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 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 that 34% of veterans in the program achieved improved cholesterol levels below 70 mg/dL after 24 months. This finding is particularly significant given that heart disease and stroke are the leading causes of death among veterans, and elevated LDL cholesterol represents a major risk factor for both conditions.

The study addressed several barriers to effective cholesterol management that had been identified within the veteran population. These included poor medication adherence, gaps in health information and education support for both veterans and health care professionals regarding cholesterol management and lifestyle changes, and staffing shortages at Veterans Affairs health care centers. The program implemented a multipronged approach to overcome these challenges, incorporating 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.

Analysis of the program results revealed substantial improvements across multiple metrics. Researchers observed a 32% increase in the number of veterans reducing their LDL cholesterol below 70 mg/dL during the program. Among participants who remained in the program for at least two years and had a second LDL cholesterol measurement, 33.5% achieved the target LDL cholesterol goal. The benefits were consistent across both men and women, and notably, veterans aged 75 years and older showed particularly strong results, with 36% achieving the LDL cholesterol goal of less than 70 mg/dL. The average reduction in LDL cholesterol among all participants was 15.9 mg/dL, with the most significant reductions occurring among veterans who initially had the highest LDL cholesterol levels.

Medication management also showed marked improvement throughout the program. The proportion of veterans being prescribed cholesterol-lowering medication increased from 78% at baseline to 88%, while patient adherence to these medications improved from 65% to 77%. These improvements in prescription rates and adherence were observed consistently across both male and female veterans. The study's large participant pool of 83,232 veterans with prevalent atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dL or higher at baseline strengthens the potential generalizability of these findings to broader populations.

Researchers expressed particular interest in the strong performance among older veterans. Study author Luc Djousse noted that similar reductions in LDL levels among veterans ages 75 and older were surprising and 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 potentially change clinical practice for this age group. The program's use of health coaches and simple, inexpensive approaches suggests that significant improvement in cholesterol management can be achieved through accessible methods that are sustainable within the VA system and potentially transferable to non-VA health care systems.

The VALOR-QI program represents a collaboration between the Department of Veterans Affairs and the American Heart Association and stands as the first large-scale quality-improvement program specifically designed to support former military service personnel with atherosclerotic cardiovascular disease or those at high risk of cardiovascular events. With nearly 160,000 veterans engaged in the program since its launch in 2022, the initiative demonstrates how systematic approaches to chronic disease management can yield substantial clinical improvements. Additional information about the American Heart Association's initiatives is available at https://www.heart.org. The program's success in improving cholesterol management among veterans highlights the potential for similar quality improvement strategies to benefit other populations struggling with cardiovascular disease management.