551
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Similarities and differences between coronary heart disease and stroke in the associations with cardiovascular risk factors: The Japan Collaborative Cohort Study. Atherosclerosis 2017; 261:124-130. [PMID: 28292514 DOI: 10.1016/j.atherosclerosis.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Coronary heart disease (CHD) and stroke have common risk factors, but some of these differ in the magnitude or direction of associations between CHD and stroke. We assessed whether the impact of each risk factor differed between CHD and stroke mortality in Asians. METHODS In total, 104 910 subjects aged 40-79 years without histories of cancer, CHD and stroke at baseline were followed between 1988 and 2009. Competing-risks analysis was used to test for differences in the associations of each risk factor with two endpoints (CHD and stroke). Population attributable fractions (PAFs) were also calculated for these endpoints to estimate the population impact of each risk factor. RESULTS During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The association of hypertension with CHD was similar to that with stroke in terms of the magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking (CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension in women; that for stroke was caused by hypertension in both sexes. CONCLUSIONS Hypertension associations and PAFs were consistent between CHD and stroke, but not for other risk factors. These findings may be useful to optimize public health intervention strategies.
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552
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Accetto R, Korenčan S, Radenković S, Milenković J. Treatment of Patients with Risk Factors: Compliance and Adherence. ACTA FACULTATIS MEDICAE NAISSENSIS 2017. [DOI: 10.1515/afmnai-2017-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Hypertension and dyslipidemias represent important risk factors for the occurrence of cardiovascular diseases which have a high mortality rate. Although we know how to treat both, the success rate remains low. More than half of patients need at least two antihypertensive agents to achieve target blood pressure. Also, dyslipidemia frequently coexists and thus the burden of life-long pill taking is high and the adherence is low. We suggest treating both conditions simultaneously in a fixed combination. This would increase patients' adherence and compliance to therapy and therefore provide a more successful management of both conditions.
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553
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Lynggaard V, Nielsen CV, Zwisler AD, Taylor RS, May O. The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial. Int J Cardiol 2017; 236:65-70. [PMID: 28259552 DOI: 10.1016/j.ijcard.2017.02.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education 'Learning and Coping Strategies' (LC) on patient adherence to an eight-week CR program. METHODS 825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression. RESULTS More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P=0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P=0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income. CONCLUSIONS Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention. TRIAL REGISTRATION www.clinicaltrials.gov identifier NCT01668394.
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Affiliation(s)
- Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark.
| | - Rod S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark; Institute of Health Research, University of Exeter Medical School, Exeter, England, UK.
| | - Ole May
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
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554
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Steen DL, Khan I, Ansell D, Sanchez RJ, Ray KK. Retrospective examination of lipid-lowering treatment patterns in a real-world high-risk cohort in the UK in 2014: comparison with the National Institute for Health and Care Excellence (NICE) 2014 lipid modification guidelines. BMJ Open 2017; 7:e013255. [PMID: 28213597 PMCID: PMC5318572 DOI: 10.1136/bmjopen-2016-013255] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In 2014, guidelines from the National Institute for Health and Care Excellence (NICE) provided updated recommendations on lipid-modifying therapy (LMT). We assessed clinical practice contemporaneous to release of these guidelines in a UK general practice setting for secondary and high-risk primary-prevention populations, and extrapolated the findings to UK nation level. METHODS Patients from The Health Improvement Network database with the following criteria were included: lipid profile in 2014 (index date); ≥20 years of age; ≥2 years representation in database prior to index; ≥1 statin indication either for atherosclerotic cardiovascular disease (ASCVD) or the non-ASCVD conditions high-risk diabetes mellitus and/or chronic kidney disease. RESULTS Overall, 183 565 patients met the inclusion criteria (n=91 479 for ASCVD, 92 086 for non-ASCVD). In those with ASCVD, 79% received statin treatment and 31% received high-intensity statin. In the non-ASCVD group, 62% were on a statin and 57% received medium-intensity or high-intensity statin. In the ASCVD and non-ASCVD cohorts, 6% and 15%, respectively, were already treated according to dosing recommendations as per updated NICE guidelines. Extrapolation to the 2014 UK population indicated that, of the 3.3 million individuals with ASCVD, 2.4 million would require statin uptitration and 680 000 would require statin initiation (31% de novo initiation, 60% reinitiation, 9% addition to non-statin LMT) to achieve full concordance with updated guidelines. Of the 3.5 million high-risk non-ASCVD individuals, 1.6 million would require statin uptitration and 1.4 million would require statin initiation (59% de novo initiation, 36% reinitiation, 5% addition to non-statin LMT). CONCLUSIONS A large proportion of UK individuals with ASCVD and high-risk non-ASCVD received statin treatment (79% and 62%, respectively) during the year of NICE 2014 guidelines release. Up to 94% of patients with ASCVD and 85% of high-risk non-ASCVD individuals, representing ∼3 million individuals in each group, would require statin uptitration or initiation to achieve full concordance with updated guidelines.
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Affiliation(s)
- Dylan L Steen
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Irfan Khan
- Global Health Economics and Outcomes Research, Sanofi, Bridgewater, New Jersey, USA
| | | | - Robert J Sanchez
- Global Health Economics and Outcomes Research, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College, London, UK
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555
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Jarbøl DE, Larsen PV, Gyrd-Hansen D, Søndergaard J, Brandt C, Leppin A, Barfoed BL, Nielsen JB. Determinants of preferences for lifestyle changes versus medication and beliefs in ability to maintain lifestyle changes. A population-based survey. Prev Med Rep 2017; 6:66-73. [PMID: 28271023 PMCID: PMC5331161 DOI: 10.1016/j.pmedr.2017.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/21/2017] [Accepted: 02/13/2017] [Indexed: 01/16/2023] Open
Abstract
Preferences for medication treatment versus lifestyle changes are of major importance in the management of chronic diseases. This study aims to investigate determinants of preference for lifestyle changes versus medication for prevention of cardiovascular disease as well as determinants of respondents' beliefs in their ability to maintain lifestyle changes. A representative sample of 40-60-year old Danish inhabitants was in 2012 invited to a survey and were asked to imagine that they had been diagnosed as being at increased risk of heart disease. Subsequently they were presented with a choice between a preventive medical intervention versus lifestyle change. The study population for the present paper comprises 1069 participants. A total of 962 participants preferred lifestyle changes to medication treatment. Significant determinants for preferring lifestyle changes were female gender and high level of physical activity. Significant determinants for not opting for lifestyle changes were being self-employed, poor self-rated health and smoking. Low educational attainment, lifestyle risk factors, self-reported health-related challenges and prior experience with heart disease were associated with a low belief in ability to maintain lifestyle changes. For conclusion we found a pervasive preference for lifestyle changes over medical treatment when individuals were promised the same benefits. Lifestyle risk factors and socioeconomic characteristics were associated with preference for lifestyle changes as well as belief in ability to maintain lifestyle changes. For health professionals risk communication should not only focus on patient preferences but also on patients' beliefs in their own ability to initiate lifestyle changes and possible barriers against maintaining changes.
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Affiliation(s)
- Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Pia Veldt Larsen
- Research Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Dorte Gyrd-Hansen
- COHERE, Department of Public Health & Department of Business and Economics, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Carl Brandt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Anja Leppin
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark
| | - Benedicte Lind Barfoed
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark
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556
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Munkhaugen J, Sverre E, Otterstad JE, Peersen K, Gjertsen E, Perk J, Gullestad L, Moum T, Dammen T, Husebye E. Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients. Eur J Prev Cardiol 2017; 24:981-989. [PMID: 28196429 DOI: 10.1177/2047487317693134] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Understanding the determinants of low-density lipoprotein cholesterol (LDL-C) control constitutes the basis of modelling interventions for optimal lipid control and prognosis. We aim to identify medical and psychosocial (study) factors associated with unfavourable LDL-C control in coronary patients. Methods A cross-sectional explorative study used logistic and linear regression analysis to investigate the association between study factors and LDL-C in 1095 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records, a comprehensive self-report questionnaire, clinical examination and blood samples after 2-36 months follow-up. Results Fifty-seven per cent did not reach the LDL-C target of 1.8 mmol/l at follow-up. Low socioeconomic status and psychosocial factors were not associated with failure to reach the LDL-C target. Statin specific side-effects (odds ratio 3.23), low statin adherence (odds ratio 3.07), coronary artery by-pass graft operation as index treatment (odds ratio 1.95), ≥ 1 coronary event prior to the index event (odds ratio 1.81), female gender (odds ratio 1.80), moderate- or low-intensity statin therapy (odds ratio 1.62) and eating fish < 3 times/week (odds ratio 1.56) were statistically significantly associated with failure to reach the LDL-C target, in adjusted analyses. Only side-effects (standardized β 0.180), low statin adherence ( β 0.209) and moderate- or low-intensity statin therapy ( β 0.228) were associated with LDL-C in continuous analyses. Conclusions Statin specific side-effects, low statin adherence and moderate- or low-intensity statin therapy were the major factors associated with unfavourable LDL-C control. Interventions to improve LDL-C should ensure adherence and prescription of sufficiently potent statins, and address side-effects appropriately.
