From the LipidSpin Editor: Emphasizing Population Health Management

Our healthcare organization has designated “population health management” as a core part of our strategy planning and accountability. This is reflected through the implementation of what is defined as the “quadruple aim:”

–providing health care which is affordable, improves the patient experience from the standpoint of quality and satisfaction in terms of outcomes, and also supports the physicians and providers of that healthcare in their life goals and personal quality–

A few days ago, I read an outstanding paper in Journal of Clinical Cardiology which aligns perfectly with this strategy and is pertinent to all of us as clinical lipidogists dedicated to reducing the risk of atherosclerotic cardiovascular disease (ASCVD) and improving the health of our patients. The paper is entitled “Impact of Lipids on Cardiovascular Health” and is part of their Health Promotion Series.1 In essence it focuses on refinement of the seven metrics of ideal cardiovascular health defined by the American Heart Association’s national goals, which include addressing behaviors such as smoking cessation, eating a heart healthy diet low in saturated fats and refined carbohydrates, and being physically active.

Additionally targeted is the treatment of total cholesterol levels of >200 mg/dL, systemic blood pressure >120/80, serum glucose >100 mg/dL and BMI >25 kg/m2.

People who are able to achieve all of these goals have a very low lifetime risk of developing ASCVD. That said, not surprisingly <5% people actually achieve that benchmark.

Plaque burden correlates with cumulative exposure over time to higher levels of atherogenic lipoproteins expressed as “mg-yrs” (age * LDL-c mg/dL) highlighting the importance of not only “primary prevention” but “primordial prevention. Primordial prevention is defined as preventing the development of risk factors compared to primary prevention which is defined in the lipid management setting as reduction of atherogenic lipoproteins to an optimal level to prevent cardiovascular events among those who do not have clinical evidence of cardiovascular disease. An example of primordial prevention in this context would be optimizing LDL-C which reflects the ‘acquired’ burden of atherogenic lipoproteins over a lifetime, beginning in childhood and adolescence. Therefore, the authors of this paper support an approach which reduces the rate of atheroma/plaque burden progression rather than just reduce the rate of cardiovascular events.

To accomplish the lofty ambition of lifetime risk reduction, there needs to be a societal focus on healthy diet and exercise patterns from childhood and improvements in our ability to detect atherosclerosis at earlier stages (e.g. biomarkers and atherosclerosis imaging).

Returning to our healthcare system’s emphasis on population health management we must take on challenges such as making it easier to promote and incentivize lifelong healthy diets from the community standpoint.2 Partnership at all levels with healthcare providers, city and community leaders and government resources is the key. All of us in the NLA are already working towards achievement of these goals with our patients and communities and we plan to continue to highlight these efforts in this and future issues of LipidSpin.

Disclosure statement: Dr. Willard has received honoraria from Regeneron, Sanofi, Amgen and Akcea.

References can be found here.