New Evidence Suggests Frequent Lipid Monitoring May be Unnecessary

Most routine testing for monitoring of lipid profiles does not result in a change in therapy, according to a research letter published in the October issue of JAMA Internal Medicine. This finding, combined with a recent change in lipid management guidelines calling for a risk-assessment approach rather than a target low-density lipoprotein (LDL) level may indicate low utility for frequent lipid monitoring.

Though there is insufficient data to show that monitoring lipids leads to meaningful improvements in clinical outcomes or adherence to pharmacologic treatment, 3 US guidelines recommend lipid monitoring every 3 to 12 months, whereas European guidelines advise annual lipid monitoring among patients receiving therapy.

The researchers assessed clinician rationale for ordering lipid testing and changes to lipid lowering therapy among a random sampling of 4,945 patients (aged 40 to 79 years) who had been seen by a primary care physician in the past 12 months and had been receiving statin therapy at least 3 years.

Over the 3-year study period, a mean of 3.01 lipid panels were performed per patient. For 79 percent of patients, primary prevention of cardiovascular events was the stated indication for statin therapy in the medical records. Rationale for ordering lipid tests was available for 183 patients with the most commonly reported indications including: monitoring (70 percent), follow-up of statin dosage change (8 percent), and patient request (4 percent).

"The high frequency of testing may reflect adherence to current guidelines, practice habits stemming from the historic treat-to-target approach, patient expectations, and a perception that lipid testing may allow for monitoring adherence to therapy," write the authors led by Karen Stenehjem, M.D., from University of Colorado School of Medicine in Aurora.

Despite the frequent monitoring, the researchers found that most lipid testing did not result in a change in therapy (548 of 634 lipid tests).

"Because the key clinical decision has shifted from treatment to an LDL goal to mitigating cardiovascular risk, the utility of lipid monitoring may be diminished," the authors suggest. "The appropriate frequency of lipid testing is uncertain. As attention to value-based care increases nationally, this may be a target for cost savings and warrants further study."

Takeaway: Frequent lipid monitoring does not lead to a change in treatment, which calls into question the utility of routine testing.