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Despite the abundant evidence base for the secondaryprevention of coronary artery disease,1 many ofthese therapies are underused in clinical practice.1–4 These gaps between evidence and clinical reality are linked to poor outcomes for patients.5 Improved uptake of secondary-prevention therapies would reduce cardiac mor-bidity and mortality.6 However, most quality-improvement initiatives in coronary artery disease have focused on patients in hospital. Few studies have evaluated means of translating evidence into clinical practice for outpatients cared for by primary care physicians.7 Previously,8 we developed and tested the Local Opinion Leader Statement (Appendix 1, available at www.cmaj.ca /cgi/content/full/cmaj.090917/DC1), a quality-improvement tool consisting of a 1-page summary of evidence with explicit treatment advice about secondary prevention of coronary artery disease. This summary was endorsed by local opinion leaders and was faxed to the primary care physicians of patients with coronary artery disease. Although this fax did not lead to a significant improvement in statin prescribing, our pilot trial was small (117 patients) and enrolled patients with chronic coronary artery disease at the time they presented to their community pharmacy for medication refills. We hypoth-esized that this was not a “teachable moment ” and that if the intervention was given at a time when the diagnosis was made, it would be more influential on the primary care physician. Thus, we designed this trial to test the impact of the opinion leader statement if it was sent to the primary physician at the time when patients were diagnosed with coronary artery disease. In addition, because local opinion leaders are not always self-evident and conducting surveys to identify them for each condi-tion and in each locale would be time-consuming and expen-sive, we also evaluated the impact of an unsigned statement. Method