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Azagew AW, Abate HK, Mekonnen CK, Mekonnen HS, Tezera ZB, Jember G. Diabetic dyslipidemia and its predictors among people with diabetes in Ethiopia: systematic review and meta-analysis. Syst Rev 2024; 13:190. [PMID: 39033198 PMCID: PMC11264949 DOI: 10.1186/s13643-024-02593-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Dyslipidemia is an imbalance of lipid profiles. It increases the chance of clogged arteries and may cause heart attacks, strokes, and other circulatory disorders. Dyslipidemia affects the general population, but its severity is higher in diabetic populations. As a result, the chance of dyslipidemia-associated morbidity and mortality is highest in diabetic patients. In Ethiopia, around 2 to 6.5% of the population live with diabetes, but their lipid profiles are inconsistent across the studies. Therefore, this study aimed to estimate the pooled prevalence of diabetic dyslipidemia and its predictors among people with diabetes in Ethiopia. METHOD A systematic review and meta-analysis was conducted. The searches were carried out in MEDLINE via PubMed and OVID, EBSCO, Embase, and other supplementary gateways such as Google and Google Scholar, for articles published up to June 2023. The articles were searched and screened by title (ti), abstract (ab), and full text (ft). The quality of the eligible studies was assessed by the Newcastle-Ottawa scale. The heterogeneity was detected by the Cochrane Q statistic test and the I-squared (I2) test. Then subgroup analysis and meta-regression analysis were used to identify the source of the variations. A random or fixed-effect meta-analysis model was used to estimate the overall pooled prevalence and average effects. The publication bias was assessed by the funnel plot asymmetry test and/or Begg and Mazumdar's test for rank correlation (p-value < 0.05). The protocol has been registered in an international database, the prospective register of systematic reviews (PROSPERO), with reference number CRD42023441572. RESULT A total of 14 articles with 3662 participants were included in this review. The pooled prevalence of diabetic dyslipidemia in Ethiopia was found to be 65.7% (95% confidence interval (CI): 57.5, 73.9), I2 = 97%, and p-value < 0.001. The overall prevalence of triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) were found to be 51.8% (95% CI: 45.1, 58.6) and 44.2% (95% CI: 32.8, 55.7), respectively, among lipid profiles. In meta-regression analysis, the sample size (p value = 0.01) is the covariate for the variation of the included studies. Being female (adjusted odds ratio (AOR): 3.9, 95% CI: 1.5, 10.1), physical inactivity (AOR: 2.6, 95% CI: 1.5, 4.3), and uncontrolled blood glucose (AOR: 4.2, 95% CI: 1.9, 9.4) were found to be the determinants of dyslipidemia among diabetic patients. CONCLUSION This review revealed that the prevalence of diabetic dyslipidemia is high among people with diabetes in Ethiopia. Being female, having physical inactivity, and having uncontrolled blood glucose were found to be predictors of dyslipidemia among people with diabetes. Therefore, regular screening of lipid profiles and the provision of lipid-lowering agents should be strengthened to reduce life-threatening cardiovascular complications. Furthermore, interventions based on lifestyle modifications, such as regular physical activity and adequate blood glucose control, need to be encouraged.
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Affiliation(s)
- Abere Woretaw Azagew
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Hailemichael Kindie Abate
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewdu Baye Tezera
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Jember
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dalal JJ, Khan T. Managing dyslipidaemia in young adults. Indian Heart J 2024; 76 Suppl 1:S101-S103. [PMID: 38360458 PMCID: PMC11019311 DOI: 10.1016/j.ihj.2023.11.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/24/2023] [Indexed: 02/17/2024] Open
Abstract
Indians have early onset atherosclerotic cardiovascular disease and acquire the risk factors at a younger age, and hence we need to aggressively address the management of dyslipidemia in the young. Cholesterol levels early in life will influence the development of atherosclerosis. Young atherosclerotic cardiovascular disease (ASCVD) patients (18-40 yrs) should receive lipid-lowering drugs to reduce LDL-C<55 mg. Due to the asymptomatic nature of dyslipidemia, early screening will enable the implementation of management strategies which will decrease future cardiovascular events. In this review, we will provide insights into identifying and managing dyslipidemia in the 18-40 years age group (young adults). It is suggested that early detection and more aggressive management of dyslipidemia in young adults with or without risk factors like diabetes, hypertension, tobacco and central obesity, might reduce the risk of CV events occurring later in life. Although lifestyle modification is the mainstay of treatment (dietary recommendations, exercise, tobacco cessation, weight reduction, etc.) but in certain young adults we suggest use of statins in low dose or non-statin drugs if they have associated risk factors, LDL-C >160 mg or a high coronary calcium score. Young adults who are carriers of FH gene should receive aggressive lifestyle modification and appropriate antilipidemic therapy.