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Affiliation(s)
| | - Elise Sverre
- 1 Department of Medicine, Drammen Hospital, Norway.,2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway
| | | | - Kari Peersen
- 3 Department of Medicine, Vestfold Hospital, Norway.,4 Department of Cardiology, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Norway
| | | | - Joep Perk
- 5 Department of Cardiology, Public Health Department, Linnaeus University, Kalmar, Sweden
| | - Lars Gullestad
- 4 Department of Cardiology, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Norway
| | - Torbjørn Moum
- 2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway
| | - Toril Dammen
- 2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway
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557
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Peersen K, Munkhaugen J, Gullestad L, Dammen T, Moum T, Otterstad JE. Reproducibility of an extensive self-report questionnaire used in secondary coronary prevention. Scand J Public Health 2017; 45:269-276. [PMID: 28181463 PMCID: PMC5405837 DOI: 10.1177/1403494816688375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aims: Self-reported information from questionnaires is frequently used in clinical epidemiological studies, but few provide information on the reproducibility of instruments applied in secondary coronary prevention studies. This study aims to assess the test–retest reproducibility of the questionnaire applied in the cross-sectional NORwegian CORonary (NOR-COR) Prevention Study. Methods: In the NOR-COR study 1127 coronary heart disease (CHD) patients completed a self-report questionnaire consisting of 249 questions, of which there are both validated instruments and de novo questions. Test–retest reliability of the instrument was estimated after four weeks in 99 consecutive coronary patients. Intraclass Correlation Coefficient (ICC) and Kappa (κ) were calculated. Results: The mean interval between test and retest was 33 (±6.4) days. Reproducibility values for questions in the first part of the questionnaire did not differ from those in the latter. A good to very good reproducibility was found for lifestyle factors (smoking: κ = 1.0; exercise: ICC = 0.90), medical factors (drug adherence: ICC = 0.74; sleep apnoea: ICC = 0.87), and psychosocial factors (anxiety and depression: ICC = 0.95; quality of life 12-Item Short-Form Health Survey (SF12): ICC = 0.89), as well as for the majority of de-novo-created variables covering the patient’s perceptions, motivation, needs, and preferences. Conclusions: The present questionnaire demonstrates a highly acceptable reproducibility for all key items and instruments. It thus emerges as a valuable tool for evaluating patient factors associated with coronary risk factor control in CHD patients.
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Affiliation(s)
- Kari Peersen
- 1 Department of Medicine, Hospital of Vestfold, Norway.,2 Faculty of Medicine, University of Oslo, Norway
| | - John Munkhaugen
- 3 Department of Medicine, Drammen Hospital, Norway.,4 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Lars Gullestad
- 2 Faculty of Medicine, University of Oslo, Norway.,5 Department of Cardiology, Oslo University Hospital, Norway
| | - Toril Dammen
- 4 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torbjorn Moum
- 4 Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
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558
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Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:69-85. [PMID: 28173956 DOI: 10.1016/j.arteri.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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559
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Minneboo M, Lachman S, Snijder MB, Vehmeijer JT, Jørstad HT, Peters RJG. Risk factor control in secondary prevention of cardiovascular disease: results from the multi-ethnic HELIUS study. Neth Heart J 2017; 25:250-257. [PMID: 28181106 PMCID: PMC5355388 DOI: 10.1007/s12471-017-0956-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the quality of contemporary secondary prevention of cardiovascular disease (CVD), and the differences between six ethnic groups in a large, observational cohort. DESIGN We included participants with a self-reported history of CVD from the HEalthy LIfe in an Urban Setting (HELIUS) study, which investigates inequalities in health between six ethnic groups living in Amsterdam, the Netherlands. We quantified the proportions of patients who were at the preventive treatment goal according to the guidelines of the European Society of Cardiology for six risk factors: hypertension, dyslipidaemia, smoking, overweight, physical inactivity and diabetes mellitus, and the use preventive medication. RESULTS Of 22,165 participants, 1163 (5%) reported a history of CVD. Mean age was 54 years. Overall, 69% had a systolic blood pressure of <140 mm Hg, and 42% had a low-density lipoprotein (LDL) cholesterol of <2.5 mmol/l. Non-smoking was found in 67%. Body mass index (BMI) <25 kg/m2 was found in 24%, and 54% reported adequate physical activity. The mean number of risk factors per patient was three (±1.1) out of six, and only 2% had all risk factors on target. Across the ethnic groups, non-smoking was more prevalent in the Ghanaian and Moroccan groups than in the Dutch (p < 0.001 and p = 0.001, respectively); BMI <25 kg/m2 and adequate physical activity were less prevalent among all ethnic minority groups compared with the Dutch group. CONCLUSION We found large treatment gaps in secondary prevention of CVD. Ethnic differences in risk factors were found; however, strategies to improve overall risk factor management may be mandated before designing ethnic-specific strategies.
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Affiliation(s)
- M Minneboo
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - S Lachman
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M B Snijder
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - J T Vehmeijer
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - R J G Peters
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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560
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Ribas N, García-García C, Meroño O, Recasens L, Pérez-Fernández S, Bazán V, Salvatella N, Martí-Almor J, Bruguera J, Elosua R. Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion. BMC Cardiovasc Disord 2017; 17:54. [PMID: 28173757 PMCID: PMC5297147 DOI: 10.1186/s12872-017-0493-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry. DESIGN AND METHODS Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. RESULTS A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. CONCLUSIONS Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.
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Affiliation(s)
- Núria Ribas
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Medicine Department, Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Cosme García-García
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oona Meroño
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lluís Recasens
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Pérez-Fernández
- IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Víctor Bazán
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Neus Salvatella
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julio Martí-Almor
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Bruguera
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Roberto Elosua
- IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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561
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The polypill approach - An innovative strategy to improve cardiovascular health in Europe. BMC Pharmacol Toxicol 2017; 18:10. [PMID: 28166827 PMCID: PMC5294740 DOI: 10.1186/s40360-016-0102-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of disability and premature death. Despite European guidelines advocating the use of medical therapies in CVD, many patients still do not achieve the guideline-recommended treatment, which highlights the need for change and innovations in this field. This requirement has been widely recognised by the national ministries of health, several European cardiology societies, and the European Parliament, who support the initiation of strategies to improve and promote cardiovascular health. Discussion One of the key risk factors to recurrent cardiovascular events is the lack of adherence to medication and this has been added to the agenda of the European Commission. With the intention to improve treatment adherence in CVD, polypills have been investigated and numerous studies demonstrate that they significantly improve medication adherence, which contributes to the improvement of health outcomes. In Europe, the first cardiovascular polypill, developed by a public-private partnership (CNIC-Ferrer), recently became available for general prescription as a therapy for CVD prevention. This polypill significantly improves adherence, preventing fatal and non-fatal cardiovascular events, and appears to be a cost-effective strategy to improve sustainability of the health care systems in CVD. Conclusions Given the importance of urgent and simple solutions to restraining the pandemic nature of CVD, the polypill approach should therefore be considered by physicians and public health systems as an available and innovative option to improve cardiovascular health.
