title: Cardiovascular Risk Factor Management Performance in Canada and the United States: A Systematic Review.
abstract: Comparative cardiovascular risk factor care across North America is unknown. We aimed to determine current performance in Canada and the United States (US).
  
  
  
  A systematic review was conducted of Medline and EMBASE (to June 1, 2014). Eligible studies reported on screening, awareness, treatment, or control rates for hypertension, dyslipidemia, diabetes, and smoking. Categorical performance 'ratings' on the basis of the most successful US health plans were used to classify rates as suboptimal (< 50%), below target (50%-70%), above target (70%-90%), or optimal (> 90%).
  
  
  
  A total of 127 studies reporting on 10,510,324 individuals across North America were included. Hypertension awareness (84.3%) and treatment (82.0%) rates in Canada and the US (82.7% and 75.6%, respectively) were above target, whereas control in both nations was below target (68.1% vs 51.8%, respectively). Canadian awareness, treatment, and control rates for dyslipidemia (42.7%, 40.9%, and 41.5%, respectively) were suboptimal, and American indicators were generally below target (61.5%, 43.0%, and 63.6%, respectively). Canada and the US showed diabetes awareness (88.2% vs 86.8%) and treatment rates (82.3% vs 82.5%) above target. However, glucose control was suboptimal in Canada (35.3%), and below target in the US (58.8%). There was a modest decline in absolute smoking prevalence rates in Canada from 1999 to 2013 (25.2% to 14.6%). Screening for tobacco use (72.2%) and counselling rates (73.8%) in the US were above target.
  
  
  
  Substantial variation exists in cardiovascular risk factor care across North America. Standardized reporting, dissemination of practice guidelines, and setting explicit goal-directed targets for performance might facilitate improvement.
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Alabousi
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Peri
authors.initials: P
authors.lastname: Abdullah
authors.affiliation: Toronto Rehabilitation Institute and Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Booth
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre and Cardiovascular Division, University Health Network, Toronto, Ontario, Canada.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre and Cardiovascular Division, University Health Network, Toronto, Ontario, Canada; Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada. Electronic address: jay.udell@utoronto.ca.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Udell
mesh_terms: D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D009017:Morbidity / Q000639:trends; D012307:Risk Factors; D014481:United States / Q000453:epidemiology