Improving Implementation of Guideline-Recommended LDL-C Management in High-Risk Cardiovascular Patients

The goal of this observational study is to learn whether implementing evidence-based strategies in cardiology practices can improve guideline-recommended low-density lipoprotein cholesterol (LDL-C) management in adults at high risk for cardiovascular disease. Participants include adults with a recent myocardial infarction (heart attack), coronary stent placement, percutaneous coronary intervention (PCI), ischemic heart disease, or a coronary artery calcium (CAC) score of 300 or higher. The main questions it aims to answer are: * Do implementation strategies increase the proportion of patients who receive LDL-C testing, have lipid-lowering therapy (LLT) started or intensified, and achieve guideline-recommended LDL-C goals within 6 months of their index visit? * Do implementation strategies improve cardiovascular risk factor management and LDL-C goal attainment at 3 and 12 months after the index visit? * How acceptable, feasible, and effective are these implementation strategies for patients, clinicians, and healthcare sites? Researchers will compare outcomes among patients receiving care after implementation of the study strategies with outcomes from a retrospective cohort of similar patients treated before the strategies were introduced. Participants will: * Receive usual cardiovascular care from their healthcare providers. * Be cared for at sites implementing one or more evidence-based strategies, which may include clinician performance scorecards, electronic health record best practice alerts, clinician education, patient education, and/or follow-up through an Advanced Practice Provider (APP) care pathway. * Attend routine follow-up visits and undergo LDL-C testing and other cardiovascular assessments as part of standard clinical care. * Have information from their electronic health records reviewed, including laboratory results, medications, blood pressure measurements, smoking status, and cardiovascular outcomes. * Complete surveys about their experiences with the implementation strategies, if applicable. * Be followed for up to 12 months after their index visit.

Inclusion Criteria: * Patients who were discharged from the hospital with a recent acute myocardial infarction (MI) (identified by catheterization records and with \> 50% stenosis) or coronary stent (if they are very-high risk). * Patients discharged from the hospital without a recent acute MI following Percutaneous Coronary Intervention (PCI) and/or with ischemic heart disease if they are high but not very high risk, or with a CAC score \> 300 and aged 40-75. * Patients aged 40-75 years old with CAC score \> 300. Exclusion Criteria: \- Age under 18 years.