• Printer-friendly Adult Clinical Measure 6: Dyslipidemia Detail Sheet (Acrobat/pdf)

# of males 35-79 and females 45-79 in the denominator with documented lipids levels in goal range per guideline.

LDL is the most commonly used dyslipidemia/or abnormal lipid profile measure, however, other lipids such as total cholesterol, and/or HDL, and/or triglycerides may be used per guideline.

The goal for LDL levels, per current guidelines:
a. LDL < 100 if CHD1 or high 10 year CHD risk3
b. LDL < 130 if no CHD but > 2 risk factors2 or moderate 10 year CHD risk3
c. LDL < 160 if no CHD and 0-1 risk factors2 or low 10 year CHD risk3

1. CHD includes any clinical coronary heart disease, symptomatic carotid artery disease, peripheral arterial disease, abdominal aortic aneurysm.
2. The following are risk factors to be counted:

• Cigarette smoking
• Hypertension (BP 140/90 mmHg or on antihypertensive medication)
• Low HDL cholesterol (<40 mg/dl)*
• Family history of premature CHD (CHD in male first degree
  relative <55 years; CHD in female first degree relative <65 years)
• Age (men 45 years; women 55 years)
• HDL cholesterol 60 mg/dL counts as a "negative" risk factor;
  its presence removes one risk factor from the total count.

3. CHD 10 year risk calculator: http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof

# of all males age 35-79 plus females age 45-79 with at least one encounter for any reason or service during the prior calendar year, and who have had either a prior diagnosis of abnormal serum lipids or a prior laboratory test result with abnormal serum lipid (high total cholesterol, high LDL, high triglyceride, low LDL).

National Numeric Benchmark:

HEDIS goal (i.e. those with prior cardiovascular event): 68% of commercial and 41% of Medicaid plans controlled with LDL<130.

Health Disparities Collaborative goal: > 60%.

From registry or EHR/EMR if available.

If chart audit, then sample from the sample frame of persons meeting denominator criteria.

Some health centers should be collecting this data, since control of persons with a prior cardiovascular event is part of the HEDIS data set reporting. It may require sampling and manual record abstraction by the Grantee’s QA committee.

Cardiovascular disease (CVD) is the leading cause of death in the United States. Some 15 million Americans suffer from coronary artery disease (CAD), the most common form of heart disease, in which the coronary arteries narrow due to plaque formation. CAD is the leading cause of premature, permanent disability in the U.S. labor force, accounting for 19 percent of disability allowance by the Social Security Administration. One critical (and modifiable) risk factor for CAD is elevated cholesterol. Over 106 million American adults (49 and 46 percent of men, and women, respectively) have total blood cholesterol levels that are higher than desirable. Effective cholesterol management can help reduce the huge economic burden of cardiovascular disease in the United States, estimated to be more than $393.5 billion in 2005, with heart disease accounting for $254.8 billion. Management of serum cholesterol, especially low-density lipoprotein (LDL-C), is an important and effective way to prevent and reduce the suffering and disability caused by CAD. Less than half of those who qualify for cholesterol-lowering therapy are receiving it.

Elevated levels of cholesterol, as well as others such as triglycerides, (i.e. “dyslipidemia”) is well recognized as a leading concern by the general public and health professionals, insurers (HEDIS) and government (GPRA and HP2010) and HDC:
http://www.healthdisparities.net/hdc/html/collaboratives.topics.cvd.aspx (measure 5)

This measure is a good proxy for all adult care, not limited to only persons with specific conditions, but rather directed towards the need for universal screening, follow-up and intervention when indicated. It links provider education, patient education, screening and follow-up.
see Adult Treatment Panel III (ATPIII):
http://www.nhlbi.nih.gov/guidelines/cholesterol/
http://www.nhlbi.nih.gov/about/ncep/index.htm