Clinical Therapeutics/Volume 29, Number 4, 2007

Prevalence and Treatment of Dyslipidemia in Canadian

Primary Care: A Retrospective Cohort Analysis
RobertJ. Petrella, MD, PhD1; Elizabeth Merikle, PhD2; and JaredJones, BSc1
1Faculty of Medicine and Dentistry, Sckulick School of Medicine, University of Western Ontario, London,
Ontario, Canada; and 2Outcomes Research, Pfizer Canada Inc., Kirkland, Quebec, Canada
ABSTRACT
Background: Dyslipidemia is an important modifiable risk factor for cardiovascular disease (CVD).
Studies suggest that dyslipidemia is underdiagnosed
and undertreated in Canada.
Objective: The objective of this study was to describe dyslipidemia prevalence, patient characteristics,
and lipid-lowering treatment (LLT) patterns in a cohort representing Canadian primary care practice.
Methods: In this retrospective cohort analysis, the
Southwestern Ontario database (which comprises
data from >150,000 adult patients in rural and urban
primary care practices) was used as the data source.
Male and female patients with data available from
4 physician visits were included; data were captured
quarterly between April 2000 and December 2003
and included demographic and lifestyle information,
CVD risk factors, and cardiovascular drug treatments.
Data gathered included clinical diagnoses at each visit,
symptoms corroborating the diagnoses, clinical data
(eg, blood pressure, smoking status, height, weight,
fitness level), medications (including name, dose, duration, and quantity prescribed), and diagnostic test
results and laboratory analyses. For the purposes of
this study, a patient was considered to have dyslipidemia if >1 of the following conditions was met: (1)
physician-diagnosed hyperlipidemia or hypercholesterolemia; (2) at least 1 measurement of low-density
lipoprotein cholesterol (LDL-C) or total cholesterol:
high-density lipoprotein cholesterol (TC:HDL-C)
ratio greater than the recommended targets based
on 10-year coronary artery disease (CAD) risk;
and/or (3) at least 1 prescription for a lipid-lowering
drug.
Results: A total of 49,667 patients were included in
the study cohort. Dyslipidemia was identified in 6961
(14.0%) patients. Of patients with dyslipidemia, more
were untreated (63.2%) than treated (36.7%) with
LLTs, with women receiving treatment less often than
742

men (P < 0.001). Of those treated, 47.2% had disease

that was not adequately controlled, with fewer treated women having controlled disease than treated men
(P < 0.017). Patients with dyslipidemia fell mostly into
very-high-risk (45.7%) or low-risk (31.1%) categories
for CAD. A total of 73.0% of treated patients were
prescribed monotherapy with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin); of statin prescriptions, most were for atorvastatin (51.8%)
or simvastatin (29.4%). Initial LDL-C levels and initial
TC:HDL-C ratios were statistically similar between
patients prescribed atorvastatin and those prescribed
simvastatin.
Conclusion: Based on the results of this retrospective cohort analysis, dyslipidemia prevalence in Canadian primary care is high, and despite clinical evidence and treatment guidelines, dyslipidemia is largely
untreated in family practice, suggesting a gap in care.
(Clin Ther. 2007;29:742-750) Copyright 2007
Excerpta Medica, Inc.
Key words: Canadian primary care, cardiovascular
risk, dyslipidemia prevalence, low-density lipoprotein
cholesterol, statins.

INTRODUCTION
Cardiovascular disease (CVD) is one of the leading
causes of morbidity and mortality in Canada 1 and
worldwide. 2 In 1999, 36% of deaths in Canada were
associated with CVD. 1 CVD carries large societal 1
and economic burdens3; in Canada for the year 2000,
direct and indirect CVD costs were estimated to be
over Can $20 billion. 4
Accepted for publication February20, 200Z
doi:l 0.1016/j.clinthera.2007.04.009
0149-2918/$32.00
Printed in the USA. Reproduction in whole or part is not permitted.

