Related Experiment Video
Updated: Jul 9, 2026
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Missed opportunities for the secondary prevention of cardiovascular disease in Canada
Daniel G Hackam1, Lawrence A Leiter, Andrew T Yan
1Department of Medicine, University of Western Ontario, London, Canada. dhackam@uwo.ca
Insights
Guideline-recommended cardiovascular disease treatments are underused and suboptimally dosed in Canada. Improving patient care requires shifting focus from awareness to implementing effective solutions for treatment gaps.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Evidence supports antithrombotics, statins, and ACE inhibitors for atherosclerotic cardiovascular disease.
- Beta-blockers are indicated for coronary artery disease.
Purpose of the Study:
- To assess the adoption of guideline-recommended treatments and target goals in Canadian ambulatory cardiovascular disease patients.
Main Methods:
- Analysis of 6296 cardiovascular disease patients from two large, prospective Canadian registries (2001-2004).
- Included patients with coronary artery disease, cerebrovascular disease, peripheral vascular disease, or multiple risk factors.
Main Results:
- High use of antithrombotics (92%), statins (80%), ACE inhibitors (57%), and beta-blockers (59% in CAD).
- Suboptimal drug dosing and attainment of treatment goals (LDL-C 50%, BP 58% systolic, 78% diastolic).
Conclusions:
- Data indicate opportunities to improve cardiovascular disease patient care in Canada.
- Emphasis needed on implementing solutions to address identified treatment gaps.
Background:
Strong evidence supports the use of antithrombotic agents (antiplatelets or oral anticoagulants), statins and angiotensin-converting enzyme inhibitors in patients with atherosclerotic cardiovascular disease; beta-blockers are additionally indicated in patients with coronary artery disease.
Objectives:
The investigators sought to determine the extent to which guideline-recommended treatments and target goals are adopted in ambulatory patients with cardiovascular disease in Canada.
Methods:
Two large, prospective, community-based registries (the Vascular Protection Registry and the Guideline Oriented Approach to Lipid Lowering Registry) enrolled 9809 outpatients with coronary artery disease, cerebrovascular disease, peripheral vascular disease or multiple cardiovascular risk factors from primary care settings in nine provinces across Canada between 2001 and 2004. This analysis focused primarily on patients with cardiovascular disease (n=6296).
Results:
At baseline, antithrombotics, statins and angiotensin-converting enzyme inhibitors were used in 92%, 80% and 57% of patients, respectively; beta-blockers were used in 59% of patients with coronary artery disease. The dosing of most drug therapies was suboptimal compared with guideline-recommended dosing derived from clinical trials. Treatment goals for cardiovascular risk factors were suboptimally attained: low-density lipoprotein cholesterol in 50% of patients, total to high-density lipoprotein cholesterol ratio in 51% of patients, systolic and diastolic blood pressure in 58% and 78% of patients, respectively, and waist circumference and body mass index in 45% and 19%, respectively.
Conclusions:
These data suggest specific opportunities for improving the care of patients with cardiovascular disease in Canada. The focus must now shift from awareness of treatment gaps to implementation of effective solutions.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:26Levels of Health Promotion and Illness Prevention
In primary prevention, actions taken before disease onset prevent the disease from...
01:26Atherosclerosis III: Management
01:30Preventive Healthcare Services