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In Reply We appreciate the comments of McConnell and colleagues regarding the emphasis of current performance measures on attaining low-density lipoprotein cholesterol (LDL-C) targets, which could drive redundant lipid testing. In addition, we agree that the bulk of scientific evidence points toward a “statin dose–based approach” to cardiovascular risk reduction as opposed to a “treat-to-target” approach. As noted by McConnell and colleagues, the Department of Veterans Affairs (VA) has incorporated moderate-dose statin use in the definition of effective cholesterol care in patients with diabetes or ischemic heart disease (IHD). Although the current performance measure incorporates moderate-dose statin use in the VA health care system, the measure also still labels LDL-C level lower than 100 mg/dL (to convert to millimoles per liter, multiply by 0.0259) in patients with diabetes or IHD as a metric of effective cholesterol care. In other words, a health care clinician may opt to treat LDL-C level to lower than 100 mg/dL without using a moderate-dose statin medication and still meet the performance measure.
Virani SS, Ballantyne CM, Petersen LA. Decrease the Incentives to Order Lipid Panels—Reply. JAMA Intern Med. 2014;174(3):473-474. doi:10.1001/jamainternmed.2013.12842