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562
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Kharlamov AN. Cardiovascular burden and percutaneous interventions in Russian Federation: systematic epidemiological update. Cardiovasc Diagn Ther 2017; 7:60-84. [PMID: 28164014 DOI: 10.21037/cdt.2016.08.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The situation with cardiovascular (CV) burden in Russian population is alerting, and becomes of interest due to high CV mortality, and shorter lifespan if compare with the Western society amid the absence of the established monitoring or screening system for major CV risk factors. The purpose of this systematic epidemiological update was to explore CV burden in Russia. The study represents pooled results with a systematic epidemiological review of the national mass screening, selected randomized clinical trials and statistical datasets of the national public health CV institutions exploring the trends of the CV burden in all 83 regions of Russia. We overviewed data from a number of the available Russian-speaking national data sources of 2001-2014, and NANOM-FIM trial (NCT01270139) as the only available real-world population study. The CV diseases in Russia accounted for 54.9% of all deaths in 2011-2014. The death rate was 13.3 per 1,000 citizens with CV mortality of 653.9 per 100,000. The life expectancy achieves 64.3 years for male and 76.1 years for female. The mean age of pts in trial was 51.6 years (77.2% males). A total of 175 Russian PCI centers implemented 205,902 angio a year, and 75,378 PCI achieving 531 PCI per 1,000,000 with placement of 101,451 stents (1.37 stents per PCI; 48,057 DES). The smoking (17.3% of screened with a 2,786 cigarettes a year; 70.6% in trial), excessive alcohol consumption (1.8% of screened with a 11.6 L per year; 50.6% in trial), unhealthy Russian diet (abundance of carbohydrates/sugar, saturated and trans fats in 24.3% of screened), psychosocial factors (20%) and physical inactivity (19.6% of screened) remain the major modifiable risk factors. They, in turn, affect such risk factors as dyslipidemia (86.7% in trial), obesity (16.7% of screened; BMI in trial was 28.4), and hypertension (40.8% suffered; 86.1% in trial). CV mortality was not directly associated with a level of poverty (r=0.26, P=0.02) or socio-economic development (P>0.05) in regions. The documented 27% 10-year decline of CV mortality was interpreted as a success of the national policy. Mortality statistics show the stark reality of a high CV burden in Russia. New national program and aggressive emerging efforts are required to tackle CV diseases in Russia.
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563
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Benzer W, Rauch B, Schmid JP, Zwisler AD, Dendale P, Davos CH, Koudi E, Simon A, Abreu A, Pogosova N, Gaita D, Miletic B, Bönner G, Ouarrak T, McGee H. Exercise-based cardiac rehabilitation in twelve European countries results of the European cardiac rehabilitation registry. Int J Cardiol 2017; 228:58-67. [DOI: 10.1016/j.ijcard.2016.11.059] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/28/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
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564
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Documento de consenso del uso clínico de la Polypill en la prevención secundaria del riesgo cardiovascular. Med Clin (Barc) 2017; 148:139.e1-139.e15. [DOI: 10.1016/j.medcli.2016.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/17/2016] [Accepted: 10/27/2016] [Indexed: 01/13/2023]
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565
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Vrsalovic M. Diabetes and peripheral artery disease: A bad combination. Am J Surg 2017; 216:182-183. [PMID: 28168957 DOI: 10.1016/j.amjsurg.2017.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Mislav Vrsalovic
- University of Zagreb School of Medicine, Zagreb, Croatia; Department of Vascular Medicine, Cardiovascular Center, Sisters of Charity University Hospital, Zagreb, Croatia.
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566
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Asselbergs FW, Visseren FLJ, Bots ML, de Borst GJ, Buijsrogge MP, Dieleman JM, van Dinther BGF, Doevendans PA, Hoefer IE, Hollander M, de Jong PA, Koenen SV, Pasterkamp G, Ruigrok YM, van der Schouw YT, Verhaar MC, Grobbee DE. Uniform data collection in routine clinical practice in cardiovascular patients for optimal care, quality control and research: The Utrecht Cardiovascular Cohort. Eur J Prev Cardiol 2017; 24:840-847. [DOI: 10.1177/2047487317690284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank LJ Visseren
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Marc P Buijsrogge
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, the Netherlands
| | - Jan M Dieleman
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Anaesthesiology and Intensive Care, University Medical Center Utrecht, the Netherlands
| | - Baukje GF van Dinther
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Imo E Hoefer
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Cardiology Laboratory, University Medical Center Utrecht, the Netherlands
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, the Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Steven V Koenen
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Obstetrics, University Medical Center Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Cardiology Laboratory, University Medical Center Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
- Center for Circulatory Health, University Medical Center Utrecht, Utrecht, The Netherlands
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567
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Bezin J, Groenwold RH, Ali MS, Lassalle R, Robinson P, de Boer A, Moore N, Klungel OH, Pariente A. Comparative effectiveness of recommended versus less intensive drug combinations in secondary prevention of acute coronary syndrome. Pharmacoepidemiol Drug Saf 2017; 26:285-293. [DOI: 10.1002/pds.4171] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/16/2016] [Accepted: 01/07/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Julien Bezin
- University of Bordeaux, U1219; Bordeaux France
- Department of Clinical Pharmacology; University Hospital of Bordeaux; Bordeaux France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team; Bordeaux France
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
| | - Rolf H.H. Groenwold
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - M. Sanni Ali
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
- ADERA; Pessac France
| | - Philip Robinson
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
- ADERA; Pessac France
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Nicholas Moore
- University of Bordeaux, U1219; Bordeaux France
- Department of Clinical Pharmacology; University Hospital of Bordeaux; Bordeaux France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team; Bordeaux France
- Bordeaux PharmacoEpi, INSERM CIC1401; Bordeaux France
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Utrecht The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - Antoine Pariente
- University of Bordeaux, U1219; Bordeaux France
- Department of Clinical Pharmacology; University Hospital of Bordeaux; Bordeaux France
- INSERM, U1219, Bordeaux Population Health Research Center, Pharmacoepidemiology Research Team; Bordeaux France
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568
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Sverre E, Peersen K, Husebye E, Gjertsen E, Gullestad L, Moum T, Otterstad JE, Dammen T, Munkhaugen J. Unfavourable risk factor control after coronary events in routine clinical practice. BMC Cardiovasc Disord 2017; 17:40. [PMID: 28109259 PMCID: PMC5251244 DOI: 10.1186/s12872-016-0387-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 10/26/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Risk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event. METHODS A cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up. RESULTS Twenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed. CONCLUSIONS The majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits. TRIAL REGISTRATION Registered at ClinicalTrials.gov (ID NCT02309255 ).
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Affiliation(s)
- Elise Sverre
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Kari Peersen
- Department of Medicine, Vestfold Hospital, Tonsberg, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Medical Faculty, University of Oslo, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | | | - Toril Dammen
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
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569
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Gómez-Barrado JJ, Ortiz C, Gómez-Turégano M, Gómez-Turégano P, Garcipérez-de-Vargas FJ, Sánchez-Calderón P. [Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:13-19. [PMID: 28062171 DOI: 10.1016/j.arteri.2016.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of <70mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area. METHODS An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed. RESULTS The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3±11.8 for women and 65.8±12.6 for men (P<.001). A total of 52.3% patients achieved the LDLc target of <70mg/dl, with no gender differences. Only 44.8% of the patients <55 years achieved their lipid targets, compared to 59.3% of the patients >75 years. About 68.2% of men had an HDLc>40mg/dl, and 54.8% of women had an HDLc>50mg/dl. Overall, 79.4% of patients had a TG<150mg/dl, with no gender differences, and 59.8% had a non-HDLc<100mg/dl. CONCLUSIONS Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence.
