A groundbreaking quality improvement initiative targeting cholesterol management has revealed promising results for military veterans grappling with heart and vascular diseases. Presented at the American Heart Association’s Scientific Sessions 2025 in New Orleans, this preliminary research elucidates the impact of a comprehensive program designed to optimize the control of low-density lipoprotein cholesterol (LDL-C), commonly known as “bad cholesterol,” which is intrinsically linked to cardiovascular events such as heart attacks and strokes.
Cardiovascular disease remains a predominant cause of mortality among veterans, exacerbated by elevated LDL cholesterol levels. Despite the availability of effective lipid-lowering pharmacotherapies, evidence indicates that approximately two-thirds of veterans with atherosclerotic cardiovascular disease (ASCVD) fail to achieve LDL cholesterol goals, underscoring significant gaps in management and adherence. This program, known as the Veterans Affairs Lipid Optimization Reimagined Quality Improvement (VALOR-QI) initiative, undertaken as a collaboration between the Department of Veterans Affairs and the American Heart Association, seeks to bridge these gaps through a multifaceted intervention approach.
The VALOR-QI program employs a strategy integrating health care coaches, multidisciplinary clinical teams, targeted patient engagement, and enhanced prescribing practices, alongside educational resources addressing lifestyle modifications and cholesterol management. Over 160,000 veterans have been enrolled since the program’s inception in late 2022, making it one of the most extensive efforts to date aimed at improving lipid profiles within this high-risk population. This large-scale intervention leverages both behavioral and systemic solutions to overcome entrenched barriers such as medication non-adherence and staff shortages within Veterans Affairs healthcare facilities.
Data analyzed up to June 2025 from over 83,000 veterans with pre-existing ASCVD and LDL cholesterol levels above 70 mg/dL reveal significant cholesterol improvements. Notably, the cohort exhibited an approximate 16 mg/dL average reduction in LDL cholesterol levels, a clinically meaningful decrease given the direct correlation between LDL-C reduction and cardiovascular event risk mitigation. The greatest improvements were observed in individuals presenting with the highest baseline LDL cholesterol, suggesting that those at greatest risk may derive the most benefit from such targeted quality improvement programs.
One of the most compelling outcomes from the VALOR-QI analysis is the increase in the proportion of veterans attaining guideline-recommended LDL cholesterol goals below 70 mg/dL. The study reports a remarkable 32% surge in the number of participants with controlled LDL cholesterol during the intervention, with 33.5% of those engaged in the program for at least two years reaching this threshold. The success of the program transcended age and gender, with older veterans aged 75 and above—an often underrepresented demographic in lipid management trials—achieving target LDL levels at a rate comparable to the overall cohort.
Enhanced prescription patterns and medication adherence were also hallmarks of the intervention. The percentage of veterans prescribed cholesterol-lowering agents increased from 78% at baseline to 88%, while adherence rates, assessed through prescription refill data and laboratory monitoring, improved from 65% to 77%. These adherence improvements signify not only increased access or prescribing but also greater patient engagement with their treatment regimens, a critical factor in long-term cardiovascular risk reduction.
The VALOR-QI program’s success is further augmented by its pragmatic design, emphasizing simple yet effective tools that can sustainably fit into clinical workflows. Employing health coaches who work directly with veterans to promote medication adherence and lifestyle change provides personalized support that nurses, physicians, and pharmacists alone often cannot adequately deliver due to systemic constraints. Such a holistic approach facilitates an ecosystem of continuous care, education, and behavioral reinforcement, delivering scalable and reproducible benefits.
Despite its promising findings, the program’s design does have inherent limitations. Because the initiative relies on LDL cholesterol measurements obtained from routine clinical care rather than standardized, protocol-driven sampling, data completeness and timing may vary. Additionally, while LDL-C reduction serves as a surrogate marker for cardiovascular risk, the program is not yet structured to directly correlate cholesterol improvements with the incidence of cardiovascular events like myocardial infarction or stroke. Further longitudinal assessment is essential to validate the program’s impact on hard clinical outcomes and associated healthcare costs.
Another notable point relates to the broader implications for clinical practice, particularly concerning older adults. Historically, clinical trials have underrepresented patients aged 75 years and older in studies surrounding lipid-lowering therapies. The VALOR-QI program’s demonstration of effective LDL cholesterol reduction in this subgroup provides valuable real-world evidence that may prompt reconsideration of cholesterol management guidelines and therapeutic strategies for geriatric populations, pending confirmation by ongoing large-scale trials.
The demographic diversity of the study cohort enhances the generalizability of the results. Participants ranged in age, race, and gender, with approximately 7% women, 69% self-identified White adults, and 22% Black adults. This heterogeneity reflects the veteran population’s composition and addresses a historical underrepresentation of minorities and women in cardiovascular research, indicating that quality improvement interventions can be equally beneficial across these groups.
Strategically, the role of local clinical champions leading multidisciplinary teams at each participating VA healthcare site is a critical component of successful implementation. These champions tailor interventions to address specific site-level challenges, whether related to resource allocation, staff engagement, or patient education. The program’s adaptability and focus on site-specific barriers enhance the potential for widespread adoption and sustainability across diverse healthcare settings within the VA system.
Looking ahead, the ongoing evaluation of the program’s effects on healthcare expenditures and outcome metrics will be vital. Reducing LDL cholesterol effectively has the potential not only to improve patient quality of life and reduce morbidity but also to decrease healthcare utilization and costs associated with recurrent cardiovascular events. The VALOR-QI initiative embodies a proactive, system-level effort to translate evidence-based cardiovascular care into real-world practice, offering a scalable model that could influence chronic disease management beyond the veteran population.
In essence, the VALOR-QI program illustrates how coordinated, multidisciplinary, patient-centered interventions can overcome longstanding barriers to optimal cholesterol management in a high-risk population. By combining clinical expertise, behavioral support, and system-level innovation, this program sets a precedent for advancing cardiovascular health outcomes through quality improvement science, reinforcing the imperative to integrate such approaches broadly in healthcare systems.
Subject of Research: Quality improvement program to optimize LDL cholesterol management in military veterans with cardiovascular disease.
Article Title: Not specified in the source content.
News Publication Date: November 10, 2025.
Web References:
- American Heart Association Scientific Sessions 2025: https://professional.heart.org/en/meetings/scientific-sessions
- VALOR-QI program news release: https://newsroom.heart.org/news/ldl-cholesterol-improved-among-veterans-in-program-with-health-coaches-other-resources?preview=fe2082c54edb36580eb0ddedbe4e2b22
Keywords: Cholesterol, LDL cholesterol, cardiovascular disease, quality improvement, veterans, medication adherence, cardiovascular risk, lipid management, health coaching, atherosclerotic cardiovascular disease (ASCVD).