Copyright 2007 Excerpta Medica, Inc.

Volume 29 Number 4

R.J. Petrella et al.

Dyslipidemia is an important modifiable risk factor

for CVD. 1,s A review by Fitchett et al 6 of CVD in
Canada found a relationship between elevated cholesterol levels and the development of CVD, and that
decreases in cardiovascular events (CVEs) were proportional both to degree of reduction in low-density
lipoprotein cholesterol (LDL-C) level and the absolute
levels of LDL-C achieved during treatment. The most
recent Canadian Working Group on Hypercholesterolemia and Other Dyslipidemias s recommends a reduction in LDL-C levels as the primary goal of lipidlowering therapy (LLT) and lowering of high ratios of
total cholesterol to high-density lipoprotein cholesterol
(TC:HDL-C) as a secondary goal.
Changes in lifestyle, such as diet and exercise, can
lead to improvement in dyslipidemia, but in many
patients LLT is also necessary,s,7 The 3-hydroxy-3methylglutaryl coenzyme A reductase inhibitors, or
"statins," have been found to lower LDL-C and improve cardiovascular morbidity and mortality, s,9
Statins are recommended as first-line LLT.s,7 Other
LLTs include fibrates, niacin, bile-acid sequestrants,
and cholesterol-absorption inhibitors, s,7
A number of studies 1-14 in various patient populations have concluded that dyslipidemia is undertreated
in Canada. For example, in groups of patients from
western 1 and eastern Canada, 1,11 in those with diabetes, 13 and in the high-risk elderly,u many at-risk patients had undiagnosed and untreated dyslipidemia.
The most recent population-based estimated prevalence
of dyslipidemia in Canada was conducted between
1986 and 1992. ls,16 However, in view of changing
recommendations for dyslipidemia treatment and targets from the Canadian Medical Association's Working
Group on Hypercholesterolemia and Other Dyslipidemias, s,17 these estimates need to be updated. Furthermore, there is little information correlating patient
characteristics with LLT choices; it is important to understand how treatment decisions are being made so
that the gap between recommended and actual care
can be understood and reduced.
The objective of this study was to describe current
dyslipidemia prevalence, patient characteristics, and
LLT patterns in a cohort of patients from Canadian
primary care practices.
MATERIALS A N D METHODS
This study was approved by the institutional review
board at the University of Western Ontario, London,
April 2007

Ontario, Canada and complied with international standards of health information protection.
Data Collection
This retrospective cohort analysis was conducted
using a subset of data from the Southwestern Ontario
(SWO) database, which housed information collected
from 2000 to 2003 from >150,000 adult patients followed up in rural and urban practices. The SWO records on lifestyle, indicators of CVD, and cardiovascular
treatments were collected using chart abstraction
from 37 primary care practices (including 6 rural
practices) in London, Ontario, and the surrounding
area. Index enrollment took place between April and
December 2000, with longitudinal data updates conducted quarterly until December 2003, as part of an
initial study of lifestyle indicators of cardiovascular
health. Data gathered included clinical diagnoses at
each visit, symptoms corroborating the diagnoses, clinical data (eg, blood pressure, smoking status, height,
weight, fitness level), medications (including name,
dose, duration, and quantity prescribed), and results of
diagnostic tests and laboratory analyses. Studies using
portions of this data set have been reported previously, is
Study Cohort
Male and female patients aged >18 years with data
available from 4 physician visits over the study period
(2000-2003) were identified and included.
Study Design
Patients were identified as having dyslipidemia if
>1 of the following conditions was met: (1) physiciandiagnosed hyperlipidemia or hypercholesterolemia;
(2) at least 1 measurement of LDL-C or TC:HDL-C
greater than the recommended targets 5 based on
10-year coronary artery disease (CAD) risk; or (3) at
least 1 prescription for a lipid-lowering drug. Prevalence of CVD was calculated by dividing the number
of patients identified as having dyslipidemia by the
total number of patients in the study cohort.
Patients with dyslipidemia were considered treated
if they had a prescription for at least 1 LLT (statin, fibrate, niacin, bile-acid sequestrant, and/or cholesterol
absorption inhibitor) filled at any time during the
study period. Patients were classified as being at low,
moderate, high, or very high risk according to the categories defined in the Canadian guidelines in effect at
the time of study outset. 17 The 10-year CAD risk was
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Clinical Therapeutics