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Affiliation(s)
- José J Gómez-Barrado
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España.
| | - Carolina Ortiz
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España
| | - Marta Gómez-Turégano
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España
| | - Paula Gómez-Turégano
- Complejo Hospitalario Universitario de Cáceres, Hospital San Pedro de Álcantara, Cáceres, España
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570
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Corsini A. Low-density lipoprotein cholesterol variability increases the risk of cardiovascular events. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e91-e93. [DOI: 10.2459/jcm.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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571
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Heintjes E, Kuiper J, Lucius B, Penning-van Beest F, Kutikova L, Liem A, Herings R. Characterization and cholesterol management in patients with cardiovascular events and/or type 2 diabetes in the Netherlands. Curr Med Res Opin 2017; 33:91-100. [PMID: 27646783 DOI: 10.1080/03007995.2016.1239190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe clinical characteristics and cholesterol management of patients with cardiovascular events (CVEs) and/or type 2 diabetes mellitus (T2DM) with high low-density lipoprotein cholesterol (LDL-C) > 1.8 mmol/L in the Netherlands. RESEARCH DESIGN AND METHODS From the PHARMO Database Network a cross-sectional cohort was constructed. The descriptive study included patients on lipid modifying therapy (LMT) in 2009, classified as high cardiovascular risk based on a history of T2DM or CVE, with 2010 LDL-C levels above 1.8 mmol/L (2011 European Society of Cardiology [ESC] target). Sub-cohorts were created: T2DM + CVE from the T2DM cohort and multiple CVE from the CVE only cohort. MAIN OUTCOME MEASURES Clinical characteristics and drug treatment were determined at the time of the last LDL-C measurement in 2010. RESULTS Of 10,864 very high risk patients, 66% had T2DM, 37% of whom also had CVE. In the CVE only cohort (34%), 18% had multiple events. More regular check-ups skewed inclusion towards diabetes patients. T2DM vs. CVE cohort characteristics were: 53% vs. 63% male, 42% vs. 27% obese, 19% vs. 24% current smoker, 54% vs. 51% systolic blood pressure <140 mmHg, with similar proportions in the sub-cohorts. Proportions reaching the Dutch guideline LDL-C target of <2.5 mmol/L were 56% (T2DM), 57% (T2DM + CVE), 48% (CVE only) and 53% (multiple CVE only). Frequencies of high intensity dose statin (simvastatin ≥80 mg, atorvastatin ≥40 mg or rosuvastatin ≥20 mg) were 6% (T2DM), 9% (T2DM + CVE, CVE only) and 14% (multiple CVE only); 1-2% received additional ezetimibe and 3-5% received non-statin LMT only, including ezetimibe. CONCLUSION Despite LMT, >40% of the patients above ESC target also failed to reach the less stringent Dutch target, even in the higher risk groups. Therefore, management of hypercholesterolemia after CVE or T2DM should be optimized to improve cardiovascular outcomes. There is substantial room for improving other cardiovascular risk factors.
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Affiliation(s)
- Edith Heintjes
- a PHARMO Institute for Drug Outcomes Research , Utrecht , Netherlands
| | - Josephina Kuiper
- a PHARMO Institute for Drug Outcomes Research , Utrecht , Netherlands
| | - Bianca Lucius
- b Amgen BV , Dept. Value Access & Policy , Breda , Netherlands
| | | | - Lucie Kutikova
- c Amgen Europe , GmbH, Dept. Global Health Economics , Zug , Switzerland
| | - Anho Liem
- d Sint Franciscus Gasthuis , Dept. Cardiology , Rotterdam , Netherlands
| | - Ron Herings
- a PHARMO Institute for Drug Outcomes Research , Utrecht , Netherlands
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572
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Role of Optimal Medication Given to Patients with Hypertension and Ischemic Heart Disease Prior to an Acute Coronary Syndrome. Heart Int 2017; 12:10.5301_heartint.5000237. [PMID: 30263100 PMCID: PMC6159667 DOI: 10.5301/heartint.5000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Administering optimal cardiovascular medication (OCM) to patients with
hypertension (HBP) and ischemic heart disease (IHD) lowers cardiovascular
morbidity and mortality. The main objective of this study was to compare in-hospital cardiac mortality
among patients with HBP and/or IHD, treated or untreated with OCM, who
developed a first episode of acute coronary syndrome (ACS). Methods The study was carried out retrospectively and included patients admitted with
a first episode of ACS between 2013 and 2016. The patients were divided into
three groups: those with HBP, IHD, and a history of HBP + IHD. Patients were
then divided into two subgroups: subgroup A consisted of patients undergoing
optimal anti-ischemic and/or antihypertensive therapy, while subgroup B
consisted of patients without OCM. Results This analysis comprised 1096 patients. Mean age was 64.3 ± 18 years. There
were 581 patients in subgroup A – 53%, and 515 patients in subgroup B – 47%.
Total cardiac mortality was 9.98%, different depending on the groups and
subgroups studied: HBP group total – 7%, subgroup A – 5.1%, significantly
lower compared to subgroup B – 9.4% (p = 0.05); IHD group total – 12.2%,
subgroup A – 9.07%, significantly lower compared to subgroup B – 15.8% (p =
0.05); HBP + IHD group total – 14.35%, subgroup A – 9.9%, significantly
lower compared to subgroup B – 18.8% (p = 0.05). Conclusions The lack of OCM in patients with HBP and/or IHD is correlated to a
significant increase in in-hospital cardiac mortality among patients who
develop a first-episode ACS.
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573
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Mark L, Paragh G, Ray KK. The need for a new classification of cholesterol lowering therapies. Curr Med Res Opin 2017; 33:67-69. [PMID: 27599680 DOI: 10.1080/03007995.2016.1233102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laszlo Mark
- a Bekes County Central Hospital Pandy Kalman Section , Department of Cardiology , Gyula , Hungary
| | - György Paragh
- b Medical and Health Science Centre , University of Debrecen, 1st Department of Medicine , Debrecen , Hungary
| | - Kausik K Ray
- c Department of Primary Care and Public Health , School of Public Health, Imperial College London , London , UK
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574
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Pedro-Botet J, Climent E. [A glow in the secondary prevention of cardiovascular disease]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2017; 29:20-21. [PMID: 28173922 DOI: 10.1016/j.arteri.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Elisenda Climent
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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575
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Alvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Cammafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. HIPERTENSION Y RIESGO VASCULAR 2016; 34:24-40. [PMID: 28017552 DOI: 10.1016/j.hipert.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/21/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
- M Á Royo-Bordonada
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
| | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | - R Elosua
- Sociedad Española de Epidemiología
| | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria
| | - B Serrano
- Sociedad Española de Medicina y Seguridad en el Trabajo
| | | | | | - A Pérez
- Sociedad Española de Diabetes
| | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria
| | | | - A Castro
- Sociedad Española de Cardiología
| | | | - C Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - M Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - P Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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Gyberg V, De Bacquer D, Kotseva K, De Backer G, Schnell O, Tuomilehto J, Wood D, Rydén L. Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV. BMJ Open 2016; 6:e013835. [PMID: 27932342 PMCID: PMC5168687 DOI: 10.1136/bmjopen-2016-013835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND WHO advocates 2-hour oral glucose tolerance test (OGTT) for detecting diabetes mellitus (DM). OGTT is the most sensitive method to detect DM in patients with coronary artery disease (CAD). Considered time consuming, the use of OGTT is unsatisfactory. A 1-hour plasma glucose (1hPG) test has not been evaluated as an alternative in patients with CAD. OBJECTIVES To create an algorithm based on glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 1hPG limiting the need of a 2-hour plasma glucose (2hPG) in patients with CAD. METHODS 951 patients with CAD without DM underwent OGTT. A 2hPG≥11.1 mmol/L was the reference for undiagnosed DM. The yield of HbA1c, FPG and 1hPG was compared with that of 2hPG. RESULTS Mean FPG was 6.2±0.9 mmol/L, and mean HbA1c 5.8±0.4%. Based on 2hPG≥11.1 mmol/L 122 patients (13%) had DM. There was no value for the combination of HbA1c and FPG to rule out or in DM (HbA1c≥6.5%; FPG≥7.0 mmol/L). In receiver operating characteristic analysis a 1hPG≥12 mmol/L balanced sensitivity and specificity for detecting DM (both=82%; positive and negative predictive values 40% and 97%). A combination of FPG<6.5 mmol/L and 1hPG<11 mmol/L excluded 99% of DM. A combination of FPG>8.0 mmol/L and 1hPG>15 mmol/L identified 100% of patients with DM. CONCLUSIONS Based on its satisfactory accuracy to detect DM an algorithm is proposed for screening for DM in patients with CAD decreasing the need for a 2-hour OGTT by 71%.
