Prevention and Management of Cardiovascular Disease in Primary Care: A Comment on the PEER Simplified Lipid Guideline

BackgroundThere are 2 guidelines in Canada providing guidance for the management of dyslipidemia. The Patients Experience Evidence Research (PEER) simplified lipid guidelines, intended for primary care practitioners, and the Canadian Cardiovascular Society (CCS) guidelines, intended for all practitioners are based on differing methodology with distinct priorities and preferences. The disparate approaches may contribute to confusion among family practitioners and their co-managed patients with the potential for compromised care, differing standards for training in the fundamentals of lipidology and differing criteria that might be used in practice audits to evaluate quality of care.MethodsThe PEER recommendations were considered by primary authors of the CCS guideline to identify areas of concordance, discordance or agreement with qualifications.ResultsDiscordance between the guidelines is greatest with respect to interpretation of the cholesterol profile, the implications of elevated triglycerides, the utility of apolipoprotein B and non-High Density Lipoprotein-Cholesterol measurements, the role of non-statin medications and the importance of assuring adherence and avoiding under-treatment through follow-up measurement of lipid profiles. The disparate importance attached to identifications of patients with enhanced risk due to elevated lipoprotein (a) is also apparent.ConclusionsThis comparison attempts to reconcile key principles of practice in order to foster both high quality of care and fully informed patient-centered decision-making. There are 2 guidelines in Canada providing guidance for the management of dyslipidemia. The Patients Experience Evidence Research (PEER) simplified lipid guidelines, intended for primary care practitioners, and the Canadian Cardiovascular Society (CCS) guidelines, intended for all practitioners are based on differing methodology with distinct priorities and preferences. The disparate approaches may contribute to confusion among family practitioners and their co-managed patients with the potential for compromised care, differing standards for training in the fundamentals of lipidology and differing criteria that might be used in practice audits to evaluate quality of care. The PEER recommendations were considered by primary authors of the CCS guideline to identify areas of concordance, discordance or agreement with qualifications. Discordance between the guidelines is greatest with respect to interpretation of the cholesterol profile, the implications of elevated triglycerides, the utility of apolipoprotein B and non-High Density Lipoprotein-Cholesterol measurements, the role of non-statin medications and the importance of assuring adherence and avoiding under-treatment through follow-up measurement of lipid profiles. The disparate importance attached to identifications of patients with enhanced risk due to elevated lipoprotein (a) is also apparent. This comparison attempts to reconcile key principles of practice in order to foster both high quality of care and fully informed patient-centered decision-making.