calculated for each patient using the most recent clinical data available, the 2003 recommendations for dyslipidemia management and prevention from the
Canadian Medical Association's Working Group on
Hypercholesterolemia and Other Dyslipidemias, 5 and
the Third Report of the National Cholesterol
Education Program Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol
in Adults (Adult Treatment Panel III) 19 adaptation of
the Framingham Heart Study 2 equations. 21 These
adapted equations estimated the 10-year risk for hard
cardiac end points, including nonfatal myocardial infarction and CAD-related death. The following risk
factors were included in the calculation of 10-year risk
for CAD: sex, age, TC, HDL-C, smoking status, and
blood pressure. Table I shows the categories and target levels used.
The targets for LDL-C concentration and TC:HDL-C
ratio in each risk category were set according to the
2003 recommendations, 5 with the very high-risk and
high-risk groups having the same targets (LDL-C,
2.5 retool/L; TC:HDL-C ratio, 4.0). If, at the most
recent recorded visit, a patient had an above-target
LDL-C concentration and/or TC:HDL-C ratio, the patient was considered to have uncontrolled dyslipidemia.
Each prescription written for an LLT during the
study period was counted as a separate event. For
statin prescriptions, the drug name and dose were
noted; other LLTs were grouped in a category named
"other." Because >80% of prescriptions were related
to atorvastatin and simvastatin, these drugs were compared separately.

Statistical Analysis
Qualitative data were expressed as percentages and
numeric values. To assess differences between sexes

within categories of treatment status (treated vs untreated), treatment success (controlled vs uncontrolled
dyslipidemia), and across risk levels, Z2 analysis was
performed, followed by the Fisher exact test. Pairwise
comparisons between atorvastatin and simvastatin
with regard to LDL-C levels and TC:HDL-C ratios
were conducted using unpaired t tests. Analyses were
performed using SPSS version 11.0 (SPSS Inc.,
Chicago, Illinois). Results of statistical analyses were
considered significantly different at the P < 0.05 level.

RES U LTS
A total of 49,667 patients from the SWO database
met the inclusion criteria. A comparison of baseline
demographic and clinical characteristics between patients with dyslipidemia and the entire cohort of patients identified for study inclusion is shown in Table II.
Urban and rural practice settings were similar in distribution across demographic characteristics. Dyslipidemia was identified in 6961 (14.0%) patients. The
ratio of women to men was slightly greater in the entire cohort (51.2% vs 48.8%) and in the subgroup
with dyslipidemia (53.4% vs 46.6%). Overall, patients with dyslipidemia were older, with a mean age
of 63.7 years versus 43.3 years. Body mass index was
similar in patients of both sexes in both groups. Fewer
dyslipidemic patients smoked (10.2%) compared with
the entire cohort (16.5%), and more patients with
dyslipidemia had a family history of dyslipidemia
(57.0% vs 10.0%), were hypertensive (73.6% vs
13.0%), and were diabetic (24.0% vs 4.4%).
Among patients with dyslipidemia, there were
slightly more females than males (14.6% vs 13.4%).
The prevalence of dyslipidemia increased with age,
following a similar distribution across age for both
sexes, and peaking in the group aged 65 to 74 years.