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Affiliation(s)
- Viveca Gyberg
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany
| | - Jaakko Tuomilehto
- Danube-University Krems, Krems, Austria
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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577
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Gupta P, Patel P, Horne R, Buchanan H, Williams B, Tomaszewski M. How to Screen for Non-Adherence to Antihypertensive Therapy. Curr Hypertens Rep 2016; 18:89. [PMID: 27889904 PMCID: PMC5124437 DOI: 10.1007/s11906-016-0697-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The quality of assessment of non-adherence to treatment in hypertensive is poor. Within this review, we discuss the different methods used to assess adherence to blood-pressure-lowering medications in hypertension patients. Subjective reports such as physicians' perceptions are inaccurate, and questionnaires completed by patients tend to overreport adherence and show a low diagnostic specificity. Indirect objective methods such as pharmacy database records can be useful, but they are limited by the robustness of the recorded data. Electronic medication monitoring devices are accurate but usually track adherence to only a single medication and can be expensive. Overall, the fundamental issue with indirect objective measures is that they do not fully confirm ingestion of antihypertensive medications. Detection of antihypertensive medications in body fluids using liquid chromatography-tandem mass spectrometry is currently, in our view, the most robust and clinically useful method to assess non-adherence to blood-pressure-lowering treatment. It is particularly helpful in patients presenting with resistant, refractory or uncontrolled hypertension despite the optimal therapy. We recommend using this diagnostic strategy to detect non-adherence alongside a no-blame approach tailoring support to address the perceptions (e.g. beliefs about the illness and treatment) and practicalities (e.g. capability and resources) influencing motivation and ability to adhere.
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Affiliation(s)
- Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- British Heart Foundation Cardiovascular Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- British Heart Foundation Cardiovascular Research Centre, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Robert Horne
- Department of Behavioral Medicine, School of Pharmacy, University College London, London, UK
| | - Heather Buchanan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, London, UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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578
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Gouni‐Berthold I, Descamps OS, Fraass U, Hartfield E, Allcott K, Dent R, März W. Systematic review of published Phase 3 data on anti-PCSK9 monoclonal antibodies in patients with hypercholesterolaemia. Br J Clin Pharmacol 2016; 82:1412-1443. [PMID: 27478094 PMCID: PMC5099564 DOI: 10.1111/bcp.13066] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/14/2016] [Accepted: 07/04/2016] [Indexed: 01/06/2023] Open
Abstract
AIMS Two anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies, alirocumab and evolocumab, have been approved for the treatment of hypercholesterolaemia in certain patients. We reviewed data from Phase 3 studies to evaluate the efficacy and safety of these antibodies. METHODS We systematically reviewed Phase 3 English-language studies in patients with hypercholesterolaemia, published between 1 January 2005 and 20 October 2015. Congress proceedings from 16 November 2012 to 16 November 2015 were also reviewed. RESULTS We identified 12 studies of alirocumab and nine of evolocumab, including over 10 000 patients overall. Most studies enrolled patients with hypercholesterolaemia and used anti-PCSK9 antibodies with statins. The ODYSSEY FH I, FH II and HIGH FH alirocumab studies and the RUTHERFORD-2 evolocumab study exclusively recruited patients with heterozygous familial hypercholesterolaemia. Two evolocumab studies focused mainly on homozygous familial hypercholesterolaemia (HoFH): TESLA Part B and TAUSSIG (a TESLA sub-study); only those data for HoFH are reported here. All comparator studies demonstrated a reduction in LDL cholesterol (LDL-C) with the anti-PCSK9 antibodies. No head-to-head studies were conducted between alirocumab and evolocumab. Up to 87% of patients receiving alirocumab and up to 98% receiving evolocumab reached LDL-C goals. Both antibodies were effective and well tolerated across a broad population of patients and in specific subgroups, such as those with type 2 diabetes. CONCLUSIONS Using anti-PCSK9 antibodies as add-on therapy to other lipid-lowering treatments or as monotherapy for patients unable to tolerate statins may help patients with high cardiovascular risk to achieve their LDL-C goals.
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Affiliation(s)
- Ioanna Gouni‐Berthold
- Center for Endocrinology, Diabetes and Preventive Medicine (ZEDP)University of CologneCologneGermany
| | - Olivier S. Descamps
- Department of Internal MedicineCentres Hospitaliers JolimontHaine Saint‐PaulBelgium
| | | | | | | | | | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory DiagnosticsMedical University GrazGrazAustria
- Medical Clinic V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty MannheimUniversity of HeidelbergGermany
- Synlab AcademySynlab Holding Deutschland GmbHMannheim and AugsburgGermany
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579
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580
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Kähkönen O, Kankkunen P, Miettinen H, Lamidi ML, Saaranen T. Perceived social support following percutaneous coronary intervention is a crucial factor in patients with coronary heart disease. J Clin Nurs 2016; 26:1264-1280. [DOI: 10.1111/jocn.13527] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Outi Kähkönen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | - Päivi Kankkunen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
| | | | - Marja-Leena Lamidi
- Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Terhi Saaranen
- Department of Nursing Science; University of Eastern Finland; Kuopio Finland
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581
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Characteristics and Course of Heart Failure Stages A–B and Determinants of Progression – design and rationale of the STAAB cohort study. Eur J Prev Cardiol 2016; 24:468-479. [DOI: 10.1177/2047487316680693] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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582
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Piironen M, Ukkola O, Huikuri H, Havulinna AS, Koukkunen H, Mustonen J, Ketonen M, Lehto S, Airaksinen J, Antero Kesäniemi Y, Salomaa V. Trends in long-term prognosis after acute coronary syndrome. Eur J Prev Cardiol 2016; 24:274-280. [DOI: 10.1177/2047487316679522] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marjo Piironen
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Aki S Havulinna
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Heli Koukkunen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | | | | | - Seppo Lehto
- University of Eastern Finland, Kuopio, Finland
| | | | - Y Antero Kesäniemi
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Veikko Salomaa
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
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583
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Schiele F, Farnier M, Krempf M, Bruckert E, Ferrières J, Angoulvant D, Boccara F, Bonnet J, Bonnet JL, Bruckert E, Cayla G, Chatot M, Chopard R, Collet JP, Danchin N, Ducrocq G, Elbaz M, Ferrari E, Galinier M, Farnier M, Ferrières J, Gerbaud E, Guedj D, Kownator S, Krempf M, Lemesle G, Levai L, Mansencal N, Mansourati J, Meune C, Morel O, Paillard F, Piot C, Probst V, Puymirat E, Roubille F, Sabouret P, Schiele F, Teiger E. A consensus statement on lipid management after acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 7:532-543. [DOI: 10.1177/2048872616679791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.
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Affiliation(s)
- François Schiele
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Eric Bruckert
- Endocrinologie métabolisme et prevention cardiovasculaire, Institut E3M et IHU cardiométabolique, Groupe hospitalier Pitié-Salpétrière, Paris, France
| | - Jean Ferrières
- Service de Cardiologie B, CHU Rangueil, Toulouse, France
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584
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Ergatoudes C, Thunström E, Rosengren A, Björck L, Bengtsson Boström K, Falk K, Fu M. Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome. BMC Cardiovasc Disord 2016; 16:226. [PMID: 27855640 PMCID: PMC5114745 DOI: 10.1186/s12872-016-0400-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/07/2016] [Indexed: 12/02/2022] Open
Abstract
Background A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI. Methods Patients aged 18–85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden. All patients who agreed to participate in the study (16.2%) were invited for a structured interview, physical examinations and laboratory analysis 2 years after AMI. Guideline-directed secondary preventive goals were defined as optimally controlled blood pressure, serum cholesterol, glucose, regular physical activity, smoking cessation and pharmacological treatment. Results The mean age of the study cohort (n = 200) at the index AMI was 63.0 ± 9.7 years, 79% were men. Only 3.5% of the cohort achieved all six guideline-directed secondary preventive goals 2 years after infarction. LDL < 1.8 mmol/L was achieved in 18.5% of the cohort, regular exercise in 45.5% and systolic blood pressure <140 mmHg in 57.0%. Anti-platelet therapy was used by 97% of the patients, beta-blockers by 83.0%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers by 76.5% and statins by 88.5%. During follow-up, non-fatal adverse cardiovascular events (cardiac hospitalization, recurrent acute coronary syndrome, angina pectoris, new percutaneous coronary intervention, new onset of atrial fibrillation, post-infarct heart failure, pacemaker implantation, stroke/transient ischemic attack (TIA), cardiac surgery and cardiac arrest) occurred in 47% of the cohort and readmission due to cardiac causes in 30%. Conclusions Our data showed the failure of secondary prevention in our daily clinical practice and high rate of non-fatal adverse cardiovascular events 2 years after AMI.