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Affiliation(s)
- Jamshed J Dalal
- , Cardiac Sciences, Kokilaben Hospital, Mumbai, Maharashtra, India.
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Sayed A, Navar AM, Slipczuk L, Ballantyne CM, Samad Z, Lavie CJ, Virani SS. Prevalence, Awareness, and Treatment of Elevated LDL Cholesterol in US Adults, 1999-2020. JAMA Cardiol 2023; 8:1185-1187. [PMID: 37910086 PMCID: PMC10620668 DOI: 10.1001/jamacardio.2023.3931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023]
Abstract
This cross-sectional study compares the prevalence, awareness, and treatment of elevated low-density lipoprotein (LDL) cholesterol in US adults in 1999-2000 vs 2017-2020.
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Affiliation(s)
- Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ann Marie Navar
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
- Deputy Editor, Diversity, Equity, and Inclusion, JAMA Cardiology
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Healthcare Network/Albert Einstein College of Medicine, New York, New York
| | | | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Salim S. Virani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D. REPRINT OF: Current Methods of the U.S. Preventive Services Task Force: A Review of the Process. Am J Prev Med 2020; 58:316-331. [PMID: 32087860 DOI: 10.1016/j.amepre.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Editor's Note: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Harris RP, Helfand M, Woolf SH, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(3S):21-35. The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). The Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. Once assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive service. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. The Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. The third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications.
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Affiliation(s)
- Russell P Harris
- School of Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mark Helfand
- Division of Medical Informatics and Outcomes Research, and Evidence-based Practice Center, Oregon Health Sciences University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon
| | - Steven H Woolf
- Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Fairfax, Virginia
| | - Kathleen N Lohr
- Research Triangle Institute, Research Triangle Park, North Carolina; Program on Health Outcomes, and School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia D Mulrow
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Steven M Teutsch
- Outcomes Research and Management, Merck & Co., Inc., West Point, Pennsylvania
| | - David Atkins
- Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality, Rockville, Maryland
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Grant DSL, Scott RD, Harrison TN, Cheetham TC, Chang SC, Hsu JWY, Wei R, Boklage SH, Romo-LeTourneau V, Reynolds K. Trends in Lipid Screening Among Adults in an Integrated Health Care Delivery System, 2009-2015. J Manag Care Spec Pharm 2018; 24:1090-1101. [PMID: 30063170 PMCID: PMC10397736 DOI: 10.18553/jmcp.2018.18100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lipid screening determines eligibility for statins and other cardiovascular risk reduction interventions. OBJECTIVE To examine trends in lipid screening among adults aged ≥20 years in a large, multiethnic, integrated health care delivery system in southern California. METHODS Temporal trends in lipid screening were examined from 2009 to 2015 with an index date of September 30 of each year. Lipid screening was defined as the proportion of eligible members each year who (a) had ever been screened among those aged 20-39 years and (b) had been screened in the previous 6 years for those aged ≥ 40 years. Trends were analyzed by age, gender, and the presence of atherosclerotic cardiovascular disease (ASCVD) or diabetes without ASCVD status. RESULTS More than 2 million individuals were included each year: 5%-6% had ASCVD (includes those with diabetes), 7%-8% had diabetes without ASCVD, and 87% had neither condition. Among the entire population, lipid screening increased from 79.8% in 2009 to 82.6% in 2015 (P < 0.0001). Among those with ASCVD or diabetes, lipid screening was 99% across all years. Among those without ASCVD or DM, screening increased from 76.9% in 2009 to 80.0% in 2015 (P < 0.0001), with higher screening among women compared with men and lower screening among individuals younger than 55 years. CONCLUSIONS Consistently high rates of lipid screening were observed among individuals with ASCVD or diabetes. In individuals without these conditions, screening increased over time. However, there is room to further increase screening rates in adults younger than 55 years. DISCLOSURES This manuscript and research work was supported by a contractual agreement between the Southern California Permanente Medical Group and Regeneron Pharmaceuticals and Sanofi U.S. Researchers from Regeneron and Sanofi collaborated on the study design, interpretation of data, and writing of the manuscript. Ling Grant, Harrison, Chang, Hsu, Cheetham, Wei, and Reynolds are employed by Kaiser Permanente Southern California. Scott is employed by Southern California Permanente Medical Group. Boklage is employed by Regeneron, and Romo-LeTourneau is employed by Sanofi. Preliminary results from this study were presented at the American Heart Association Scientific Sessions; November 12-16, 2016; New Orleans, LA.