Table I. Categories and target levels used in the calculation o f 10-year risk for coronary artery disease (CAD).
Risk Category
High

Moderate
Low

10-Year Risk for CAD, %

Target LDL-C, mmol/L

Target TC:HDL-C Ratio

_>20, or history of diabetes mellitus or

any atherosclerotic disease

<2.5

<4.0

>10-<20

<3.5

<5.0

_<10

<4.5

<6.0

LDL-C = low-density lipoprotein cholesterol; TC = total cholesterol; HDL-C = high-density lipoprotein cholesterol.

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R.J. Petrella et al.

Table II. Baseline characteristics of the study cohort* and a subset of patients with dyslipidemia.

Characteristic
Age, mean (SD), y
Sex, no. (%)
Female
Male

Men aged >45 y,

no. (%)
Women aged >55 y,
no. (%)

Entire Cohort
(N = 49,667)

Patients with
Dyslipidemia
(n = 6961 )

43.3 (22.9)

63.7 (15.1)

25,446 (51.2)
24,221 (48.8)

3716 (53.4)
3245 (46.6)

10,192 (20.5)

2905 (41.7)

8209 (16.5)

2777 (39.9)

Characteristic

Entire Cohort
(N = 49,667)

Patients with
Dyslipidemia
(n = 6961)

BMI, mean (SD)

Men
Women

30.46 (5.31)
29.67 (6.60)

30.82 (5.20)
30.1 0 (6.66)

8221 (16.5)
6468 (13.0)

710(10.2)
5125 (73.6)

4967 (10.0)
2173 (4.4)

3968 (57.0)
1671 (24.0)

Risk factors, no. (%)

Smoking
Hypertension
Family history of
dyslipidemia
Diabetes

BMI = body mass index.

*Included patients with _>4 quarters of data available in the Southwestern Ontario database.

We found that more patients with dyslipidemia were

untreated (63.2%) than treated, with women less likely to be treated than men (58.1% vs 67.7%; P <
0.001). Treatment rates increased with age until age
55 to 64 years in men and 65 to 74 years in women,
and thereafter declined. Among patients who were
treated for dyslipidemia, approximately half of the
women (597/1201 [49.7%]) and just under half of the
men (612/1360 [45.0%]) had not reached target levels, leaving their dyslipidemia uncontrolled. In this
treated cohort, dyslipidemia control was significantly
different in women (604/1201 [50.3%]) compared
with men (748/1360 [55.0%]) (P < 0.017). Rates of
control appeared to increase with age for both females
and males.
The risk for CAD in patients with dyslipidemia is
shown in Table Ill. Almost half of dyslipidemic patients were at very high risk (45.7%). More patients
were at low risk (31.1%) than at either moderate risk
(17.1%) or high risk (6.2%). Proportions of men and
women at very high risk were similar; however, a significantly greater proportion of men were at low risk
compared with women (36.2% vs 26.1%; P < 0.001).
Young (<35 years) patients diagnosed with dyslipidemia
appeared to be at generally higher risk for CAD compared with older patients with dyslipidemia, but among
those aged 35 to 74 years, risk increased with age.
Among patients receiving treatment for dyslipidemia, statins accounted for 73.0% of all prescripApril 2 0 0 7

tions for LLT. Atorvastatin and simvastatin were the

most commonly prescribed statins, making up 51.8%
and 29.4% of statin prescriptions, respectively, followed by pravastatin (8.1%), rosuvastatin (5.6%),
lovastatin (2.7%), cerivastatin ~ (1.3 % ), and fluvastatin
(1.1%). Atorvastatin was most commonly prescribed
at the 10- and 20-mg doses (50% and 35% of atorvastatin prescriptions, respectively); simvastatin was
most commonly prescribed at the 20-mg dose (45%),
with similar proportions of prescriptions at 10- and
40-mg doses (23% and 27% of simvastatin prescriptions, respectively).
Focusing on the 2 most prescribed statins, Figure 1
shows the CAD risk at the time of first prescription
for each of the dose forms of atorvastatin and simvastatin. Most patients who were prescribed atorvastatin
or simvastatin, regardless of dose, were at either very
high risk or low risk. Patients at higher risk received
slightly higher doses of atorvastatin; no trend was evident for CAD risk level and dose of simvastatin.
Table IV shows individual CAD risk factors in patients receiving each of the dose forms of atorvastatin
and simvastatin. Almost all (94.9% and 99.5%) patients prescribed atorvastatin or simvastatin, respectively, were hypertensive. Patients with low HDL-C,
smokers, and men aged >45 years were most likely to
be prescribed higher statin doses.
*Cerivastatin was withdrawn From the market in August 2001.
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Clinical Therapeutics

