GOAL Canada: Physician Education and Support Can Improve Patient Management

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Many Canadian patients with cardiovascular disease (CVD) fail to reach recommended low-density lipoprotein cholesterol (LDL-C) levels despite statin use.
• Approximately 40-50% of Canadian patients with known CVD do not achieve their LDL-C goal.
• The Guidelines Oriented Approach to Lipid lowering (GOAL) study investigated real-world secondary and third-line lipid-lowering therapy.

Purpose of the Study:

• To assess the impact of second- and third-line lipid-lowering therapies on LDL-C goal achievement in a real-world Canadian setting.
• To evaluate the effectiveness of guideline-oriented management in patients with clinical vascular disease or familial hypercholesterolemia.

Main Methods:

• The GOAL study enrolled 2009 patients with CVD or familial hypercholesterolemia and LDL-C > 2.0 mmol/L despite maximally tolerated statin therapy.
• Physicians managed patients with online reminders of guideline recommendations during follow-up.
• Baseline lipid levels and therapies were recorded, and LDL-C goal achievement (< 2.0 mmol/L) was assessed.

Main Results:

• 50.8% of patients achieved the target LDL-C level (< 2.0 mmol/L) following the introduction of additional lipid-lowering therapies.
• Patients achieving LDL-C goals were more likely to be not statin intolerant and to receive high-efficacy statin therapy.
• Key reasons for not using ezetimibe included patient refusal (33%) and perceived lack of need (22%); for PCSK9 inhibitors, cost (26%) and patient refusal (25%) were primary barriers.

Conclusions:

• Optimizing lipid-lowering management is feasible and leads to achievement of guideline-recommended LDL-C levels in Canadian patients.
• Improved LDL-C control has the potential to significantly reduce cardiovascular morbidity and mortality in this population.
• Addressing barriers such as patient refusal, cost, and perceived need is crucial for effective lipid management.