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Affiliation(s)
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Skövde, Sweden
| | | | - Kristin Falk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Skövde, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden. .,Department of Medicine, Section of Cardiology, Sahlgrenska University Hospital/Östra, 41651, Göteborg, Sweden.
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585
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Joly B, D'Athis P, Gerbaud L, Hazart J, Perriot J, Quantin C. Smoking cessation attempts: is it useful to treat hard core smokers? Tob Induc Dis 2016; 14:34. [PMID: 27822177 PMCID: PMC5093930 DOI: 10.1186/s12971-016-0100-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 10/21/2016] [Indexed: 02/08/2023] Open
Abstract
Background Hard core smokers have been studied in many countries but only a few trials have compared the effectiveness of smoking cessation with other smokers. The objective of this study was to compare the frequencies of success in smoking cessation between hard-core smokers and other smokers. Methods Data were collected in Clermont-Ferrand from the Emile Roux dispensary ‘Pneumology and Tobaccology Centre’ between 1999 and 2009. Assistance with smoking cessation was proposed to 1367 patients but only 1296 patients were included: 219 HCS and 1077 other smokers. Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation. The profiles of the two types of smokers were compared using Chi square test and Student’s t test. Multivariate logistic regression was used to investigate the association between the smoking cessation result and the type of smokers. Results HCS more frequently consumed other psychoactive substances (41.1 % vs 25.7 % for other smokers; p < 0.001). Current depression was more frequent in HCS (46.6 % vs 34.8 % for other smokers; p = 0.001). Smoking cessation was less frequent in HCS (45.2 % vs 56.5 % for other smokers ; p = 0.002). In multivariate analysis, after controlling for other factors, the frequency of smoking cessation was not significantly associated with the type of smokers (p = 0.47). After limiting to initial factors (present before the beginning of smoking cessation), the frequency of smoking cessation was still not significantly associated with the type of smokers (p = 0.78). Conclusion Smoking cessation is possible for hard core smokers, who should be treated as other types of smokers taking into account other factors:the problem is how to encourage them to try to stop smoking.
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Affiliation(s)
- B Joly
- Service de Biostatistique et d'Informatique Médicale (DIM), CHRU Dijon, Dijon, F-21000 France
| | - P D'Athis
- Service de Biostatistique et d'Informatique Médicale (DIM), CHRU Dijon, Dijon, F-21000 France
| | - L Gerbaud
- Service de santé Publique, CHU Clermont-Ferrand, EA PEPRADE4681 Université d'Auvergne, Clermont-Ferrand, France
| | - J Hazart
- Service de santé Publique, CHU Clermont-Ferrand, EA PEPRADE4681 Université d'Auvergne, Clermont-Ferrand, France
| | - J Perriot
- Dispensaire Emile Roux, Centre d'Aide à I'Arrêt du Tabagisme (IRAAT), Centre de Lutte Anti-Tuberculeuse (CLAT), 63100 Clermont-Ferrand, France
| | - C Quantin
- Service de Biostatistique et d'Informatique Médicale (DIM), CHRU Dijon, Dijon, F-21000 France ; INSERM, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical epidemiology/clinical trials unit, Dijon, France ; Inserm UMR 1181 « Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases » (B2PHI), Univ. Bourgogne Franche-Comté, F-21000 Dijon, France
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586
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Pedro-Botet J, Climent E, Giralt Martínez E, Flores-Le Roux JA. [Map of resources and healthcare needs for patients with dyslipidaemia in Spain: The MADI study]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:257-264. [PMID: 27692631 DOI: 10.1016/j.arteri.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Dyslipidaemia is a major modifiable determining factor of vascular risk and, despite this, a significant number of patients do not achieve lipid goals. The aim of this study is to describe the resources and current needs in clinical practice in Spain, through an analysis of management, organisation and the patient care circuit of dyslipidaemia patient. METHODS A descriptive, cross-sectional, multicentre study, using a questionnaire, was conducted on physicians, 266 in primary care (PC) and 258 in specialised care (SC), who attended patients with dyslipidaemia in hospitals and centres within the National Health System. Probabilistic analyses were performed, stratifying by care-level, existence of a lipid unit (LU), and geographic area. RESULTS Observed differences were mostly due to geographic location, rather than the existence of LU in the referral hospitals. Most system deficiencies were found in the southern provinces of the country. Nearly all primary care physicians declared that they diagnose, manage and control dyslipidaemia patients, but a general agreement was lacking for diagnostic and referral criteria. The scarce use of a shared protocol between PC and SC showed evidence of poor coordination between health care providers. Furthermore, there was a remarkably low proportion of patients receiving health care education for their disease. CONCLUSIONS This study emphasises the need to identify weaknesses in the dyslipidaemia patient care circuit, and to perform the appropriate remedial actions, in particular, to promote coordination between levels of care and to foster patient education about their disease.
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Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Elisenda Climent
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Eva Giralt Martínez
- Línea de investigación, Grupo Saned, Esplugues de Llobregat, Barcelona, España
| | - Juana A Flores-Le Roux
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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587
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Achelrod D, Gray A, Preiss D, Mihaylova B. Cholesterol- and blood-pressure-lowering drug use for secondary cardiovascular prevention in 2004–2013 Europe. Eur J Prev Cardiol 2016; 24:426-436. [DOI: 10.1177/2047487316676906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Dmitrij Achelrod
- Hamburg Center for Health Economics, University of Hamburg, Germany
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - David Preiss
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
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588
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Zhong Y, Rosengren A, Fu M, Welin L, Welin C, Caidahl K, Mandalenakis Z, Dellborg M, Svärdsudd K, Hansson PO. Secular changes in cardiovascular risk factors in Swedish 50-year-old men over a 50-year period: The study of men born in 1913, 1923, 1933, 1943, 1953 and 1963. Eur J Prev Cardiol 2016; 24:612-620. [DOI: 10.1177/2047487316676905] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- You Zhong
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Beijing Hospital, Beijing, PR China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Welin
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Lidköping Hospital, Lidköping, Sweden
| | - Catharina Welin
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kurt Svärdsudd
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Perrone V, Sangiorgi D, Buda S, Degli Esposti L. Residual cardiovascular risk in patients who received lipid-lowering treatment in a real-life setting: retrospective study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:649-655. [PMID: 27822076 PMCID: PMC5087588 DOI: 10.2147/ceor.s107992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction The objective of this study was twofold: 1) to assess the residual cardiovascular (CV) risk among patients treated with statins according to guidelines and at the recommended dosages; and 2) to assess the difference, if any, in the frequency of CV events when patients were treated with other lipid-lowering agents alongside statins. Methods A retrospective observational study including one local health unit was conducted. Administrative databases were linked to laboratory test database in order to collect cholesterol values at baseline. Patients were included if they had filled at least one prescription for statins between January 1, 2009 and December 31, 2011; patients’ records were considered for a 12-month time span. Results A total of 27,330 patients treated with statins were included (50% male, mean age 68.0±11.5 years). Among them, 770 were treated with statins according to guidelines and at the recommended dosages and had a low density lipoprotein-cholesterol value below the therapeutic target. Nevertheless, the risk of myocardial infarction or stroke remained: incidence rates were 1.3±1.0 per patient per year for moderate CV risk, 4.1±2.6 for high risk, and 12.5±11.0 for very high risk. This incremental risk was confirmed further using the Cox model, by correcting for age, sex, use of antiplatelet and/or antihypertensive therapy, and adherence to treatment. As a second analysis, we compared, after a propensity score matching, patients extracted from the overall sample who were treated with fibrates. Based on the Cox model, patients on fibrates had a risk for myocardial infarction or stroke lower than patients on statins. Conclusion Among patients treated with statins according to guidelines and at the recommended dosages, a residual CV risk was observed. We concluded that intervention for managing residual CV risk during statin therapy should be implemented.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Health, Economics & Outcomes Research, Ravenna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Health, Economics & Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon S.r.l., Health, Economics & Outcomes Research, Ravenna, Italy