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Affiliation(s)
- Deborah S Ling Grant
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - Ronald D Scott
- 2 Southern California Permanente Medical Group, Los Angeles
| | - Teresa N Harrison
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - T Craig Cheetham
- 3 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, and Western University College of Pharmacy, Pomona, California
| | - Shen-Chih Chang
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - Jin-Wen Y Hsu
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - Rong Wei
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | | | | | - Kristi Reynolds
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
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Earnshaw SR, McDade CL, Chu Y, Fleige LE, Sievenpiper JL. Cost-effectiveness of Maintaining Daily Intake of Oat β-Glucan for Coronary Heart Disease Primary Prevention. Clin Ther 2017; 39:804-818.e3. [DOI: 10.1016/j.clinthera.2017.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/10/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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Özyilmaz A, Boersma C, Visser ST, Postma MJ, de Jong-van den Berg LT, Lambers-Heerspink HJ, de Jong PE, Gansevoort RT. The association of albuminuria and high-sensitivity C-reactive protein with the efficacy of HMG-coenzyme A reductase inhibitors for cardiovascular event prevention. Eur J Prev Cardiol 2015; 23:847-55. [PMID: 26358992 DOI: 10.1177/2047487315604310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is not clear which hypercholesterolemic patients benefit most from β-hydroxy-β-methylglutaryl coenzyme A reductase inhibitors with respect to the prevention of cardiovascular events. Early signs of atherosclerotic vascular damage may identify high-risk patients. DESIGN We studied whether subjects with hypercholesterolemia will benefit more from starting statin treatment in the case of high albuminuria and/or high-sensitivity C-reactive protein (hsCRP). METHODS Included were subjects who had hypercholesterolemia at baseline, a negative cardiovascular disease history and who were not treated with statins. In total, 2011 subjects were analysed, of whom 695 started with a statin during a follow-up of 7.0 ± 1.7 years. Adjusted hazard ratios (HRs) for cardiovascular events were calculated in subjects who started versus those who did not start a statin stratified for albuminuria less than or ≥ 15 mg/day and/or hsCRP less than or ≥ 3 mg/L. RESULTS The start of a statin was associated with a beneficial effect on cardiovascular risk in subjects with high albuminuria (HR 0.38 (0.23-0.60)), while the effect of starting a statin was non-significant in subjects with low albuminuria (HR 0.74 (0.44-1.24), P for interaction < 0.05). The effect of starting a statin was similar in subgroups with high and low hsCRP (P for interaction 0.34). When combining albuminuria and hsCRP subgroups, the start of statin treatment was associated with a lower risk of cardiovascular events dependent on albuminuria and not on the hsCRP level. CONCLUSIONS The start of statin treatment is associated with a significantly lower absolute as well as relative risk of cardiovascular events in subjects with hypercholesterolemia and elevated albuminuria, whereas these drugs had less effect in subjects with normal albuminuria.
