Abstract P162: Has LDL Cholesterol (LDL-C) and Non-HDL Cholesterol (Non-HDL-C) Goal Attainment Improved 7 Years After Adult Treatment Panel III (ATP III) Guidelines Were Published?
Bibliographic record
Abstract
Background In coronary heart disease (CHD) patients, ATP III guidelines (2001) recommended LDL-C goal of <100 mg/dl, with optional goal of <70 in a 2004 update, and in patients with triglycerides (TG) ≥ 200mg/dl, non-HDL-C goal of <130 mg/dl with optional goal of <100. In a 2003 survey (NEPTUNE II), 62% of CHD patients achieved LDL-C goal of < 100 mg/dl but only 33% achieved both LDL-C and non-HDL-C goals. Methods To assess whether goal attainment has improved, we analyzed data from 7 Veterans Affairs (VA) medical centers. In patients with ICD-9 codes for CHD and a primary care visit in 2008, we assessed LDL-C and (in patients with TG ≥200 mg/dl) non-HDL-C (calculated as total cholesterol - HDL-C), to compare goal attainment for LDL-C and non-HDL-C in the VA system with NEPTUNE II. Results We analyzed 24,769 CHD patients. Significantly more VA patients ( table ) attained LDL-C goals per ATP III guidelines. Attainment of optional LDL-C goals per the 2004 update was statistically better than NEPTUNE II, but still low (34%). A major treatment gap was noted in patients with TG ≥ 200, with poor attainment for both LDL-C (primary goal) and non-HDL-C (secondary goal) per both ATP III (51%) and the update (12%), although goal attainment was better in the VA patients compared to NEPTUNE II. Controlling for facility clustering and patient's illness severity, non-physician providers (p=0.07), care at a teaching facility (p=0.09), patient's age > 55 years (p= 0.001) and diabetes (p=0.005) were positively associated with goal attainment, whereas African American patients were less likely to achieve lipid goals (p=0.04). Conclusion LDL-C goal attainment per ATP III guidelines has improved, but attainment of <70 mg/dl in CHD patients remains low. CHD patients with elevated TG continue to have poor attainment of non-HDL-C goals, which recent data indicate is as important as LDL-C goal attainment. We also identify factors associated with goal attainment which have implications for future interventions.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".