Guidelines from the National Cholesterol Education Program (NCEP) recommend
reduction of low-density lipoprotein cholesterol (LDL-C) to 100 mg/dL (2.59
mmol/L) or less in patients with established coronary heart disease (CHD).
However, the National Committee for Quality Assurance (NCQA) is implementing
a new performance measure as part of the Health Plan Employer and Data Information
Set (HEDIS) that appears to endorse a different target. The new HEDIS measure
will require managed care organizations seeking NCQA accreditation to measure
and report the percentage of patients who have had major CHD events who achieve
LDL-C levels less than 130 mg/dL (3.36 mmol/L) between 60 and 365 days after
discharge. These different LDL-C thresholds emphasize the difference between
a clinical goal for the management of individual patients (≤100 mg/dL)
and a performance measure used to evaluate the care of a population of patients
(<130 mg/dL). This article discusses the rationale for each threshold and
explains the use of 2 different thresholds for these 2 purposes. Both the
NCQA and NCEP expect that the new HEDIS measure will encourage managed care
organizations to develop systems that improve secondary prevention of CHD.