Treating to target: ready, fire, aim.

Evidence • Multiple cohort studies found PC patients did not achieve SMTs (ie, cholesterol, blood pressure [BP], glycated hemoglobin [HbA1c]). -Of 1706 patients with diabetes mellitus (DM), 7.3% achieved 3 targets (HbA1c < 7%, BP < 130/80 mm Hg, and cholesterol < 5.18 mmol/L)1; of 1701 Canadians, 24% had low-density lipoprotein (LDL) levels of < 2 mmol/L2; and of 3167 patients with coronary artery disease (CAD), 16% achieved 3 targets (BP < 130/80 to 85 mm Hg, LDL < 2.2 mmol/L, and acetylsalicylic acid use).3 • Some RCTs have found achieving targets difficult (despite intense care, maximum doses, and multiple therapies). -In a meta-analysis of 7 RCTs (29 395 patients), less than 50% attained LDL levels of less than 2 mmol/L with maximum statin dose.4 -In 3 RCTs of DM patients with CAD (5034 patients), about 23% achieved 4 targets (LDL < 2.5 mmol/L, systolic BP < 130 mm Hg, HbA1c < 7%, and not smoking). 5