Hi, I'm doctor Shaun Goodman.

I'm the Associate Head in the Division of Cardiology at St. Michael's Hospital and I'm a professor at the University of Toronto.

What drew me to this field was that cardiovascular disease is the leading cause of death and disability around the world, and I'm hoping to have an impact on reducing that risk.

I think it's really important to continue to advocate for research, because we need to find additional solutions that are safe and effective to lower cholesterol and to reduce the risk of cardiovascular events.

But we also need to work on and research how do we best get those therapies to the patients, so that they can benefit from them.

I think one of the biggest challenges that doctors face is that patients are not always easily convinced that this silent condition can lead to lots of problems down the road.

It's really important, particularly if people have had a previous heart attack or another bad cardiovascular event, to be aware of and to manage their cholesterol levels.

We know that individuals who have heart disease often it's under-recognized that they have these high levels of the bad cholesterol.

And so again, awareness and being able to manage that high bad cholesterol level is important to prevent future events.

We've had the opportunity recently to look at Canadian patients in a study that we did, who had high levels of cholesterol after, for example, having a heart attack compared to those after a heart attack who were able to get their cholesterol levels down with appropriate treatment.

The people that have continued high levels of the bad cholesterol were more than double the risk of having another cardiovascular event.

I think one of the best things that we can do is to empower patients to be their own advocate.

We see that in the team sport of looking after patients after a heart attack to lower their bad cholesterol levels, there's so many players, and so the patient is the common theme there.

And we want them to be aware of their levels and to seek out their healthcare providers to make sure that their levels are getting as low as possible.

Following a cardiovascular event, most patients feel quite well.

They might not be aware that their levels of cholesterol are too high, so they need to follow up with their clinician, have a repeat cholesterol test in four to six weeks’ time, and then have a discussion with their clinician about going on appropriate cholesterol-lowering therapy.

Beyond treatment, there are a number of things that people can do to reduce the risk of having another cardiovascular event.

This includes lifestyle modification, increasing your activity, watching your diet.

But it's important that you make only small changes that you can sustain, that you can maintain.

It's not all or nothing.

I think it's important that patients be their own best advocate.

That they seek out medical care, that they follow their cholesterol levels, that they make changes to their lifestyle, including diet and exercise.

They need to make changes that are going to be able to be sustained over the course of time.

There are challenges for the doctors to keep up with the guidelines.

There's so much new and emerging information that it takes a while for this to translate to the clinicians and also to their patients.

I think the problem with the care gap is that many clinicians and patients aren't aware of the newest information and guidelines, and so it takes time for them to adopt what we now know is the best way forward to reduce the risk of cardiovascular events.

For example, to get LDL cholesterol below the threshold of 1.8 millimoles per liter, and what we're actually doing in routine clinical practice.

I think the biggest pain point is that it takes a long time to translate the evidence and the guideline recommendations into routine clinical practice.

In Canadian patients, we observed that if you had persistent elevation of your bad cholesterol above the guideline-recommended target that you were at increased risk for having a subsequent cardiovascular event.

We have so many great treatments in cardiovascular research that have shown that we can reduce the risk of cardiovascular events, and yet we don't use them routinely in clinical practice.

I think part of this is a reflection of the time that it takes for clinicians and patients to become aware of the emerging of the new information.

I think the biggest takeaway is if you've had a cardiovascular event you want to get your LDL cholesterol, the bad cholesterol, as low as possible.

There's nothing magical about the 1.8 millimole per liter threshold that the current Canadian Cardiovascular Society guidelines recommend.

This is changed over the course of time and gets progressively lower each time that we get another addition.

So try to reduce your risk by getting the LDL cholesterol as low as possible.

I think the biggest takeaway for healthcare practitioners is that most patients are going to be feeling just fine, and yet their LDL cholesterol, their bad cholesterol, might be persistently elevated.

And so to reduce the risk, it's important to have repeat testing of the cholesterol profile.

I think the landscape of cardiovascular medicine has really evolved a lot in the last couple of decades, and it's been exciting to be involved in the lowering of LDL cholesterol pathway, and the journey that has led to the reduction in cardiovascular event rates.

However, there are other things that can be complementary to lowering LDL cholesterol, such as anti-inflammatory treatments, that I think will be the way of the future to be able to further lower the risk of cardiovascular disease.

I think my hopes for the future of heart healthcare relates to translating all this great information that we have into routine clinical practice.

And so that's going to involve empowering patients to be their own best advocate, and to work together in a partnership with healthcare practitioners to be able to lower their risk of cardiovascular disease.