A large-scale quality improvement program significantly improved LDL cholesterol levels among military veterans with atherosclerotic cardiovascular disease, according to late-breaking research presented at the American Heart Association’s Scientific Sessions 2025. The program, which included health coaches, multidisciplinary teams, and enhanced medication management, led to a 32% increase in the number of veterans achieving an LDL goal of less than 70 mg/dL over two years.
Led by Dr. Luc Djousse of the Boston VA Medical Center and Harvard Medical School, the VALOR-QI program enrolled approximately 160,000 veterans across 50 VA health care sites. The analysis focused on 83,232 veterans with baseline LDL ≥70 mg/dL who had a follow-up measurement. Key results showed that among those in the program for at least two years, 33.5% reached the LDL goal, with similar benefits seen in both men and women and among those aged 75 and older.
“We were surprised to see similar reductions in LDL levels among veterans ages 75 and older,” said Djousse. “This could change clinical practice for this age group if confirmed by ongoing trials.” The program also improved medication prescribing rates from 78% to 88% and adherence from 65% to 77%.
The program addressed common barriers such as poor adherence, gaps in education, and staffing shortages. Each site had a local clinical champion and health coaches who worked with American Heart Association consultants to implement tailored strategies. This approach was simple and inexpensive, making it sustainable for widespread adoption within the VA system and potentially in non-VA settings, according to the researchers.
The study’s strengths include a large, diverse participant pool, enhancing generalizability. However, limitations include reliance on routine clinical LDL measurements and the inability to directly link improvements to reduced heart attacks or strokes, as the program was not designed for that outcome.
The VALOR-QI program is a collaboration between the Department of Veterans Affairs and the American Heart Association, supported by Novartis. It continues through December 2025. The findings underscore the importance of structured quality improvement in managing cholesterol among high-risk veterans.
