Does management of lipid lowering differ between specialists and primary care: Insights from GOAL Canada
Open accessAbstract
BACKGROUND: We studied whether significant differences in care gaps exist between specialists and primary care physicians (PCPs). METHODS: GOAL Canada enrolled patients with CVD or familial hypercholesterolemia (FH) and LDL-C > 2.0 mmol/L despite maximally tolerated statin therapy. During follow-up, physicians received online reminders of treatment recommendations based on Canadian Guidelines. RESULTS: A total of 177 physicians (58% PCPs) enrolled 2009 patients; approximately half of the patients were enrolled by each physician group. Patients enrolled by specialists were slightly older (mean age 63 years vs 62), female (45% vs 40%), Caucasian (77% vs 65%), and had a slightly higher systolic pressure and lower heart rate. Patients enrolled by specialists had less frequent history of FH, diabetes, hypertension, chronic kidney disease and liver disease but more frequent history of coronary artery disease, atrial fibrillation and premature family history of CVD. There was no significant baseline difference in LDL-C, HDL-C or non-HDL-C, although total cholesterol and triglycerides were slightly higher in patients managed by PCPs. At baseline, PCPs were more likely to use statins (80% vs 73%, P = .0002) and other therapies such as niacin or fibrate (10% vs 6%, P = .0006) but similar use of ezetimibe (24% vs 27%, P = .15). At the end of follow-up, specialists used less statins (70% vs 77%, P = .0005) and other therapies (6% vs 10%, P = .007) but more ezetimibe (45% vs 38%, P = .01) and the same frequency of PCSK9i (28% vs 27%, P = .65). The proportion of patients achieving the recommended LDL-C level of 2.0 mmol/L or below (primary endpoint) was similar at last available visit between specialists and PCPs (44% vs 42%, P = .32). CONCLUSION: Despite minor differences in the clinical profile of their patients, both PCPs and specialists actively participate in the management of lipid-lowering therapy in high-risk CVD patients and experience similar challenges and care gaps.
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There are knowledge gaps in PCPs when compared to specialists in other common conditions, such as sexual dysfunction and HLD management.
“There are knowledge gaps in PCPs when compared to specialists in other common conditions, such as sexual dysfunction and HLD management.13,14”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [14]
For lipid-lowering management, the Discussion identifies knowledge or treatment gaps in both PCPs and specialists, rather than a greater knowledge gap in PCPs. The Abstract conclusion says the groups experienced similar care gaps, and recommended LDL-C attainment was similar (44% versus 42%). This paper does not address the sentence’s separate point about sexual dysfunction. (LLM, conf=0.88)
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Hurt, R. T., Stephenson, C. R., Gilman, E. A., Aakre, C. A., Croghan, I. T., Mundi, M. S., Ghosh, K., & Edakkanambeth Varayil, J. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251332215 · Cited by 78 · see citing works
“13,14 Despite these knowledge differences, to date, most AI CDM tools have been focused on specific organ or disease problems because of the narrower data elements (i.e., liver enzymes and imaging) needed for the LLMs compared to the undifferentiated nature of PCC patients.”
- Authors
- Langer, A., Tan, M., Goodman, S. G., Grégoire, J., Lin, P. J., Mancini, G. B. J., Stone, J. A., & Leiter, L. A.
- Affiliations
- Canadian Heart Research Centre (CA)
- St. Michael's Hospital (CA)
- Montreal Heart Institute (CA)
- University of British Columbia (CA)
- University of Calgary (CA)
- Corresponding author
- Langer, Anatoly
- ORCID
- Venue
- International Journal of Clinical Practice
- Publisher
- Wiley
- Published
- 2020-12-14
- Volume
- 75
- Issue
- 4
- Pages
- e13861-e13861
- ISSN
- 1368-5031 (ISSN-L)
- 1742-1241
- OpenAlex
- W3110633358
- Cited by
- 6
- References
- 3
- Citations by year
- 2025: 3 · 2023: 1 · 2022: 1 · 2021: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- International Journal of Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen Canada
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- lipid-lowering therapy, LDL cholesterol, familial hypercholesterolemia, cardiovascular disease, care gaps, ezetimibe, PCSK9 inhibitors, statins, treatment guidelines
- MeSH terms
- Ezetimibe, Anticholesteremic Agents, Canada, Female, Goals, Humans, Lipids, Cholesterol, LDL, Middle Aged, Primary Health Care, Specialization, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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