Background/Rationale: Cardiovascular disease (CVD) is the leading cause of death worldwide accounting for one third of the overall deaths every year. Despite the drastic reduction in its recent rates, CVD is still one of the leading causes of death in Canada. It also carries a financial burden on the Canadian economy with a cost of $21 billion every year divided between loss of productivity and healthcare costs.

Despite the risks associated with the major CVD risk factors and the treatment advancement, their prevalence is still substantial in North America. Treatment gaps were also reported amongst such factors. Leiter and colleagues (2013) reported that almost half of the patients with type 2 diabetes did not achieve their HbA1c or cholesterol target, slightly more than one third achieved their blood pressure targets and only 13% achieved the composite triple target.

Community pharmacists are well positioned to identify patients with/at high risk for CVD, determine their CVD risk and assist in their disease management. The efficacy of pharmacists’ intervention in chronic disease has been well demonstrated in the literature.

Primary objective: To evaluate the effect of a community pharmacy-based case finding and intervention program in patients at high risk for cardiovascular events on reduction in estimated risk for major cardiovascular events.

Study design: Randomized controlled trial with the patient as the unit of randomization.

Sample size: 704 adults.

Intervention: The pharmacist will complete a comprehensive annual care plan or a standard medication management assessment for all the participants in the advanced care group. This will include patient assessment, certain laboratory tests (e.g. HbA1c, lipid panel if not done in the last 3 months), individual cardiovascular risk assessment using validated risk engines and education regarding this risk.

Follow-up: Patients will be followed up by the pharmacist every 3-4 weeks for 3 months to provide ongoing care, monitor their progress and capture any adverse events.

Usual Care: Patients receive usual care with no specific intervention for 3 months. At the end of the 3 months period the patients will be crossed over to receive the intervention described above.

Primary outcome: The primary outcome is the difference in change in cardiovascular risk between advanced care and usual care groups. Cardiovascular risk is defined as the risk for future cardiovascular events (myocardial infarction, revascularization, cardiovascular death) as estimated by validated risk engines.

What this study adds:

• This is the first large scale study on global cardiovascular risk reduction in community pharmacy setting
• It utilizes already available resource: community pharmacists, their expanded scope of practice and remuneration system already in place
• It has public health importance since we have a special focus on vulnerable populations such as rural, South Asian, Aboriginal and can reach patients who don’t or can’t see a family physician
• We will use several innovative methods to capture patients at high risk for cardiovascular disease
• We will pay unique attention to case finding, this is the sine qua non of chronic disease management – without good case finding, interventions are worthless