An Educational Approach to Improve Physician Effectiveness in the Detection, Treatment and Control for patients with Hypercholesterolemia and high Cardiovascular Disease (CVD) risk in low-resource settings in Argentina

In Argentina, the National Risk Factor Surveys conducted by the Ministry of Health (MoH) indicate that between 2005 and 2009 the prevalence of hypercholesterolemia increased from 27.9% to 29.1%, whereas the rate of non-optimal LDL-C,is 28.0%. The rate of high cholesterol awareness is 37.3 and the percentage of those who are under pharmacological treatment is dismally low: only 11.1%. Furthermore, only one of every four subjects with a self-reported diagnosis of CHD is taking statins and most individuals with coronary heart disease (CHD) who are on statins have sub-optimal LDL-C levels. Until now, the MoH has provided drugs free-of-charge for the treatment of different cardiovascular risk factors. Nevertheless, statins havenot been included to date in the list of covered drugs. As of 2014, statins (simvastatin) will be incorporated into the package of drugs provided free-of-charge for patients with high cholesterol, according to CVD risk stratification. The goal ofthisstudy is to test whether a multifaceted educational intervention targeting physicians and nurses improvesdetection, treatment and control of hypercholesterolemia among uninsured patients with moderate-high cardiovascular risk in Argentina. This randomized cluster trial will enroll 350 patients from 10 public primary care clinics who will be assigned to receive either the intervention or the usualstandard of care. The interventionprogram will target the public primary care system through clinician education for implementation of a Clinical Practice Guideline to improve management of dyslipidemias. This study, strongly supported by the Argentine Lipid Society and the MoH, is timely and necessary to address CHD risk in vulnerable populations in Argentina.