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 (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 LDL cholesterol represents a major risk factor for both conditions. Study author Luc Djousse, M.D., a research health scientist at Massachusetts Veterans Epidemiology Research and Information Collaborative (MAVERIC), emphasized that while effective cholesterol-lowering medications exist, two-thirds of veterans with heart disease do not have their cholesterol treated to goal levels. The program addressed this gap through a comprehensive approach targeting medication adherence, education, and clinical support.
The analysis revealed a 32% increase in veterans achieving LDL cholesterol levels below 70 mg/dL during the program. Among participants who remained in the program for at least two years and had follow-up cholesterol measurements, 33.5% reached the LDL cholesterol goal. The benefits extended across demographic groups, with similar improvements observed in both men and women and particularly notable results among older veterans.
Researchers were especially encouraged by the outcomes for veterans ages 75 and older, with 36% of this population achieving the LDL cholesterol goal of 70 mg/dL or less. Djousse noted that this finding is significant because fewer older adults have been included in previous clinical trials of LDL cholesterol medications. If confirmed by ongoing large trials, these results could influence clinical practice for older patient populations.
The program successfully addressed several barriers to cholesterol management, including poor medication adherence, gaps in health information, 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 at https://www.heart.org.
Medication adherence improved substantially during the program, rising from 65% to 77% among participants. The proportion of veterans prescribed cholesterol-lowering medication increased from 78% at baseline to 88%. Overall, participants experienced an average LDL cholesterol reduction of 15.9 mg/dL, with the greatest improvements occurring among veterans who initially had the highest cholesterol levels.
The study included 83,232 veterans with atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dL or higher at baseline who had follow-up cholesterol measurements during the program. Participants averaged 70 years of age, with 7% women, 69% white adults, and 22% Black adults. The program involved 50 VA health care sites, each led by a local clinical champion working with health care professionals and American Heart Association consultants.
While the program demonstrated significant improvements in cholesterol management, researchers noted limitations. The program was not designed to evaluate impact on heart attacks or strokes, so direct connections to these cardiovascular events cannot be established. Additionally, researchers relied on LDL cholesterol measurements taken as part of routine clinical care rather than requiring frequent blood samples.
The VALOR-QI program represents the first large-scale quality improvement initiative designed specifically for military veterans with atherosclerotic cardiovascular disease or high cardiovascular risk. With nearly 160,000 veterans engaged since its 2022 launch, the program's simple, inexpensive strategies show potential for broader implementation throughout the VA system and non-VA health care systems, potentially transforming cholesterol management for vulnerable populations.