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590
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Renilla A, Hevia S, Barriales V. Insuficiente control de parámetros lipídicos en pacientes con enfermedad coronaria: un problema por resolver. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.06.004] [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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591
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More Versus Less Blood Pressure Lowering: An Update. Clin Ther 2016; 38:2135-2141. [DOI: 10.1016/j.clinthera.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 11/19/2022]
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592
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Xia SJ, Du X, Li C, Wu JH, Tang RB, Chang SS, Guo XY, Yu RH, Long DY, Bai R, Liu N, Sang CH, Li SN, Liu XH, Pan JH, Dong JZ, Lip GY, Ma CS. Uptake of evidence-based statin therapy among atrial fibrillation patients in China: A report from the CAFR (Chinese Atrial Fibrillation Registry) Study. Int J Cardiol 2016; 220:284-9. [DOI: 10.1016/j.ijcard.2016.06.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/04/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022]
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593
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Renilla A, Hevia S, Barriales V. Insufficient Lipid Control in Patients With Coronary Artery Disease: An Unresolved Problem. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:996-997. [PMID: 27543260 DOI: 10.1016/j.rec.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Alfredo Renilla
- Unidad de Rehabilitación Cardiaca y Prevención Secundaria, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - Sergio Hevia
- Unidad de Rehabilitación Cardiaca y Prevención Secundaria, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Vicente Barriales
- Unidad de Rehabilitación Cardiaca y Prevención Secundaria, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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594
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Kim SH, Jo SH, Lee SC, Lee SY, Yoon MH, Lee HL, Lee NH, Ha JW, Lee NH, Kim DW, Han GR, Hyon MS, Cho DG, Park CG, Kim YD, Ryu GH, Kim CH, Kim KS, Chung MH, Chae SC, Seung KB, Oh BH. Blood Pressure and Cholesterol-lowering Efficacy of a Fixed-dose Combination With Irbesartan and Atorvastatin in Patients With Hypertension and Hypercholesterolemia: A Randomized, Double-blind, Factorial, Multicenter Phase III Study. Clin Ther 2016; 38:2171-2184. [DOI: 10.1016/j.clinthera.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/10/2016] [Accepted: 04/24/2016] [Indexed: 10/20/2022]
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595
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Al Sayed N, Al Waili K, Alawadi F, Al-Ghamdi S, Al Mahmeed W, Al-Nouri F, Al Rukhaimi M, Al-Rasadi K, Awan Z, Farghaly M, Hassanein M, Sabbour H, Zubaid M, Barter P. Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East. Int J Cardiol 2016; 225:268-283. [PMID: 27741487 DOI: 10.1016/j.ijcard.2016.09.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Plasma lipid disorders are key risk factors for the development of atherosclerotic cardiovascular disease (ASCVD) and are prevalent in the Middle East, with rates increasing in recent decades. Despite this, no region-specific guidelines for managing plasma lipids exist and there is a lack of use of guidelines developed in other regions. METHODS A multidisciplinary panel of regional experts was convened to develop consensus clinical recommendations for the management of plasma lipids in the Middle East. The panel considered existing international guidelines and regional clinical experience to develop recommendations. RESULTS The panel's recommendations include plasma lipid screening, ASCVD risk calculation and treatment considerations. The panel recommend that plasma lipid levels should be measured in all at-risk patients and at regular intervals in all adults from the age of 20years. A scoring system should be used to calculate ASCVD risk that includes known lipid and non-lipid risk factors. Primary treatment targets include low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol. Lifestyle modifications should be first-line treatment for all patients; the first-line pharmacological treatment targeting plasma lipids in patients at moderate-to-high risk of ASCVD is statin therapy, with a number of adjunctive or second-line agents available. Guidance is also provided on the management of underlying conditions and special populations; of particular pertinence in the region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. CONCLUSIONS These consensus clinical recommendations provide practicing clinicians with comprehensive, region-specific guidance to improve the detection and management of plasma lipid disorders in patients in the Middle East.
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Affiliation(s)
- Nasreen Al Sayed
- Gulf Diabetes Specialist Center, P.O. Box 21686, Manama, Bahrain.
| | - Khalid Al Waili
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
| | - Saeed Al-Ghamdi
- Department of Medicine, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Wael Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
| | - Fahad Al-Nouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Mona Al Rukhaimi
- Dubai Medical College, P.O. Box 22331, Dubai, United Arab Emirates.
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Al-Khod, P.O. Box 38, postal code 123, Muscat, Oman.
| | - Zuhier Awan
- King Abdulaziz University, Jeddah 22254, Saudi Arabia.
| | | | | | - Hani Sabbour
- Shaikh Khalifa Medical City, Cardiac Sciences Institute, Abu Dhabi, United Arab Emirates.
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
| | - Philip Barter
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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596
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Frederix I, Vandenberk T, Janssen L, Geurden A, Vandervoort P, Dendale P. eEduHeart I: A Multicenter, Randomized, Controlled Trial Investigating the Effectiveness of a Cardiac Web-Based eLearning Platform - Rationale and Study Design. Cardiology 2016; 136:157-163. [PMID: 27657799 DOI: 10.1159/000448393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Cardiac telerehabilitation includes, in its most comprehensive format, telemonitoring, telecoaching, social interaction, and eLearning. The specific role of eLearning, however, was seldom assessed. The aim of eEduHeart I is to investigate the medium-term effectiveness of the addition of a cardiac web-based eLearing platform to conventional cardiac care. METHODS In this prospective, multicenter randomized, controlled trial, 1,000 patients with coronary artery disease will be randomized 1:1 to an intervention group (receiving 1-month unrestricted access to the cardiac eLearning platform in addition to conventional cardiac care) or to conventional cardiac care alone. The primary endpoint is health-related quality of life, assessed by the HeartQoL questionnaire at the 1- and 3-month follow-ups. Secondary endpoints include pathology-specific knowledge and self-reported eLearning platform user experience. Data on the eLearning platform usage will be gathered through web logging during the study period. RESULTS eEduHeart I will be one of the first studies to report on the added value of eLearning. CONCLUSIONS If the intervention is proven effective, current cardiac telerehabilitation programs can be augmented by including eLearning, too. The platform can then be used as a model for other chronic diseases in which patient education plays a key role.
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Affiliation(s)
- Ines Frederix
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
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597
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Bertelsen JB, Refsgaard J, Kanstrup H, Johnsen SP, Qvist I, Christensen B, Christensen KL. Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up. Eur J Cardiovasc Nurs 2016; 16:334-343. [PMID: 27566597 DOI: 10.1177/1474515116666781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To investigate whether phase II cardiac rehabilitation (CR) conducted by a community model of shared care CR (SC-CR) including health care centres and general practice was feasible and provided acceptable results and to compare SC-CR to hospital-based CR (H-CR) in a randomised controlled trial. METHODS Patients were randomised to H-CR or SC-CR after admission for acute coronary syndrome. In SC-CR, the general practitioner took over the responsibility of the remaining rehabilitation, pharmacological treatment and risk factor management after the initial visit to the hospital outpatient clinic. The Municipal Health Care Centres provided courses on smoking cessation, nutrition, and exercise training and contributed to disease education and psychosocial support. The main endpoint was adherence to the CR programme and compliance with lifestyle modifications. RESULTS In total, 1364 patients were screened, 327 (24%) were eligible, and 212 (65%) accepted participation. Phase II CR was completed by 192 (91%) of the participants. Full adherence to the CR programme was seen in 53% in SC-CR versus 54% in H-CR (relative risk (RR): 0.98, 95% confidence interval: 0.73-1.32). In H-CR, patients had higher rates of adherence to dietary advice and health education. In SC-CR, 12% of patients did not attend the risk factor evaluation and clinical assessment with their general practitioner. No difference in risk factor improvement was found. Exercise training was declined by 25% in both groups. CONCLUSION Adherence to phase II CR was high in both groups. SC-CR did not improve adherence and efficacy, but had comparable effects on medication and risk factors. Thus, SC-CR was safe and effective.
