Cholesterol Management

Improving Health Care Through Patient-Centered Outcomes Research (PCOR)

PCOR is research that compares the impact of two or more preventive, diagnostic, treatment, or health care delivery approaches on health outcomes. PCOR outcomes are those that are meaningful to patients and families, such as pain, symptoms, quality of life, and premature death. PCOR research can focus on specific clinical interventions (such as a medication or surgical procedure) or on ways of delivering care (such as the use of text messages to remind people to take a medication daily). PCOR evidence can come from individual studies, but often comes from comprehensive reviews of a large group of studies. Using PCOR evidence gives clinicians confidence that they are providing the best care to their patients.

Rationale for Cholesterol Management

People with elevated levels of cholesterol are at increased risk of having a heart attack or stroke. Substantial PCOR evidence shows that taking a statin medication each day to manage blood cholesterol can reduce the chance of having a heart attack for people at increased risk for heart attacks and strokes, including those with diabetes; those with existing heart disease, especially those who have been treated for blocked arteries; and those with very high levels of cholesterol in their blood. People who have already had a heart attack or stroke have also been shown to benefit from statin use.1

Findings From PCOR

In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) developed an evidence-based guideline on treating high blood cholesterol to reduce heart disease and stroke risk in adults (Stone, 2014). The guideline was the result of a collaboration with the National Heart, Lung and Blood Institute (NHLBI), which conducted a systematic review of the evidence (NHLBI, 2013).

PCOR evidence supports a combined approach of promoting healthy lifestyle behaviors and use of statins as the main treatment for managing blood cholesterol and decreasing the risk of heart attack or stroke.

Prevention begins with a healthy lifestyle—following a heart-healthy diet, being physically active, avoiding tobacco, and maintaining a healthy weight.
Unless contraindicated or not tolerated, all patients at high risk should receive a high- or moderate-intensity statin.

Recently, the U.S. Preventive Services Task Force (USPSTF) released recommendations supporting statin use in adults at increased risk of cardiovascular disease. More information can be found at the USPSTF Web site

Evaluating and Measuring Use of PCOR-Supported Recommendations

The measure used by EvidenceNOW assesses the proportion of people at high risk for heart disease (including those with known heart disease, those with high LDL cholesterol levels, and those with diabetes), who have been prescribed a statin medication.
The EvidenceNOW goal is to have at least 70 percent of eligible patients in primary care practices receive a statin.

Additional Tools and Resources

Consumer fact sheets, such as the Centers for Disease Control and Prevention’s Know the Facts About High Cholesterol, and What You Need To Know About High Blood Cholesterol from the National Heart, Lung, and Blood Institute, can help people manage their cholesterol. The fact sheets provide succinct information about high cholesterol, including risk factors, symptoms, prevention, and treatment.

PCOR Evidence Sources

Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines . Circulation, 2014;129(suppl2):S1–S45.
National Heart, Lung and Blood Institute. Management of blood cholesterol in adults: Systematic evidence review from the Cholesterol Expert Panel. National Heart, Lung, and Blood Institute, National Institutes of Health; 2013.

1. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet, 2010;376(9753):1670-1681.

Page last reviewed December 2016
Page originally created October 2016

Internet Citation: Cholesterol Management. Content last reviewed December 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/evidencenow/about/pcor-evidence/cholesterol-management.html