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Affiliation(s)
- Akin Özyilmaz
- Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Cornelis Boersma
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands
| | - Sipke T Visser
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, The Netherlands
| | | | - Hiddo J Lambers-Heerspink
- Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Paul E de Jong
- Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands
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Abstract
The purpose of this article is to update the primary care community on the evidence and guidelines for cardiovascular disease screening in a general-risk adult population, with the goal of assisting clinicians in developing an evidence-based approach toward screening. This article discusses global risk assessment and screening strategies, including blood pressure, lipids, C-reactive protein, homocysteine, coronary artery calcium score, carotid intima-media thickness, ultrasound of the abdominal aorta, and electrocardiography.
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Affiliation(s)
- Margaret L Wallace
- Department of Family Medicine, University of Wisconsin, 1100 Delaplaine Court, Madison, WI 53715, USA.
| | - Jason A Ricco
- Department of Family Medicine, University of Wisconsin, 1100 Delaplaine Court, Madison, WI 53715, USA
| | - Bruce Barrett
- Department of Family Medicine, University of Wisconsin, 1100 Delaplaine Court, Madison, WI 53715, USA
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Ozyilmaz A, Bakker SJL, de Zeeuw D, de Jong PE, Gansevoort RT. Screening for albuminuria with subsequent screening for hypertension and hypercholesterolaemia identifies subjects in whom treatment is warranted to prevent cardiovascular events. Nephrol Dial Transplant 2013; 28:2805-15. [DOI: 10.1093/ndt/gft254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hansbauer B, Enthaler N, Mahlknecht A, Sönnichsen A. [Preventive screening in general practice. What examined and how reliable is it?]. MMW Fortschr Med 2012; 154 Spec No 3:46-50. [PMID: 23724719 DOI: 10.1007/s15006-012-1295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Berger JS, McGinn AP, Howard BV, Kuller L, Manson JE, Otvos J, Curb JD, Eaton CB, Kaplan RC, Lynch JK, Rosenbaum DM, Wassertheil-Smoller S. Lipid and lipoprotein biomarkers and the risk of ischemic stroke in postmenopausal women. Stroke 2012; 43:958-66. [PMID: 22308251 DOI: 10.1161/strokeaha.111.641324] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies simultaneously investigated lipids and lipoprotein biomarkers as predictors of ischemic stroke. The value of these biomarkers as independent predictors of ischemic stroke remains controversial. METHODS We conducted a prospective nested case-control study among postmenopausal women from the Women's Health Initiative Observational Study to assess the relationship between fasting lipids (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides), lipoproteins (LDL, HDL, and very low-density lipoprotein [VLDL] particle number and size, intermediate-density lipoprotein [IDL] particle number, and lipoprotein (a)), and risk of ischemic stroke. Among women free of stroke at baseline, 774 ischemic stroke patients were matched according to age and race to control subjects, using a 1:1 ratio. RESULTS In bivariate analysis, baseline triglycerides (P<0.001), IDL particles (P<0.01), LDL particles (P<0.01), VLDL triglyceride (P<0.001), VLDL particles (P<0.01), VLDL size (P<0.001), LDL size (P=0.03), and total/HDL cholesterol ratio (P<0.01) were significantly higher among women with incident ischemic stroke, whereas levels of HDL-C (P<0.01) and HDL size (P<0.01) were lower. No significant baseline difference for total cholesterol (P=0.15), LDL-C (P=0.47), and lipoprotein (a) (P=0.11) was observed. In multivariable analysis, triglycerides (odds ratio for the highest versus lowest quartile, 1.56; 95% confidence interval, 1.13-2.17; P for trend=0.02), VLDL size (odds ratio, 1.59; 95% confidence interval, 1.10-2.28; P for trend=0.03), and IDL particle number (odds ratio, 1.46; 95% confidence interval, 1.04-2.04; P for trend=0.02) were significantly associated with ischemic stroke. CONCLUSIONS Among a panel of lipid and lipoprotein biomarkers, baseline triglycerides, VLDL size, and IDL particle number were significantly associated with incident ischemic stroke in postmenopausal women.