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Affiliation(s)
| | - Jens Refsgaard
- 2 Department of Cardiology, Viborg Regional Hospital, Denmark
| | - Helle Kanstrup
- 1 Department of Cardiology, Aarhus University Hospital, Denmark
| | - Søren P Johnsen
- 3 Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Ina Qvist
- 4 Department of Medicine, Silkeborg Regional Hospital, Denmark
| | - Bo Christensen
- 5 Institute of Public Health, Section for General Practice, Aarhus University, Denmark
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598
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Banerjee A, Khandelwal S, Nambiar L, Saxena M, Peck V, Moniruzzaman M, Faria Neto JR, Quinto KC, Smyth A, Leong D, Werba JP. Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review. Open Heart 2016; 3:e000438. [PMID: 27738515 PMCID: PMC5030589 DOI: 10.1136/openhrt-2016-000438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy. Objectives To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level. Methods Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin–renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers. Results Of 2246 screened articles, 25 studies were included (12 trials, 11 cohort studies, 1 cross-sectional study and 1 case–control study) with 132 140 individuals overall (smallest n=30, largest n=63 301). 3 studies included upper middle-income countries, 1 included a low middle-income country and 21 (84%) included high-income countries (9 in the USA). Studies concerned established CVD (n=4), cerebrovascular disease (n=7) and coronary heart disease (n=14). Three studies considered persistence and adherence. Quantity and quality of evidence was limited for adherence, persistence and across drug classes. Studies were concerned with governance and delivery (n=19, including 4 trials of fixed-dose combination therapy, FDC), intellectual resources (n=1), human resources (n=1) and health system financing (n=4). Full prescription coverage, reduced copayments, FDC and counselling were facilitators associated with higher adherence. Conclusions High-quality evidence on health system barriers and facilitators to adherence to secondary prevention medications for CVD is lacking, especially for low-income settings. Full prescription coverage, reduced copayments, FDC and counselling may be effective in improving adherence and are priorities for further research.
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Affiliation(s)
- Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London , London , UK
| | | | | | | | - Victoria Peck
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
| | | | | | - Katherine Curi Quinto
- Instituto de Nutrición y Tecnología de los Alimentos, Asociación Kausasunchis-ADEK Perú, Lima , Peru
| | - Andrew Smyth
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
| | - Darryl Leong
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
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599
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Meneton P, Lemogne C, Herquelot E, Bonenfant S, Larson MG, Vasan RS, Ménard J, Goldberg M, Zins M. A Global View of the Relationships between the Main Behavioural and Clinical Cardiovascular Risk Factors in the GAZEL Prospective Cohort. PLoS One 2016; 11:e0162386. [PMID: 27598908 PMCID: PMC5012694 DOI: 10.1371/journal.pone.0162386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/22/2016] [Indexed: 12/05/2022] Open
Abstract
Although it has been recognized for a long time that the predisposition to cardiovascular diseases (CVD) is determined by many risk factors and despite the common use of algorithms incorporating several of these factors to predict the overall risk, there has yet been no global description of the complex way in which CVD risk factors interact with each other. This is the aim of the present study which investigated all existing relationships between the main CVD risk factors in a well-characterized occupational cohort. Prospective associations between 12 behavioural and clinical risk factors (gender, age, parental history of CVD, non-moderate alcohol consumption, smoking, physical inactivity, obesity, hypertension, dyslipidemia, diabetes, sleep disorder, depression) were systematically tested using Cox regression in 10,736 middle-aged individuals free of CVD at baseline and followed over 20 years. In addition to independently predicting CVD risk (HRs from 1.18 to 1.97 in multivariable models), these factors form a vast network of associations where each factor predicts, and/or is predicted by, several other factors (n = 47 with p<0.05, n = 37 with p<0.01, n = 28 with p<0.001, n = 22 with p<0.0001). Both the number of factors associated with a given factor (1 to 9) and the strength of the associations (HRs from 1.10 to 6.12 in multivariable models) are very variable, suggesting that all the factors do not have the same influence within this network. These results show that there is a remarkably extensive network of relationships between the main CVD risk factors which may have not been sufficiently taken into account, notably in preventive strategies aiming to lower CVD risk.
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Affiliation(s)
- Pierre Meneton
- INSERM U1142 LIMICS, UMR_S 1142 Sorbonne Université, UPMC Université Paris 06, Université Paris 13, Paris, France
- * E-mail:
| | - Cédric Lemogne
- Centre Psychiatrie et Neurosciences, INSERM U894, Université Paris Descartes, AP-HP Hôpitaux Universitaires Paris Ouest, Paris, France
| | | | | | - Martin G. Larson
- Department of Biostatistics, Department of Mathematics and Statistics, Boston University, Boston, MA, United States of America
| | - Ramachandran S. Vasan
- Framingham Heart Study, Department of Medicine, Boston University, Boston, MA, United States of America
| | - Joël Ménard
- INSERM/AP-HP CIC1418, Université Paris Descartes, AP-HP Hôpitaux Universitaires Paris Ouest, Paris, France
| | | | - Marie Zins
- INSERM UVSQ UMS 011 and UMR-S 1168 VIMA, Villejuif, France
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600
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Yudi MB, Clark DJ, Tsang D, Jelinek M, Kalten K, Joshi S, Phan K, Nasis A, Amerena J, Arunothayaraj S, Reid C, Farouque O. SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes [SMART-REHAB Trial]: a randomized controlled trial protocol. BMC Cardiovasc Disord 2016; 16:170. [PMID: 27596569 PMCID: PMC5011930 DOI: 10.1186/s12872-016-0356-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There are well-documented treatment gaps in secondary prevention of coronary heart disease and no clear guidelines to assist early physical activity after acute coronary syndromes (ACS). Smartphone technology may provide an innovative platform to close these gaps. This paper describes the study design of a randomized controlled trial assessing whether a smartphone-based secondary prevention program can facilitate early physical activity and improve cardiovascular health in patients with ACS. METHODS We have developed a multi-faceted, patient-centred smartphone-based secondary prevention program emphasizing early physical activity with a graduated walking program initiated on discharge from ACS admission. The program incorporates; physical activity tracking through the smartphone's accelerometer with interactive feedback and goal setting; a dynamic dashboard to review and optimize cardiovascular risk factors; educational messages delivered twice weekly; a photographic food diary; pharmacotherapy review; and support through a short message service. The primary endpoint of the trial is change in exercise capacity, as measured by the change in six-minute walk test distance at 8-weeks when compared to baseline. Secondary endpoints include improvements in cardiovascular risk factor status, psychological well-being and quality of life, medication adherence, uptake of cardiac rehabilitation and re-hospitalizations. DISCUSSION This randomized controlled trial will use a smartphone-phone based secondary prevention program to emphasize early physical activity post-ACS. It will provide evidence regarding the feasibility and utility of this innovative platform in closing the treatment gaps in secondary prevention. TRIAL REGISTRATION The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on April 4, 2016. The registration number is ACTRN12616000426482 .
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Affiliation(s)
- Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia.
- Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Tsang
- Department of Cardiology, Western Health, Melbourne, Australia
| | - Michael Jelinek
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
- Department of Heart and Mind, Australian Catholic University, Melbourne, Australia
| | - Katie Kalten
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Subodh Joshi
- Monash Heart, Monash Health, Melbourne, Australia
| | - Khoa Phan
- Monash Heart, Monash Health, Melbourne, Australia
| | - Arthur Nasis
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - John Amerena
- Department of Cardiology, Barwon Health, Geelong, Australia
| | | | - Chris Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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