Abstract Body: Background:
Despite the availability of effective lipid-lowering therapies, only about one-third of
Veterans at risk for ASCVD achieve optimal LDL-cholesterol (LDL-C) levels. Patients
with familial hypercholesterolemia (FH, LDL-C >=190 mg/dL) carry a disproportionately
high burden of ASCVD. We sought to determine the impact of the VALOR-QI program
on lipid optimization program among veterans with FH after 24 months of engagement.

Methods:
VALOR-QI was implemented across 50 VA sites from December 2022 to December
2025. Clinical Champions, Health Care Coaches, and AHA QI Consultants worked with
participating providers to address site-level barriers. Veterans were considered engaged
if they had ASCVD documented in ≥2 outpatient visits, ≥1 inpatient visit, or ≥1
procedure, and a qualifying appointment with a participating provider. Baseline LDL-C
was defined as the closest value within 365 days of the first visit. FH was defined as ≥1
LDL-C ≥190 mg/dL. The primary outcome was the percentage of veterans achieving
LDL-C< 70 mg/dL. Secondary outcomes included mean LDL-C change, lipid-lowering
therapy (LLT) use, and LLT adherence, measured using the proportion of days covered
(PDC ≥0.8).

Results:
Among 157,977 veterans with ASCVD, 1,171 had baseline LDL-C ≥190 mg/dL and
were included in the current analyses; mean age, 65±11 years; 85% male; 63% White;
and 68% urban. Between baseline and 24 months, 15% of veterans achieved LDL-
C <70 mg/dL; mean LDL-C decreased by 86 mg/dL (from 216±34 to 130±64); LLT
adherence rose from 23% to 57%; and LLT use increased from 74% to 89%.

Conclusion:
VALOR-QI demonstrates that addressing site-specific barriers with scalable, low-cost
interventions can significantly improve lipid management in Veterans with ASCVD and
FH.