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Friedrich N, Schneider H, Dörr M, Nauck M, Völzke H, Klotsche J, Sievers C, Pittrow D, Böhler S, Lehnert H, Pieper L, Wittchen HU, Wallaschofski H, Stalla GK. All-cause mortality and serum insulin-like growth factor I in primary care patients. Growth Horm IGF Res 2011; 21:102-106. [PMID: 21435927 DOI: 10.1016/j.ghir.2011.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 12/14/2010] [Accepted: 02/27/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previous population-based studies provided conflicting results regarding the association of total serum insulin-like growth factor I (IGF-I) and mortality. The aim of the present study was to assess the relation of IGF-I levels with all-cause mortality in a prospective study. DESIGN DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a large, multistage, and nationally representative study of primary care patients in Germany. The study population included 2463 men and 3603 women. Death rates were recorded by the respective primary care physician. Serum total IGF-I levels were determined by chemiluminescence immunoassays and categorized into three groups (low, moderate, and high) according to the sex- and age-specific 10th and 90th percentiles. RESULTS Adjusted analyses revealed that men with low [hazard ratio (HR) 1.70 (95% confidence interval [CI] 1.05-2.73), p=0.03] and high [HR 1.76 (95% CI 1.09-2.85), p=0.02] IGF-I levels had higher risk of all-cause mortality compared to men with moderate IGF-I levels. The specificity of low IGF-I and high IGF-I levels increased with lower and higher cut-offs, respectively. No such association became apparent in women. CONCLUSIONS The present study revealed a U-shaped relation between IGF-I and all-cause mortality in male primary care patients.
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Dimopoulou C, Sievers C, Wittchen HU, Pieper L, Klotsche J, Roemmler J, Schopohl J, Schneider HJ, Stalla GK. Adverse anthropometric risk profile in biochemically controlled acromegalic patients: comparison with an age- and gender-matched primary care population. Pituitary 2010; 13:207-14. [PMID: 20131100 PMCID: PMC2913005 DOI: 10.1007/s11102-010-0218-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
GH and IGF-1 play an important role in the regulation of metabolism and body composition. In patients with uncontrolled acromegaly, cardiovascular morbidity and mortality are increased but are supposed to be normalised after biochemical control is achieved. We aimed at comparing body composition and the cardiovascular risk profile in patients with controlled acromegaly and controls. A cross-sectional study. We evaluated anthropometric parameters (height, weight, body mass index (BMI), waist and hip circumference, waist to height ratio) and, additionally, cardiovascular risk biomarkers (fasting plasma glucose, HbA1c, triglycerides, total cholesterol, HDL, LDL, and lipoprotein (a), in 81 acromegalic patients (58% cured) compared to 320 age- and gender-matched controls (ratio 1:4), sampled from the primary care patient cohort DETECT. The whole group of 81 acromegalic patients presented with significantly higher anthropometric parameters, such as weight, BMI, waist and hip circumference, but with more favourable cardiovascular risk biomarkers, such as fasting plasma glucose, total cholesterol, triglycerides and HDL levels, in comparison to their respective controls. Biochemically controlled acromegalic patients again showed significantly higher measurements of obesity, mainly visceral adiposity, than age- and gender-matched control patients (BMI 29.5 +/- 5.9 vs. 27.3 +/- 5.8 kg/m(2); P = 0.020; waist circumference 100.9 +/- 16.8 vs. 94.8 +/- 15.5 cm; P = 0.031; hip circumference 110.7 +/- 9.9 vs. 105.0 +/- 11.7 cm; P = 0.001). No differences in the classical cardiovascular biomarkers were detected except for fasting plasma glucose and triglycerides. This effect could not be attributed to a higher prevalence of type 2 diabetes mellitus in the acromegalic patient group, since stratified analyses between the subgroup of patients with acromegaly and controls, both with type 2 diabetes mellitus, revealed that there were no significant differences in the anthropometric measurements. Biochemically cured acromegalic patients pertain an adverse anthropometric risk profile, mainly because of elevated adiposity measurements, such as BMI, waist and hip circumference, compared to an age- and gender-matched primary care population.
