Abstract Body (Do not enter title and authors here): Introduction/Background: US Veterans experience a high burden of cardiovascular disease (CVD). Improved adherence to lipid-lowering therapy (LLT) is strongly associated with reducing low-density lipoprotein cholesterol (LDL-C), which has the potential to reduce morbidity and mortality among Veterans with atherosclerotic cardiovascular disease (ASCVD).

Goals/Aims: To describe adherence to statin and non-statin LLT among US Veterans with ASCVD.

Methods/Approach: Using Veterans’ Health Administration (VHA) electronic health records from January 1, 2003, to December 31, 2019, we identified regular users of the VHA who were on at least one LLT within 12-months after ASCVD diagnosis. ASCVD diagnosis was identified using ICD9/10 and Current Procedural Terminology codes. Medication possession ratio (MPR) was calculated as the sum of days’ supply for all fills of a given LLT during 12-, 24-, and 36-month follow-up, divided by the number of days in the follow-up period. Medication adherence was defined as MPR ≥ 0.80.

Results/Data (descriptive and inferential statistics): The total number of Veterans on an LLT within 12-months after ASCVD diagnosis was 2,194,684 [mean (SD) age=68 (10) years, 98% male, and 75% white race]. Overall proportion of patients who were adherent to LLT was 68%, 64%, and 62%, at 12-, 24-, and 36-months post ASCVD diagnosis, respectively (Table).

Conclusion(s): Suboptimal adherence to LLT was observed in one third of US Veterans with ASCVD. Adherence rates were highest in the first 12 months post ASCVD diagnosis. Future studies are needed to understand factors contributing to low and declining LLT adherence over time among Veterans.