OPTIMIZING FAMILIAL HYPERCHOLESTEROLEMIA MANAGEMENT: EARLY FINDINGS FROM THE ATLANTIC LIPID LOWERING TREATMENT OPTIMIZATION PROGRAM (ALLTOP)

Therapeutic Area

Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research

Background

Despite established guidelines, lipid management in high-risk ASCVD patients remains suboptimal. This prospective, multicenter study, IRB-approved study evaluates the impact of supportive care focused on LDL-C management in high-risk ASCVD patients over two years and will eventually enroll 250 patients. These early findings represent the first 19 patients who have reached their first 6-month milestone for follow-up LDL-C levels. Using the EHR, a dedicated nurse practitioner (NP), clinical pharmacists, and primary care partnerships, we identify high-risk patients and target an LDL-C <100 mg/dL in six months. We assess LDL-C goal achievement based on 2022 ACC guidelines over 24–96 weeks, with patients as their own controls. Our goal is to develop a model for primary and secondary prevention that integrates guidelines for treatment at the practice level that has the potential to improve outcomes. For instance, higher LDL-C post-PCI increases adverse events, emphasizing targeted control. Lipid clinics using EHRs identified undiagnosed FH cases and improved therapy. EHR alerts only modestly boosted lipid-lowering therapies (LLT), requiring further adherence strategies. A multidisciplinary care model showed superior LDL-C reductions.

Methods

Participants were identified via the EHR and other databases, such FeelBetter, clinician referrals, and ClinicalTrials.gov and must have an LDL-C ≥160. Supportive care includes a dedicated NP providing weekly education and follow-up, in-person or virtually. Clinical pharmacists review medication therapy problems (MTPs), including barriers to medication access and adherence. Additional support includes genetic testing, social services, and specialist referrals.

Results

Among the 19 participants with six-month follow-up lab values, 14 (74%) reduced their LDL-C levels an average of 48 points. Seven of the 14 (50%) achieved LDL-C <100, with three (21%) achieving an LDL-C <70. Clinical pharmacist reviews identified 20 MTPs, including barriers to medication adherence, dose adjustments, and the need for additional LLTs. Sixteen participants completed genetic testing, with one identified as having a heterozygous familial hypercholesterolemia (HeFH)-related gene variant, necessitating follow-up and cascade testing, and lifestyle modifications.

Conclusions

Preliminary evidence from the ALLTOP study supports the effectiveness of a structured, multidisciplinary model for optimizing hypercholesterolemia and HeFH management.