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Comment & Response |

Decrease the Incentives to Order Lipid Panels—Reply

Salim S. Virani, MD, PhD1,2,3,4; Christie M. Ballantyne, MD3,4; Laura A. Petersen, MD, MPH1,2
[+] Author Affiliations
1Health Policy, Quality, and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, Texas
2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
3Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
4Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
JAMA Intern Med. 2014;174(3):473-474. doi:10.1001/jamainternmed.2013.12842.
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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.

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March 1, 2014
Mark McConnell, MD; John R. Downs, MD; Chester B. Good, MD, MPH
1Tomah VA Medical Center, Tomah, Wisconsin
2South Texas Veterans Healthcare System, University of Texas Health Science Center, San Antonio
3VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Intern Med. 2014;174(3):473. doi:10.1001/jamainternmed.2013.12872.
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