Gandhi S, Dorian P, Tardif JC, Steg PG, Huynh T, Wong GC, Love MP, Jervis K, Goodman SG,

1. How do Canadian patients with stable coronary artery disease compare to the rest of the world?A description of secondary prevention targets in the ProspeCtive observational LongitudinAl Registry oF patients with stable coronary arterY disease (CLARIFY) Gandhi S, Dorian P, Tardif JC, Steg PG, Huynh T, Wong GC, Love MP, Jervis K, Goodman SG, for the (ProspeCtive observational LongitudinAl Registry oF patients with stable coronary arterY Disease) CLARIFY Registry Investigators From the Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto and the Canadian Heart Research Centre, Toronto, ON; MHI Research Centre, Montreal Heart Institute, Unjversity of Montreal, Montreal, QC; Recherche Clinique en Athérothrombose, Unité INSERM U698, Centre Hospitalier Bichat-Claude Bernard, Université Paris Diderot, Paris, France; McGill University Health Centre, Montreal, QC; Vancouver General Hospital, University of British Columbia, Vancouver, BC; Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS; Servier Canada Inc, Laval, QC.

2. Disclosures • All CLARIFY data was collected and analyzed by the independent academic statistics centre at the Robertson Centre for Biostatistics, University of Glasgow, UK • Nicola Greenlaw provided the statistical analysis for this abstract • Additional Canadian data regarding medication use was collected by the Health Research Centre (AHRC) at St. Michael’s Hospital, University of Toronto • The study was designed and conducted by the investigators, supported by research grants from Servier Canada and France. • The sponsor had no role in study design, data collection and analysis, decision to publish, or writing of the abstract, but did assist with the set-up and management of the study in each country.

3. Conflicts of Interest Consulting fees, honoraria and/or research: S. Gandhi, None P. Dorian, Servier Canada Inc J.C. Tardif, Servier Canada Inc P.G. Steg, Astra Zeneca, Bayer, BoehringerIngelheim, Bristol Myers Squibb, Daiichi Sankyo Lilly, Eisai, GlaxoSmithKline, Medtronic, Merck, Novartis, Pfizer, Roche, Sanofi Aventis, Servier, The Medicines Company, NYU School of Medicine, Aterovax T. Huynh, Servier Canada Inc G.C. Wong, Servier Canada Inc M.P. Love, AstraZeneca, Eli Lilly, Bristol-Myers Squibb and Sanofi Aventis K. Jervis, Servier Canada Inc S.G. Goodman, Servier Canada Inc

4. Coronary Artery Disease • There has been a steady lowering in CAD mortality rates in Canada associated primarily with decreasing trends in risk factors and improvements in treatment • Despite reduction in smoking, blood pressure, and cholesterol levels, an increase in prevalence of diabetes, lack of exercise, and obesity have been linked with higher CAD mortality Wijeysundera et al JAMA 2011;303:1841-7

5. ProspeCtive observational LongitudinAl Registry oF patients with stable coronary arterY disease (CLARIFY) • Initiated to improve knowledge about patients with stable CAD from a broader geographic prospective • Main objectives • define contemporary stable CAD outpatients in terms of their demographics characteristics, clinical profiles, management, and outcomes; identify gaps between evidence-based recommendations and treatment; and investigate long-term prognostic determinants in this population Steg Eur Heart J 2009;11(suppl D):D13-D18

6. Purpose of this Analysis • To • describe the baseline data from the Canadian cohort and compare to the rest of the world (ROW) in CLARIFY in order to provide unique and contemporary insight regarding the characteristics and secondary prevention guideline recommended-management of stable CAD patients

7. CLARIFY • Prospective, observational, longitudinal registry • Consecutive outpatients with stable CAD from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific enrolled Nov 2009 – July 2010 • Continued follow-up for 5 years • Collection of standardized data on e-CRF • Complete data audits in 5% randomly selected sites Steg Eur Heart J 2009;11(suppl D):D13-D18

8. Enrollment criteria • Eligible patients had stable CADdefined as at least one of the following (not mutually exclusive): • Documented MI > 3 months before enrolment • Angiographic demonstration of coronary stenosis > 50% • Chest pain with evidence of myocardial ischemia (stress ECG) • PCI or CABG > 3 months before enrolment • Exclusion crtieria: • Hospital admission for CV reasons (including revascularization) in the past 3 months • Planned revascularization • Conditions hampering the participation or the 5-year follow-up e.g., limited cooperation, limited legal capacity, serious non-CV disease or conditions interfering with life expectancy (e.g. cancer, drug abuse) or severe other CV disease (e.g. advanced HF, severe valve disease, history of valve repair/replacement) Steg Eur Heart J 2009;11(suppl D):D13-D18

9. Worldwide distribution 33 284 patients enrolled in 46 countries Western Europe Austria 425 Belg/Luxem 577 Denmark 133France 2428 Germany 2250 Greece 559 Ireland 190 Italy 2114 Netherlands 206 Portugal 949 Spain 2257 Switzerland 291 UK 2351 Central/Eastern Europe Bulgaria 172 Poland 1004 Czech Rep 393 Romania 502 Hungary 344 Slovakia 183 Latvia 120 Slovenia 81 Lithuania 214 North America Canada 1232 Russia/Ukraine Russia 2248 Ukraine 777 Asia Brunei (Incl. in Mal) China 2622 India 809 Korea 1020 Malaysia 380 Singapore 113 Thailand 693 Vietnam 506 Middle East Bahrain 750 Kuwait Oman Qatar Saudi Arabia 761 UAE Central America Mexico 1342 West Indies 368 South America Argentina 234 Brazil 291 Africa South Africa 543 Australasia Australia 833

