Remaining Gaps in LDL Management for High-Risk Patients

This discussion explores how implementation science is becoming the next frontier in cardiovascular prevention. Despite the wealth of clinical evidence supporting low-density lipoprotein (LDL)–lowering therapies, gaps remain in applying this knowledge consistently across the health care system. The discussion highlights that alongside biology and epidemiology, health economics and real-world utilization data are essential to building a compelling case for systemic adoption. Without demonstrating economic value, even the most effective therapies may face resistance from payers and health systems.

To overcome these barriers, the panel emphasizes the importance of reimagining care delivery. Knowlton proposes a model that incorporates clinical pharmacists into the care team to support follow-up, monitor LDL, and adjust medications. This decentralized model can relieve pressure on primary care while providing patients with consistent, expert-led care. Brown expands on this by proposing centralized, digital teams focused on lipid management—an approach proven effective at institutions like Harvard, though often challenged by sustainability and reimbursement structures.

The conversation concludes by calling out the broader need for health care reform. Prevention remains underfunded and undervalued in a system still rooted in reactive, fee-for-service care. However, as value-based care models expand, there is hope that investment in centralized preventive strategies will grow. To truly unlock this shift, the panel agrees that rigorous data demonstrating improved outcomes and cost savings is essential to convincing stakeholders to prioritize and fund preventive cardiovascular care.