title: Perceptions of Canadian primary care physicians towards cardiovascular risk assessment and lipid management.
abstract: BACKGROUND
  Cardiovascular (CV) risk stratification remains the cornerstone of preventive cardiology. This study was performed to gain insight into how Canadian primary care physicians (PCPs) incorporate traditional and emerging risk factors in determining risk.
  
  
  METHODS
  Using a tested questionnaire, this cross-sectional survey evaluated the perceptions of 846 PCPs (38% response rate) on CV risk assessment, treatment thresholds, and novel biomarkers of vascular risk.
  
  
  RESULTS
  Most physicians (74%) perform CV risk assessment in eligible patients annually with 69% using the Framingham Risk Score (FRS). Although 89% of the physicians knew that FRS estimates 10-year risk of coronary heart disease death and myocardial infarction, 30% could not characterize FRS thresholds for high risk. Only 44% correctly used a positive family history to double the FRS. Waist circumference was considered by 79% of the physicians as a vital sign but only 6% reported measuring this routinely. Carotid ultrasound was identified by 55% as the preferred imaging technique for screening in primary prevention. Although 99% had heard of high sensitivity C-reactive protein (hs-CRP), only 49% measured it for the purposes of assessing CV risk and 27% were unsure under what clinical scenarios the test is indicated.
  
  
  CONCLUSIONS
  Our survey suggests that FRS is employed by approximately 2/3 of Canadian PCPs for risk stratification. Family history and central obesity are considered important additional CV risk markers. There are substantial knowledge gaps on the appropriate use of family history and hs-CRP in risk stratification, particularly in patients who may not present with hyperlipidemia.
authors.affiliation: Canadian Cardiovascular Research Network, Brampton, Ontario, Canada. mkgupta@rogers.com
authors.forename: Milan
authors.initials: M
authors.lastname: Gupta
authors.forename: Narendra
authors.initials: N
authors.lastname: Singh
authors.forename: Michelle
authors.initials: M
authors.lastname: Tsigoulis
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kajil
authors.forename: Sheriar
authors.initials: S
authors.lastname: Hirjikaka
authors.forename: Adrian
authors.initials: A
authors.lastname: Quan
authors.forename: Hwee
authors.initials: H
authors.lastname: Teoh
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008055:Lipids / Q000097:blood*; D058007:Physicians, Primary Care / Q000592:standards*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D008055:Lipids; D002097:C-Reactive Protein