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Kempcke R, Chan A, Haas J, Hartung HP, Koehler J, Meier U, Nelles G, Pöhlau D, Putzki N, Stangel M, Ziemssen T, Pieper L. Versorgungsstrukturelle Besonderheiten: Multiple Sklerose in Dresden und Ostsachsen. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chan A, Haas J, Hartung HP, Koehler J, Meier U, Nelles G, Pöhlau D, Putzki N, Stangel M, Pieper L, Ziemssen T. Versorgungsstrukturelle Besonderheiten: Multiple Sklerose im Großraum Bochum. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pieper L, Ziemssen T, Kern S, Thurau C, Wittchen HU. Allgemeine und psychopathologische Belastungsfaktoren bei MS-Patienten und ihren pflegenden Angehörigen: Design und Methodik der MS Ceragiver Burden Studie. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ziemssen T, Chan A, Haas J, Hartung HP, Koehler J, Meier U, Nelles G, Pöhlau D, Putzki N, Stangel M, Pieper L. Variabilität und Konvergenz regionaler Versorgungsstrukturen: ein 3-Regionen Vergleich. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Koehler J, Chan A, Haas J, Hartung HP, Meier U, Nelles G, Pöhlau D, Putzki N, Stangel M, Pieper L, Ziemssen T. Versorgungsstrukturelle Besonderheiten: Multiple Sklerose in der Region Hamburg. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pauli S, Pieper L, Häberle J, Grzmil P, Burfeind P, Steckel M, Lenz U, Michelmann HW. Proven germline mosaicism in a father of two children with CHARGE syndrome. Clin Genet 2009; 75:473-9. [PMID: 19475719 DOI: 10.1111/j.1399-0004.2009.01151.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CHARGE syndrome is an autosomal dominant malformation syndrome caused by mutations in the CHD7 gene. The majority of cases are sporadic and only few familial cases have been reported. In these families, mosaicism in one parent, as well as parent- to-child transmission of a CHD7 mutation, has been described. In some further cases, germline mosaicism has been suggested. Here, we report the first case in which germline mosaicism could be demonstrated in a father of two affected children with CHARGE syndrome. The truncating mutation c.7302dupA in exon 34 of the CHD7 gene was found in both affected children but was not detected in parental lymphocytes. However, in DNA extracted from the father's spermatozoa, the c.7302dupA mutation could be identified. Furthermore, mutation analysis of DNA isolated from 59 single spermatozoa revealed that the c.7302dupA mutation occurs in 16 spermatozoa, confirming germline mosaicism in the father of the affected children. This result has a high impact for genetic counselling of the family and for their recurrence risk in further pregnancies.
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Stute P, Pieper L, Szuwart T, Warm M, Kiesel L. HORMONE THERAPY AND DUCTAL CARCINOMA IN SITU OF THE BREAST (BDCIS). Maturitas 2009. [DOI: 10.1016/s0378-5122(09)70201-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bach J, Riedel O, Klotsche J, Pieper L, Dodel R, Wittchen H. The influence of myocardial infarction and stroke on patient related quality of life. AKTUELLE NEUROLOGIE 2008. [DOI: 10.1055/s-0028-1087018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Huppertz E, Pieper L, Klotsche J, Stridde E, Pittrow D, Böhler S, Lehnert H. Diabetes Mellitus in German Primary Care: Quality of Glycaemic Control and Subpopulations not well Controlled – Results of the DETECT Study. Exp Clin Endocrinol Diabetes 2008; 117:6-14. [DOI: 10.1055/s-2008-1073127] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pieper L, Schulz H, Klotsche J, Eichler T, Wittchen HU. Depression als komorbide Störung in der primärärztlichen Versorgung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:411-21. [PMID: 18385962 DOI: 10.1007/s00103-008-0509-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pieper L, Eichler T, Klotsche J, Depta A, Pittrow D, Huppertz E, Stridde E, Wittchen HU. Prospektive Betrachtung des Zusammenhangs zwischen Typ-2-Diabetes und Depression: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pieper L, Pittrow D, Klotsche J, Eichler T, Huppertz E, Stridde E, Wittchen HU. Das metabolische Syndrom als Prädiktor für Typ-2-Diabetes und Koronarer Herzerkrankung: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pieper L, Huppertz E, Klotsche J, Eichler T, Pittrow D, Stridde E, Wittchen HU. Auswirkungen einer DMP-Registrierung auf den 12-Monats-Krankheitsverlauf bei Patienten mit Typ-2-Diabetes: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Böhler S, Scharnagl H, Freisinger F, Stojakovic T, Glaesmer H, Klotsche J, Pieper L, Pittrow D, Kirch W, Schneider H, Stalla GK, Lehnert H, Zeiher AM, Silber S, Koch U, Ruf G, März W, Wittchen HU. Unmet needs in the diagnosis and treatment of dyslipidemia in the primary care setting in Germany. Atherosclerosis 2007; 190:397-407. [PMID: 16546194 DOI: 10.1016/j.atherosclerosis.2006.02.