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Affiliation(s)
- Jeffrey S Berger
- FAHA, New York University School of Medicine, 530 First Ave, Skirball 9R, New York, NY 10016, USA.
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Treeprasertsuk S, Lopez-Jimenez F, Lindor KD. Nonalcoholic fatty liver disease and the coronary artery disease. Dig Dis Sci 2011; 56:35-45. [PMID: 20464495 DOI: 10.1007/s10620-010-1241-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 04/06/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent and is recognized as part of the metabolic syndrome (MetS). Patients with NAFLD have a lower life expectancy compared to the general population, with coronary artery disease (CAD) as the leading cause of death. AIMS We aim to address the epidemiological data of CAD, the possible pathogenesis or linkage mechanisms of NAFLD and atherosclerosis and the strategies to reduce the CAD risk in NAFLD patients. METHODS We reviewed data from a Medline and PubMed search which was performed to identify relevant literature using search terms "NAFLD," "metabolic syndrome" and "coronary artery disease." RESULTS Patients with steatohepatitis, a part of the spectrum of NAFLD, have more cardiovascular events than patients without steatohepatitis. However, the association between liver histological progression and the risk of CAD events is not linear. A multidisciplinary approach to NAFLD patients based on controlling related risk factors and monitoring for CAD risks and liver complications is necessary. The combination of lifestyle modification with pharmacological treatment tailored to each individual's risk factors needs to be considered. There is a need for more research on primary prevention for CAD in NAFLD patients and interventional studies for determining the nature of the relationship between NAFLD and CAD. CONCLUSIONS NAFLD is recognized as part of the MetS and increases cardiovascular risks. Therefore, a multidisciplinary approach to these patients of controlling the related risk factors and monitoring for cardiovascular and liver complications must be done.
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Affiliation(s)
- Sombat Treeprasertsuk
- Division of Gastroenterology and Hepatology, Mayo Clinic, Fiterman Center for Digestive Diseases, 200 First Street, SW, Rochester, MN 55905, USA.
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Ozyilmaz A, Bakker SJL, de Zeeuw D, de Jong PE, Gansevoort RT. Selection on albuminuria enhances the efficacy of screening for cardiovascular risk factors. Nephrol Dial Transplant 2010; 25:3560-8. [DOI: 10.1093/ndt/gfq478] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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14
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Carrington MJ, Retegan C, Johnston CI, Jennings GL, Stewart S. Cholesterol complacency in Australia: time to revisit the basics of cardiovascular disease prevention. J Clin Nurs 2008; 18:678-86. [DOI: 10.1111/j.1365-2702.2008.02507.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kahn R, Robertson RM, Smith R, Eddy D. The impact of prevention on reducing the burden of cardiovascular disease. Diabetes Care 2008; 31:1686-96. [PMID: 18663233 PMCID: PMC2494659 DOI: 10.2337/dc08-9022] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S. RESEARCH DESIGN AND METHODS We used person-specific data from a representative sample of the U.S. population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the U.S. today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real U.S. population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible. RESULTS Approximately 78% of adults aged 20-80 years alive today in the U.S. are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by approximately 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced approximately 36% and 20%, respectively. Implementation of all prevention activities would add approximately 221 million life-years and 244 million quality-adjusted life-years to the U.S. adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the U.S. population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years. CONCLUSIONS Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the U.S. today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.
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Affiliation(s)
- Richard Kahn
- American Diabetes Association, Alexandria, Virginia, USA.
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Abstract
Objective—
Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the United States.
Research Design and Methods—
We used person-specific data from a representative sample of the US population (National Health and Nutrition Education Survey IV) to determine the number and characteristics of adults aged 20-80 years in the United States today who are candidates for different prevention activities related to CVD. We used the Archimedes model to create a simulated population that matched the real US population, person by person. We then used the model to simulate a series of clinical trials that examined the effects over the next 30 years of applying each prevention activity one by one, or altogether, to those who are candidates for the various activities and compared the health outcomes, quality of life, and direct medical costs to current levels of prevention and care. We did this under two sets of assumptions about performance and compliance: 100% success for each activity and lower levels of success considered aggressive but still feasible.
