Cardiovascular disease (CVD) is the leading cause of death in the United States,1 and the greatest contributor is poor nutrition.2 There is a well-established association between hyperlipidemia (HLD) and the development of CVD. Numerous societies including the American College of Cardiology, American Heart Association, and National Lipid Association recommend lifestyle intervention as an effective first step in the treatment of lipid disorders.3,4 Registered dietitian nutritionists (RDNs) have a critical role in helping patients implement lifestyle changes through medical nutrition therapy (MNT). Medical nutrition therapy is a standardized nutrition-based treatment that includes an individualized nutrition assessment and care plan, incorporation of social determinants of health such as health literacy and food security, and behavioral counseling to facilitate sustainable change.5 Several systematic reviews have illustrated that MNT improves serum lipid levels while also lowering blood pressure, hemoglobin A1c, and BMI, improving quality of life years, and reducing healthcare costs.6 Therefore, it is important for patients with lipid disorders to have access to an RDN to better their health.

At the University of Michigan, patients referred to the Preventive Cardiology Lipid Management program meet with an RDN prior to meeting with a lipid specialist. At the onset of the COVID-19 pandemic, there was a shift in practice to meet with RDNs virtually rather than face-to-face (F2F), so that patients could continue to utilize this therapy. Despite a return to F2F visits, the use of virtual appointments continues to remain high post-pandemic with approximately 1-in-4 patients using a telehealth service in 2022.7 Although the use of virtual MNT has increased, its impact on the treatment of hyperlipidemia remains uncharacterized.

In the context of increased use of telemedicine, we conducted an observational study evaluating whether virtual and F2F nutrition visits similarly improve lipid levels. We hypothesized that MNT delivered in a virtual format is comparable to F2F therapy at treating lipid disorders.