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 01/26/2006] [Accepted: 02/02/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES AND METHODS DETECT is a cross-sectional study of 55,518 unselected consecutive patients in 3188 representative primary care offices in Germany. In a random subset of 7519 patients, an extensive standardized laboratory program was undertaken. The study investigated the prevalence of cardiovascular disease, known risk factors (such as diabetes, hypertension and dyslipidemia and their co-morbid manifestation), as well as treatment patterns. The present analysis of the DETECT laboratory dataset focused on the prevalence and treatment of dyslipidemia in primary medical care in Germany. Coronary artery disease (CAD), risk categories and LDL-C target achievement rates were determined in the subset of 6815 patients according to the National Cholesterol Education Program (NCEP) ATP III Guidelines. RESULTS Of all patients, 54.3% had dyslipidemia. Only 54.4% of the NCEP-classified dyslipidemic patients were diagnosed as 'dyslipidemic' by their physicians. Only 27% of all dyslipidemic patients (and 40.7% of the recognized dyslipidemic patients) were treated with lipid-lowering medications, and 11.1% of all dyslipidemic patients (41.4% of the patients treated with lipid-lowering drugs) achieved their LDL-C treatment goals. In conclusion, 80.3% of patients in the sample with dyslipidemia went undiagnosed, un-treated or under-treated.
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Pieper L, Klotsche J, Eichler T, Pittrow D, Böhler S, Stridde E, Huppertz E, Lehnert H, Wittchen HU. Depression und Typ 2 Diabetes – Prävalenz und Patientencharakteristik: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stridde E, Pieper L, Huppertz E, Klotsche J, Eichler T, Lehnert H, Wittchen HU. Prävalenz des metabolischen Syndroms in der primärärztlichen Versorgung: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pieper L, Klotsche J, Eichler T, Pittrow D, Böhler S, Stridde E, Huppertz E, Lehnert H, Wittchen HU. Gesundheitsbezogene Lebensqualität und Nutzwerte bei Typ 2 Diabetikern in der primärärztlichen Versorgung: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Huppertz E, Pieper L, Klotsche J, Eichler T, Pittrow D, Böhler S, Stridde E, Lehnert H, Wittchen HU. Blutzucker (HbA1c) und andere Risikofaktoren bei Typ 2 Diabetikern in der primärärztlichen Versorgung: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pittrow D, Pieper L, Klotsche J, Eichler T, Huppertz E, Stridde E, Lehnert H, Wittchen HU. Mikro- und makrovaskuläre Folgeerkrankungen bei Typ 2 Diabetikern in der primärärztlichen Versorgung: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bischoff B, Silber S, Richartz BM, Pieper L, Klotsche J, Wittchen HU. Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany. Clin Res Cardiol 2006; 95:405-12. [PMID: 16799879 DOI: 10.1007/s00392-006-0399-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 04/28/2006] [Indexed: 10/24/2022]
Abstract
AIMS The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany. METHODS AND RESULTS The DETECT study was a cross-sectional clinical- epidemiological survey of a nationally representative sample of 3795 primary care offices and 55,518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long-term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications. CONCLUSION Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
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Böhler S, Pittrow D, Pieper L, Klotsche J, Huppertz E, Stridde E, Jacobi F, Glaesmer H, Lehnert H, Wittchen HU. Diabetes mellitus in der primärärztlichen Versorgung: Häufigkeit von mikro- und makrovaskulären Komplikationen – Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wittchen HU, Pieper L, Glaesmer H, Böhler S, Pittrow D, Klotsche J, Jacobi F, Stalla GK, Schneider HJ, Lehnert H. Body Mass Index und abdominelle Fettleibigkeit bei diabetischen und nichtdiabetischen Hausarztpatienten: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pieper L, Pittrow D, Böhler S, Stridde E, Huppertz E, Klotsche J, Jacobi F, Glaesmer H, Lehnert H, Wittchen HU. Prävalenz und Therapie des Diabetes mellitus in der primärärztlichen Versorgung: Ergebnisse der DETECT Studie. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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