Results—
Approximately 78% of adults aged 20-80 years alive today in the United States are candidates for at least one prevention activity. If everyone received the activities for which they are eligible, myocardial infarctions and strokes would be reduced by 63% and 31%, respectively. If more feasible levels of performance are assumed, myocardial infarctions and strokes would be reduced 36% and 20%, respectively. Implementation of all prevention activities would add ≈221 million life-years and 244 million quality-adjusted life-years to the US adult population over the coming 30 years, or an average of 1.3 years of life expectancy for all adults. Of the specific prevention activities, the greatest benefits to the US population come from providing aspirin to high-risk individuals, controlling pre-diabetes, weight reduction in obese individuals, lowering blood pressure in people with diabetes, and lowering LDL cholesterol in people with existing coronary artery disease (CAD). As currently delivered and at current prices, most prevention activities are expensive when considering direct medical costs; smoking cessation is the only prevention strategy that is cost-saving over 30 years.
Conclusions—
Aggressive application of nationally recommended prevention activities could prevent a high proportion of the CAD events and strokes that are otherwise expected to occur in adults in the United States today. However, as they are currently delivered, most of the prevention activities will substantially increase costs. If preventive strategies are to achieve their full potential, ways must be found to reduce the costs and deliver prevention activities more efficiently.
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Affiliation(s)
- Richard Kahn
- From the American Diabetes Association, Alexandria, Va (R.K.); American Heart Association, Dallas, Tex (R.M.R.); American Cancer Society, Atlanta, Ga (R.S.); and Archimedes, Inc, San Francisco, Calif (D.E.)
| | - Rose Marie Robertson
- From the American Diabetes Association, Alexandria, Va (R.K.); American Heart Association, Dallas, Tex (R.M.R.); American Cancer Society, Atlanta, Ga (R.S.); and Archimedes, Inc, San Francisco, Calif (D.E.)
| | - Robert Smith
- From the American Diabetes Association, Alexandria, Va (R.K.); American Heart Association, Dallas, Tex (R.M.R.); American Cancer Society, Atlanta, Ga (R.S.); and Archimedes, Inc, San Francisco, Calif (D.E.)
| | - David Eddy
- From the American Diabetes Association, Alexandria, Va (R.K.); American Heart Association, Dallas, Tex (R.M.R.); American Cancer Society, Atlanta, Ga (R.S.); and Archimedes, Inc, San Francisco, Calif (D.E.)
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Silverstein MD, Ogola G, Mercer Q, Fong J, Devol E, Couch CE, Ballard DJ. Impact of clinical preventive services in the ambulatory setting. Proc AMIA Symp 2008; 21:227-35. [PMID: 18628969 DOI: 10.1080/08998280.2008.11928400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Indicators of the performance of clinical preventive services (CPS) have been adopted in the ambulatory setting to improve quality of care. The impact of CPS was evaluated in a network of 49 primary care practices providing care to an estimated 245,000 adults in the Dallas-Fort Worth area through a sample chart review to determine delivery of recommended evidence-based CPS combined with medical literature estimates of the effectiveness of CPS. In this population in 2005, CPS were estimated to have prevented 36 deaths and 97 incident cases of cancer; 420 coronary heart disease events (including 66 sudden deaths) and 118 strokes; 816 cases of influenza and pneumonia (including 24 hospital admissions); and 87 osteoporosis-related fractures. Thus, CPS have substantial benefits in preventing deaths and illness episodes.
