Introduction
Low-density lipoprotein cholesterol (LDL-C) is a well-established risk
factor for cardiovascular disease (CVD) and many guidelines recommend
LDL-C lowering to reduce the risk of both cardiovascular events and
mortality in patients with CV disease (1) and familial
hypercholesterolemia (FH).
The 2016 Canadian Cardiovascular Society clinical practice guidelines
(CPG) recommend initiation of LDL-C lowering with high intensity statin
therapy and the addition of ezetimibe or a PCSK9i as needed if LDL-C is
not lowered by at least 50% or to a level below 2.0 mmol/L in patients
with established CVD or FH.(2). Despite
specific and updated CPG, many patients fail to reach
guideline-recommended levels (3-10) GOAL
Canada(11)reported that physician education based on the reminder system
significantly improved care as measured by the proportion of patients
achieving the recommended LDL-C level in relation to a greater
utilization of recommended (2) lipid lowering
therapies. CPG recommendations do not typically distinguish between the
respective roles of primary care physicians (PCPs) or specialists;
further, it is not known whether the adoption of guidelines, pattern of
management and specific strategies for lowering LDL-C are different for
these groups of physicians. This post hoc analysis of GOAL
Canada(11) aims to ascertain if any differences exist
between PCPs and specialists with respect to the utilization of lipid
lowering therapies.