Veterans' Cholesterol Levels Improve Significantly Through VA Quality Improvement Program
A Department of Veterans Affairs quality improvement program featuring health coaches and multidisciplinary teams helped military veterans with heart disease achieve better cholesterol control, with 34% reaching optimal LDL levels after two years.
A quality improvement program helped reduce "bad cholesterol" levels among military veterans with heart and blood vessel disease, according to preliminary research presented at the American Heart Association's Scientific Sessions 2025. The Veterans Affairs Lipid Optimization Reimagined Quality Improvement program, known as VALOR-QI, demonstrated significant improvements in cholesterol management through a comprehensive approach addressing multiple barriers to care.
After 24 months in the program, 34% of veterans with heart disease and high cholesterol achieved improved cholesterol levels below 70 mg/dL. The analysis showed a 32% increase in the number of veterans reducing their LDL cholesterol below this target level. Among participants who remained in the program for at least two years and had follow-up measurements, 33.5% achieved the LDL cholesterol goal, with similar benefits observed across both genders and particularly notable results among older veterans.
"Heart disease and stroke are the leading causes of death among veterans, and elevated low-density lipoprotein is a major risk factor for both," said study author Luc Djousse, M.D., a research health scientist at Massachusetts Veterans Epidemiology Research and Information Collaborative. "While there are medications that work well to lower this bad cholesterol, two-thirds of veterans with heart disease do not have cholesterol treated to goal. Lowering LDL cholesterol reduces the chances of having another heart attack or stroke."
The program addressed several identified barriers to cholesterol management, including poor medication adherence, 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.
The results showed substantial improvements across multiple metrics. Participants experienced an average 15.9 mg/dL reduction in LDL cholesterol, with the greatest reductions occurring among veterans who initially had the highest cholesterol levels. Medication prescribing rates increased from 78% at baseline to 88%, while patient adherence to cholesterol-lowering medications improved from 65% to 77%. Particularly noteworthy was the finding that 36% of veterans ages 75 and older achieved the LDL cholesterol goal of 70 mg/dL or less.
"We were surprised to see similar reductions in LDL levels among veterans ages 75 and older," Djousse noted. "This is important because fewer older adults have been included in previous clinical trials of LDL cholesterol medications. This knowledge, if confirmed by ongoing large trials among older adults, could change clinical practice for this age group."
The VALOR-QI program represents a collaboration between the Department of Veterans Affairs and the American Heart Association and is the first large-scale quality-improvement program designed specifically for former military service personnel with atherosclerotic cardiovascular disease or high cardiovascular risk. The current analysis included 83,232 veterans with prevalent ASCVD and LDL cholesterol of 70 mg/dL or higher at baseline who had follow-up measurements during the program.
Researchers emphasized that the program's success demonstrates how simple, inexpensive approaches can lead to significant improvements in cholesterol management. "Many tools and strategies used in VALOR-QI were simple, inexpensive and accessible to clinicians and patients at each point of care," Djousse explained. "This is important for sustainability within the VA system and could lead to adoption of these strategies throughout the vast VA system and also non-VA health care systems."
The study's strengths include the large number of participants representing veterans of various ages, races, and both genders, suggesting the results may be widely applicable to the general population. However, researchers noted limitations including that the program was not designed to evaluate impact on heart attacks or strokes, and LDL cholesterol measurements were taken as part of routine clinical care rather than at standardized intervals. Additional information about the American Heart Association is available at https://www.heart.org.