Sara Levintow, PhD, on How the Cholesterol Guidelines Have Changed Lipid Measurements

How have the 2013 ACC/AHA cholesterol treatment guidelines changed how low-density lipoprotein cholesterol (LDL-C) is tested and managed? A study1 published in Circulation shows the results of analyzing pre- and post-guideline testing rates and puts into perspective how the guidelines affect clinical practice.

To better understand the results of this study, Cardiology Consultant reached out to lead author Sara Levintow, PhD candidate, who is a graduate research assistant in the Department of Epidemiology at the University of North Carolina at Chapel Hill and a research fellow at NoviSci in Raleigh-Durham, North Carolina.

Here are her answers to our burning questions.

CARDIO CON: How did the release of the 2013 cholesterol guidelines affect the way lipids were tested in the United States?

Sara Levintow: Using real-world data from a large, US-based commercially insured patient population, we found no impact of the release of the 2013 cholesterol guidelines on LDL-C testing frequency. Unchanged rates of LDL-C testing were observed across multiple patient populations. These included patients initiating statins of different intensity, patients starting ezetimibe, and patients who had been recently hospitalized for myocardial infarction or ischemic stroke.

CARDIO CON: In your opinion, how do you think the 2018 guidelines on cholesterol management will affect practice in the long run?

SL: The most recent data in our study were from the end of 2016, and we are interested in repeating the analysis to identify any changes in testing trends following the 2018 guideline release (once data is available). In the current study, we observed a gradual decline in testing rates from 2008 to 2016 (that was not impacted by the 2013 guidelines). We are interested to explore whether this downward trend persists, given that the 2018 guidelines still recommend ongoing LDL-C monitoring to assess therapeutic adherence and response.

CARDIO CON: What else do cardiologists need to know about your study?

SL: Unchanged rates of LDL-C testing following the guideline release speak to the difficulty of translating new evidence into practice. However, the absence of changes in LDL-C testing do not necessarily indicate a lack of awareness or behavioral change among physicians in response to the guidelines. Although the 2013 guidelines removed the recommendation to treat to LDL-C goals, they continue to recommend LDL-C monitoring for determining therapy adherence and anticipated response.



  1. Levintow S, Reading S, Saul B, et al. Abstract 13025: Lipid testing trends in the us before and after the release of the 2013 ACC/AHA cholesterol guidelines. Circulation. 2019;140(Suppl 1):A13025.