VA Quality Improvement Program Significantly Lowers Cholesterol in Veterans with Heart Disease

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, a collaboration between the Department of Veterans Affairs and the American Heart Association, demonstrated significant improvements in cholesterol management through a multipronged approach addressing barriers to optimal care.

After 24 months, 34% of veterans with heart disease and high cholesterol in the program achieved improved cholesterol levels below 70 mg/dL. The analysis showed a 32% increase in the number of veterans reducing their LDL cholesterol below 70 mg/dL during the program. Among participants who were in the program for at least two years and had a second LDL measurement, 33.5% achieved the cholesterol goal, with similar benefits observed in both men and women.

The program addressed several 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 intervention included health care coaches, multidisciplinary teams, engagement lists for at-risk veterans, improved medication prescribing practices, and health information resources about cholesterol and lifestyle management. The proportion of veterans prescribed cholesterol-lowering medication increased from 78% at baseline to 88%, while patient adherence to these medications improved from 65% to 77%.

Notably, the program showed significant benefits for older veterans, with 36% of those ages 75 and older achieving the LDL cholesterol goal of less than 70 mg/dL. Study author Luc Djousse noted that this finding is particularly important because fewer older adults have been included in previous clinical trials of LDL cholesterol medications. The overall analysis included 83,232 veterans with prevalent atherosclerotic cardiovascular disease and LDL cholesterol of 70 mg/dL or higher at baseline who had another cholesterol measurement during the program.

The Veterans Health Administration, the largest integrated health care system in the United States, provides care at 1,380 health care facilities to over 9.1 million veterans enrolled in the VA health care program. The VALOR-QI program represents the first large-scale quality improvement initiative designed specifically for former military service personnel with atherosclerotic cardiovascular disease or high cardiovascular risk. Approximately 160,000 veterans have been engaged in VALOR-QI since its launch in 2022, with the program supported by Novartis, though the company was not involved in this particular study.

Researchers noted that the tools and strategies used in VALOR-QI were simple, inexpensive, and accessible to clinicians and patients at each point of care, which is important for sustainability within the VA system and potential adoption in non-VA health care systems. The study's strengths include the large number of participants from various ages and racial backgrounds, suggesting the results may be more widely applicable to the general population. Additional information about the American Heart Association's financial policies is available at https://www.heart.org/en/about-us/aha-financial-information.