• Michel R Joffres, Tripthi V Kamath, G Rhys Williams, Jill Casey, and Lawrence W Svenson.
• Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia. michel.joffres@dal.ca
• Can J Cardiol. 2004 Jun 1;20(8):767-72.

BackgroundGuidelines for the treatment of hyperlipidemia aim at improving the management of people at a higher risk of developing cardiovascular disease.ObjectivesTo study the potential impact of hyperlipidemia guidelines on health care use in two Canadian provinces with different levels of hyperlipidemia.MethodsTrends in physician billing were obtained from Alberta between 1990 and 2000 and from Nova Scotia between 1994 to 2001 using the 272 primary diagnostic code for hyperlipidemia. Record linkage between a 272 code and a prescription in the subsequent six months was made through the Pharmacare database (which automatically registers all individuals 65 years of age and over). Data were also linked between the 1995 Nova Scotia Health Survey and the Pharmacare data.ResultsTrends in hyperlipidemia codes were similar in Alberta and Nova Scotia by sex and age, with acceleration in the final years of the study. Approximately 5% of the adult population had a diagnosis of hyperlipidemia. Less than 60% of people aged 65 years and over with a 272 code filled an antilipemic prescription in the subsequent six months. Using the National Cholesterol Education Program Adult Treatment Panel III classification and the 1995 Nova Scotia Health Survey, less than 10% of the participants aged 65 years and over had a corresponding diagnostic code of 272, while more than half could be classified as having hyperlipidemia. In 1995, approximately one-half of people at high risk, with a 272 code in the subsequent five years, had a prescription for antilipemic drugs.ConclusionsDespite some limitations, these data show a discrepancy between guideline development and practice, leaving a high number of at-risk individuals undiagnosed and untreated. Mechanisms need to be put in place to ensure better classification and follow-up of people with hyperlipidemia at risk for cardiovascular disease.

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