Table III. Risk for coronary artery disease among patients with dyslipidemia, by age* and sex.t

Patients at
Very High Risk,
No. (%)

Women
Age group, y
18-<2S
25-<35
3,5-<4,5
45-<55
55-<65
65-<75
_>75

2439

1112 (45.6)

28

26,5
558
729
763
.

25 (89.3)
55 (57.3)
10,5 (39.6)
202 (36.2)
324 (44.4)
401 (52.6)
.
.

Men
Age group, y
18-<25
25-<35
3,5-<4,5
4,5-<,5,5
,5,5-<6,5
6,5-<7,5
_>7,5

2342

1071 (45.7)

Total

4781

Subgroup

96

13
90
302
,54,5
714
678
.

7
44
104
218
308
390

(53.8)
(48.9)
(34.4)
(40.0)
(43.1)
(,57.,5)
.

2183 (4,5.7)

Patients at
High Risk,
No. (%)

Patients at
Moderate Risk,
No. (%)

Patients at
Low Risk,
No. (%)

228 (9.3)

462 (18.9)

637 (26.1

0
0
1 (0.4)
41 (7.3)
101 (13.9)
85 (11.1)
.

0
0
9 (3.4)
112 (20.1)
192 (26.3)
149 (19.5)

3 (10.7)
41 (42.7)
1,50 (,56.6)
203 (36.4)
112 (15.4)
128 (16.8)

67 (2.9)

356 (15.2)

848 (36.2)

0
0
(0.3)
(0.7)
(3.4)
(,5.6)

0
0
(2.6)
(10.3)
(20.9)
(21.1)

1
4
24
38

8
,56
149
143

6
46
189
267
233
107

(46.2)
(,51.1)
(62.6)
(49.0)
(32.6)
(1,5.8)

.
29,5 (6.2)

818 (17.1)

148,5 (31.1)

*Presence of all Framingham risk variables and age <75 years required to calculate a Framingham risk score.
t Risk level by sex (Z 2, P < 0.001 ).

The baseline LDL-C and TC:HDL-C ratios in patients

receiving any dose of atorvastatin or simvastatin are
shown in Figure 2. The distribution of LDL-C level was
statistically similar for atorvastatin and simvastatin;
43.0% of patients receiving atorvastatin and 48.0% of
patients receiving simvastatin had initial LDL-C in the
range of 2.00 to 2.99 mmol/L. Initial TC:HDL-C ratios
were also not significantly different between patients prescribed atorvastatin and those prescribed simvastatin.
DISCUSSION
The prevalence of dyslipidemia determined in this
study in a Canadian primary care population was
14.0%, using criteria for definition of dyslipidemia
from chart abstraction as either physician-diagnosed
hyperlipidemia or hypercholesterolemia, at least 1 measurement of LDL-C or TC:HDL-C greater than the recommended targets based on 10-year CAD, or at least
1 prescription for a lipid-lowering drug. The Canadian
Heart Health Survey (CHHS), 15a6 conducted over a
746

