NLA Comments on Proposed Retirement for HEDIS 2015 with Respect to Cholesterol Management for Patients with CVD Conditions and Diabetes
The National Committee for Quality Assurance (NCQA) has proposed retiring the use of LDL-C treatment targets in response to the new ACC/AHA Task Force on Practice Guidelines. The NCQA has stated that no studies focus on treatment or titration to a specific LDL-C goal in adults with clinical atherosclerotic cardiovascular disease (ASCVD). The NLA is strongly opposed to this and submitted a statement against retiring such an important measurement.
The National Lipid Association (NLA) is a non-profit medical association consisting of members in the United States dedicated to the education of medical professionals in the recognition and treatment of dyslipidemias, atherosclerosis and their related disorders. We wish to object to the Proposed Retirement of Cholesterol Management for Patients with Cardiovascular Conditions in HEDIS 2015 and recommend the issue be withheld for consideration no earlier than 2015. Our contention is that the ACC/AHA Task Force on Practice Guidelines for the treatment of blood cholesterol was not inclusive of important evidence from clinical trials and other research that support the conclusion that LDL-C is related to the development of atherosclerotic cardiovascular disease (ASCVD), and that this relationship is log-linear to a point well below 100 mg/dL.
In addition, the ACC/AHA guidelines acknowledge knowing the baseline low-density lipoprotein cholesterol (LDL-C) level is necessary in order to confirm their evidence-based recommendation of achieving a > 50% reduction from baseline when high-intensity statin is initiated. Likewise, LDL-C control should be retained and defined as a > 50% reduction from baseline or a level < 100 mg/dL if no baseline level was measured. Therefore, the NLA believes that retiring the standard for LDL-C screening and control is unwarranted and will ultimately regress cardiovascular treatment of patients with ASCVD and diabetes.
The NLA has assembled a panel of worldwide experts to address clinical gaps and intends to release a document seeking to harmonize both major global guidelines and the previous work of the National Cholesterol Education Panel Adult Treatment Panel III (NCEP ATP III) with the ACC/AHA guidelines in August 2014.