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.