, including poor medication adherence among veterans, gaps in health information and education support, and staffing shortages at Veterans Affairs health care centers. The multipronged approach included health care coaches, multidisciplinary teams, engagement lists for at-risk veterans, improved medication prescribing practices, and comprehensive health information resources about cholesterol and lifestyle management available through the American Heart Association's website at https://www.heart.org.

The analysis of 83,232 veterans with atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dL or higher revealed a 32% increase in the number of veterans reducing their bad cholesterol below 70 mg/dL during the program. For participants who remained in the program for at least two years and had a second LDL cholesterol measurement, 33.5% achieved the LDL cholesterol goal. This benefit was consistent across both men and women and particularly notable among veterans aged 75 and older, with 36% of this age group achieving the target LDL cholesterol level of less than 70 mg/dL.

Researchers observed a 15.9 mg/dL reduction in LDL cholesterol across all participants, with the greatest improvements occurring among veterans who initially had the highest LDL cholesterol levels. The proportion of veterans prescribed cholesterol-lowering medication increased from 78% at baseline to 88%, while patient adherence to these medications improved from 65% to 77%. These improvements were consistent across both male and female veterans.

The study's significance lies in its demonstration that simple, inexpensive approaches can lead to substantial improvements in cholesterol management within large healthcare systems. The program's success with older veterans is particularly noteworthy, as fewer older adults have been included in previous clinical trials of LDL cholesterol medications. Djousse noted that if confirmed by ongoing large trials among older adults, these findings could change clinical practice for this age group.

Approximately 160,000 veterans with heart and vascular diseases are enrolled in the VALOR-QI program, which represents a collaboration between the Department of Veterans Affairs and the American Heart Association. The program, supported by Novartis and detailed in the American Heart Association Scientific Sessions 2025 Online Program Planner at https://professional.heart.org, is the first large-scale quality-improvement program designed specifically for former military service personnel with atherosclerotic cardiovascular disease or high cardiovascular risk.

The Veterans Health Administration, as the largest integrated health care system in the United States, provides care to over 9.1 million veterans enrolled in the VA health care program. The success of the VALOR-QI program suggests that similar approaches could be adopted throughout the VA system and potentially in non-VA healthcare systems, potentially improving cardiovascular outcomes for millions of patients while reducing healthcare costs.