10. Canadian population 1232 patients enrolled in 9 provinces Newfoundland n=10 (1%) Quebec n=357 (29%) British Columbia n=186 ( (15%) Manitoba n=54 (4%) Alberta n=88 (7%) Saskatchewan n=25 (2%) Ontario n=461 (37%) Nova Scotia n=21 (2%) New Brunswick n=30 (2%)

11. Enrollment by Canadian Physicians

12. Enrollment by Canadian Physicians

13. Selected Characteristics

14. Selected Characteristics

15. Medical History

16. Medical History

17. Medical History

18. Recent Vital Signs and Lipid Profile

19. Social history

20. Reimbursement Status for Medication 51% (n=630) 42% (n=515) 40% (n=12 629) 37% (n=11 658) 24% (n=7 661) 7% (n=84)

21. Summary • Low number of Canadians met guideline recommended targets for waist circumference, LDL, systolic blood pressure • Canadian cohort compared to ROW • Increased median age, body weight and BMI, more former smokers, increased peripheral arterial disease, increased dyslipidemia • Decreased ischemic stroke, lower median LDL, decreased current angina

22. Limitations • Recruited physicians and enrolled patients on a voluntary basis, introducing selection bias • The practice of these physicians is likely different from that of all physicians, and we speculate that our participating physicians are more adherent to guidelines compared with physicians who elected not to participate

23. Conclusion • Stable CAD patients in Canada have many differences with respect to baseline characteristics, duration of CAD, and prior revascularization rates when compared to the rest of the world • More than 1 in 10 continue to smoke and the majority did not meet the secondary prevention targets for waist circumference, body mass index, and physical activity • Further initiatives are needed to promote lifestyle modification in stable CAD patients

24. CLARIFY Investigators British Columbia:CE Biglow, Qualicum Beach; D Ezekiel, Vancouver; DE Manyari, Surrey; FM Villasenor, Maple Ridge; GF Vaz, Vernon; K Lai, Nanaimo; MMW Yeung, Richmond; M Fagan, Langley; MA Fazil, Duncan; P Wong, Richmond; RS Collette, Burnaby; SK Wong, Vancouver; TL Orenstein-Lyall, Richmond; TH Ashton, Penticton; WK Son, Chilliwack. Alberta:A Bailey, Spruce Grove; APT Wong, Edmonton; E Liu, Calgary; JL Myburgh, Sylvan Lake; RR Singh, Calgary; S Varma, Calgary; SH Chiu, Edmonton; W Healley, Calgary. Saskatchewan:FB Ramadan, Moose Jaw; M Shamsuzzaman, Regina. Manitoba:I Rodriguez Marrero, Brandon; M Czarnecka, Winnipeg; W Czarnecki, Winnipeg. Ontario: AS Pandey, Cambridge; AK Gupta, Toronto; AM Kushner, Etobicoke; A Grover, Mississauga; AI Bakbak, Oshawa; B Sullivan, Hamilton; B Lubelsky, North York; D Kennedy, Simcoe; DS Wong, London; DR Spink Jr, Peterborough; D Spensieri, Woodbridge; FJ Nasser-Sharif, Port Perry; GM Fullerton, Woodstock; GE Vertes, Scarborough;GW Kellam, Prescott;GA Antoniadis, Wingham; HA Boyrazian, Scarborough; HE Harlos, Elmvale; H Sullivan, Hamilton; H Kim, St Catharines;J Vavougios, Toronto;JM Cherry, Scarborough; JYM Cha, Oshawa; JS Bhatt, Brockville; J Gold, North York; JCS Leong, Etobicoke; J Berlingieri, Burlington; J Campbell, Belleville; K Yared, Scarborough; LP Quinn, Oshawa; MSC Ho, Toronto; P Morra, Oshawa; QH Tran, Chatham; R Patel, Scarborough; RS Grewal, Ottawa; S Pallie, St Catharines; V Martinho, Ottawa; W Nisker, Burlington; YK Chan, Niagara Falls.

25. CLARIFY Investigators (cont’d) Quebec: A Belanger, Courcelette; A Kokis, Montreal; A Roy, Laval; B Roy, Beauceville; C Constance, Montreal; D Savard, Montreal; D Rouse, Saint-Jerome; D Saulnier, Levis; F Perreault, Sainte-Anne-De-Bellevue; G Levesque, Saint-Pascal; G Verret, Saint-Raymond, QC; G Boutros, Laval; G Sabe-Affaki, Pointe Claire; G Lafrance, Quebec; G Brouillette, Lasalle; G Brisson, Laval; G Chouinard, Quebec; JP Lavoie, Longueuil; J Robb, Sherbrooke; L Lasalle, Verdun; M Leclair, Anjou; P Talbot, Quebec; S Garg, Montreal; TT Nguyen, Gatineau; P Belisle, Chicoutimi; P Lebouthillier, Quebec; R Chehayeb, Greenfield Park; R Gendreau, Laval; TA Cieza Lara, Chicoutimi; Y Pesant, Saint-Jerome. New Brunswick:G Searles, Saint John; JF Baril, Dieppe; P Clavette, Edmundston. Nova Scotia: HB Matheson, Halifax; N Giacomantonio, Halifax. Newfoundland: J Janes, Mount Pearl.