decade ago from 1986 to 1992, estimated that approximately half the population studied (>18,000 adults)
had abnormal lipid levels. Based on LDL-C values exceeding 4.1 retool/L, 14.0% of patients from that
study16 were deemed at high risk for CAD. Although less
stringent criteria for defining dyslipidemia were used in the
CHHS (TC >6.2 retool/L, LDL-C >3.4 retool/L, triglycerides >2.3 retool/L, and/or HDL-C _<0.9 retool/L),
better dyslipidemia treatment during the decade since
the CHHS might have led to a decreased rate of
dyslipidemia. 16
Despite a lower prevalence of dyslipidemia, however, similar to other Canadian observations, the present
study found that more patients with dyslipidemia
were untreated than treated. 1-14 A physician survey
in the United Kingdom reported that barriers to treatment with statins included economic concerns, a low
level of adherence to treatment, variation in treatment
targets, and concerns about overmedicating patients
to the neglect of modifying behavior. 22
Volume 29 Number 4

R.J. Petrella et al.

[]
[]
[]

..-

100

100-

80

80-

60

Low risk
Moderate risk
High risk
Very high risk

60-

",~

4O

40-

20

20-

010 mg
20 mg
40 mg
80 mg
(n=507) (n=373) (n=137) (n=20)

5 mg
10 mg
20 mg
40 mg
80 mg
(n=13) (n=130) (n=271) (n=162) (n=13)

Atorvastatin Dose

Simvastatin Dose

Figure 1. Coronary artery disease risk at time of first prescription of(A) atorvastatin or (B) simvastatin.

Table IV. Coronary artery disease risk factors among patients prescribed atorvastatin or simvastatin.
No. (%) of Patients with Risk Factor, By Dose
Treatment/Risk Factor

5 mg*

Atorvastati n
No. of patients
Male, age >45 y
Female, age >55 y
Hypertension
Diabetes
Low HDL-C
Smoking
Family history
Si mvastati n
No. of patients
Male, age >45 y
Female, age >55 y
Hypertension
Diabetes
Low HDL-C
Smoking
Family history

8
9
14
7
2
1

18
(2.4)
(3.2)
(2.4)
(3.3)
(1.6)
(1.2)
0

10 mg

20 mg

40 mg

80 mg

All Patients

567
249 (44.6)
260 (55.3)
484 (49.2)
187 (47.2)
98 (40.2)
71 (42.3)
52 (53.6)

398
209 (37.5)

149
87 (15.6)

23
13 (2.3)

1137
558 (53.8)

158 (33.6)
342 (34.8)

46 (9.8)
138 (14.0)

6 (1.3)
20 (2.0)

470
984
396
244
168
97

151
73 (21.6)
75 (27.1)
138 (23.5)
43 (20.4)
23 (18.3)
9 (11.0)
11 (15.7)

141 (35.6)

58 (14.6)

10 (2.5)

89 (36.5)

45 (I8.4)

12 (4.9)

60 (35.7)
30 (30.9)

29 (17.3)
11 (11.3)

8 (4.8)
4 (4.1)

289

149 (44.1)
125 (45.1)
257 (43.9)

100
58
44
40

(47.4)
(46.0)
(53.7)
(57.1)

1 72

98 (29.0)
63 (22.7)
163 (27.8)

60
39
27
18

(28.4)
(31.0)
(32.9)
(25.7)

(45.3)
(94.9)
(38.2)
(23.5)
(16.2)
(9.4)

15

645

10 (3.0)

338 (57.4)

5 (1.8)
14 (2.4)

277 (47.0)
586 (99.5)

1
4
1
1

(0.5)
(3.2)
(1.2)
(1.4)

211
126
82
70

(35.8)
(21.4)
(13.9)
(11.9)

HDL-C = high-density lipoprotein cholesterol.

*Atorvastatin is not available as a 5-mg dose.

