GOULD EDU: Cluster-Randomized Trial of an Educational Intervention to Improve Lipid-Lowering Guideline Adherence

Authors

• Christopher P Cannon
• Christie M Ballantyne
• Deepak L Bhatt
• James A de Lemos
• Qi Gao
• Naishu Kui
• Robert S Rosenson
• Katherine E Mues
• Jason Exter
• Shushama Alam
• Mikhail N Kosiborod

Language

English

Publication Date

1-1-2026

Journal

JACC: Advances

DOI

10.1016/j.jacadv.2025.102403

PMID

41344145

PMCID

PMC12721036

PubMedCentral® Posted Date

12-3-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Adherence to lipid-lowering therapy (LLT) guidelines is suboptimal, leading to poor achievement of low-density lipoprotein cholesterol (LDL-C) goals and elevated risk for atherosclerotic cardiovascular disease (ASCVD) events.

Objectives: The purpose of this study was to determine whether an educational intervention targeting physicians improves optimization of LLT over 1 year for patients with ASCVD.

Methods: GOULD (Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management) EDU (Education) was a 1-year extension in a subset of sites in the GOULD prospective, observational registry of United States patients with ASCVD. In a cluster-randomized, stepped-wedge design, sites were randomized to 2 waves of an educational intervention that included 2 webinars and access to interactive data reports showing site-specific performance alongside full-study data over the course of the study. Chart reviews assessed LLTs and patient outcomes. Outcomes assessed over 1 year included change in prescribed LLT, frequency of measurement of LDL-C, LDL-C levels, LDL-C goal achievement, and responses on a structured physician questionnaire.

Results: Thirty sites were randomized to Step 1 (n = 616) and 26 sites to Step 2 (n = 382). The mean (SD) age was 70.2 (9.6) years, 61.1% (610/998) were male, and 85.3% (851/998) were White. During the study, 83.6% (820/981) of patients had no change in LLT, and intensification occurred in only 7.0% (69/981); intensification did not differ by intervention step. The percentage of patients who met the goal of LDL-C < 70 mg/dL was 39.0% (202/518) at baseline and 39.5% (252/638) at 1 year.

Conclusions: An educational intervention with physicians had little impact on LLT optimization or LDL-C goal achievement in patients with ASCVD over a 1-year period. Novel approaches are needed to improve LDL-C goal achievement. (Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management [GOULD] a Registry of High Cardiovascular Risk Subjects in the United States; NCT02993120).

Keywords

atherosclerotic cardiovascular disease, LDL-C goals, lipid-lowering therapy, myocardial infarction, observational registry, proprotein convertase subtilisin/kexin type 9 inhibitor

Published Open-Access

yes

Recommended Citation

Cannon, Christopher P; Ballantyne, Christie M; Bhatt, Deepak L; et al., "GOULD EDU: Cluster-Randomized Trial of an Educational Intervention to Improve Lipid-Lowering Guideline Adherence" (2026). Faculty, Staff and Students Publications. 6701.
https://digitalcommons.library.tmc.edu/baylor_docs/6701