April 2007

747

Clinical Therapeutics

Atorvastatin

[]

Simvastatin

50

40

c
",~

30

o_

20

10

0-<I

I-<2

2-<3

3-<4

4-<5

_>5

4-<5

_>5

LDL-C Concentration (mmol/L)

B
5o

40

c
.~

30

o_

20

10

0
I

0-<I

I-<2

2-<3

3-<4

TC:HDL-C Ratio

Figure 2. (A) Low-density lipoprotein cholesterol (LDL-C) concentration at baseline in patients receiving atorvastatin or simvastatin. (B) Total cholesterol:high-density lipoprotein cholesterol (TC:HDL-C) ratios at
baseline in patients receiving atorvastatin or simvastatin. No significant between-treatment differences
were found.

748

Volume 29 Number 4

R.J. Petrella et al.

One study23 from Ontario showed that rates of
new statin use in seniors increased rapidly between
1994 and 2000, a statistic likely captured in this study.
Our study found that patients aged >75 years were
still less likely to receive treatment than those aged 55
to 74 years, consistent with previous observations in
Canadian seniors. 14 This difference between age groups
is not, however, as large as that seen in the United Kingdom in 1998, 24 where the likelihood of a patient aged
75 to 84 years was receiving a statin was extremely low
(odds ratio, 0.16).
Statins are indicated as first-line LLT, and treated
patients in this study were more likely to receive a
statin than any other type of LLT. This finding is consistent with data from the United States25,26; Australia27;
and Denmark, 2s Spain, 29 and other European countries, go It appears from this study that physicians do
not take risk factors into account when prescribing
different dose formulations of statins; no clear trend
has been noted between level of risk and dose of atorvastatin or simvastatin prescribed.
This study used a large cohort in a clinical practice
setting, with a mix of urban and rural practices; this
gives it a generalizability to actual practice and to the
broader Canadian population.
Study Limitations
A number of limitations of this study should be
noted. First, the definition of dyslipidemia relied in
part on physician diagnosis and/or LLT prescription,
which may vary by physician, thereby adding noise
to the estimation of the prevalence of dyslipidemia.
Second, the use of LLTs was based on prescriptions
data rather than claims data; consequently, the use of
LLTs may be overestimated and so may have resulted
in an overestimation of the number of treated patients
and an underestimation of the number of treated and
disease-controlled patients. Third, persistence and adherence with treatment could not be assessed from the
SWO database. Finally, the present study assessed only
the initial prescription and not prescribing patterns
over time (eg, dose titration). Thus, it is not possible to
understand whether treated patients had uncontrolled
dyslipidemia due to lack of compliance or other reasons, such as lack of dose titration by the physician.
Educational supports to improve detection, diagnosis, and treatment may prove useful to close the gap
in care suggested by the high rate of untreated dyslipidemia in Canadian family practice.
April 2007

CONCLUSION
Based on this retrospective cohort analysis, dyslipidemia prevalence in Canadian primary care is high,
and despite clinical evidence and treatment guidelines,
dyslipidemia is largely untreated in family practice,
suggesting a gap in care.
A C K N O W L E D G M ENTS
This research was financially supported by Pfizer
Canada Inc., Kirkland, Canada, the manufacturers of
atorvastatin. The authors wish to thank members of
the Southwestern Ontario Primary Care Research
Group for their participation.
Dr. Petrella has received clinical trial funding from
Pfizer.

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1997;349:1269-1276.
3. Policy Research Division SPDPaPHBHC. Economic burden of illness in Canada, 1998. Ottawa, Ontario, Canada:
Policy Research Division SPDPaPHBHC; 2002.
4. Choi BK, Pak AW. A method for comparing and combining cost-of-illness studies: An example from cardiovascular disease. ChronicDis Can. 2002;23:47-57.

5. Genest J, Frohlich J, Fodor G, McPherson R, for the

Working Group on Hypercholesterolemia and Other
Dyslipidemias. Recommendations for the management of
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Summary of the 2003 update [published correction appears
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Address correspondence to: Robert J. Petrella, MD, PhD, Heart Health

and Exercise Laboratory, 801 Commissioners Road East, Suite 3002,
London, ON N6C 5J1, Canada. E-maih petrella@uwo.ca
Volume 29 Number 4

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