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Does the routine use of global coronary heart disease risk scores translate into clinical benefits or harms? A systematic review of the literature. BMC Health Serv Res 2008; 8:60. [PMID: 18366711 PMCID: PMC2294118 DOI: 10.1186/1472-6963-8-60] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 03/20/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guidelines now recommend routine assessment of global coronary heart disease (CHD) risk scores. We performed a systematic review to assess whether global CHD risk scores result in clinical benefits or harms. METHODS We searched MEDLINE (1966 through June 13, 2007) for articles relevant to our review. Using predefined inclusion and exclusion criteria, we included studies of any design that provided physicians with global risk scores or allowed them to calculate scores themselves, and then measured clinical benefits and/or harms. Two reviewers reviewed potentially relevant studies for inclusion and resolved disagreement by consensus. Data from each article was then abstracted into an evidence table by one reviewer and the quality of evidence was assessed independently by two reviewers. RESULTS 11 studies met criteria for inclusion in our review. Six studies addressed clinical benefits and 5 addressed clinical harms. Six studies were rated as "fair" quality and the others were deemed "methodologically limited". Two fair quality studies showed that physician knowledge of global CHD risk is associated with increased prescription of cardiovascular drugs in high risk (but not all) patients. Two additional fair quality studies showed no effect on their primary outcomes, but one was underpowered and the other focused on prescribing of lifestyle changes, rather than drugs whose prescribing might be expected to be targeted by risk level. One of these aforementioned studies showed improved blood pressure in high-risk patients, but no improvement in the proportion of patients at high risk, perhaps due to the high proportion of participants with baseline risks significantly exceeding the risk threshold. Two fair quality studies found no evidence of harm from patient knowledge of global risk scores when they were accompanied by counseling, and optional or scheduled follow-up. Other studies were too methodologically limited to draw conclusions. CONCLUSION Our review provides preliminary evidence that physicians' knowledge of global CHD risk scores may translate into modestly increased prescribing of cardiovascular drugs and modest short-term reductions in CHD risk factors without clinical harm. Whether these results are replicable, and translate across other practice settings or into improved long-term CHD outcomes remains to be seen.
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Brauer PM, Hanning RM, Arocha JF, Royall D, Grant A, Dietrich L, Martino R. Development of a Nutrition Counselling Care Map For Dyslipidemia. CAN J DIET PRACT RES 2007; 68:183-92. [DOI: 10.3148/68.4.2007.183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Care maps or clinical pathways for nutrition therapy of dyslipidemia could add to current practice guidelines, by providing templates for feasible and recommended diet counselling processes. A care map was therefore developed by engaging expert and generalist dietitians and external experts from across Canada in a multi-stage consensus process. Methods: First, a qualitative study was undertaken with a convenience sample of 12 practitioners to identify possible diet care options, using hypothetical client scenarios and cognitive analysis. Second, these care options were rated for five case scenarios considered typical (overweight clients, with or without clinical cardiovascular disease and other comorbidities, potentially motivated to change, consuming high-fat diets, and facing various major barriers to eating behaviour change). The rating was conducted through a survey of participants. Highly appropriate, recommended, and feasible options for counselling were ranked through a two-round modified Delphi process, with teleconference discussions between rounds. Results: Forty-nine professionals started the consensus process; 39 (80%) completed all aspects. Numerous care processes were appropriate for all clients, with additional focus on barriers for low-income clients, sodium intake for clients with hypertension, and smoking cessation in smokers. Conclusions: The resulting care map, “Dietitians’ Quick Reference Guide for Clinical Nutrition Therapy for Overweight Clients with Dyslipidemia,” provides a basis for current practice and new effectiveness studies.
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Affiliation(s)
- Paula M. Brauer
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph ON
| | - Rhona M. Hanning
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON
| | - Jose F. Arocha
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON
| | | | - Andrew Grant
- CRED Collaboration in Research for Effective Diagnostics, Université de Sherbrooke, Sherbrooke QC
| | | | - Roselle Martino
- Dietitians of Canada Diabetes, Obesity and Cardiovascular Network, Toronto, ON
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Smellie WSA. What is a significant difference between sequential laboratory results?Calf muscle pain can indicate localised vasculitis. J Clin Pathol 2007; 61:419-25. [DOI: 10.1136/jcp.2007.047175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The uncertainty of a numerical laboratory result can be masked by the fact that the laboratory reports an absolute number, whereas users have limited knowledge of the confidence interval of the result. Interpretation of laboratory tests is in reality therefore an inexact science, a balance between clinical context and the likely relevance of a laboratory result.This review considers the factors which contribute to result variability and examines the implications for interpreting differences between sequential laboratory results. It offers suggestions to deal with a problem which has not yet been much addressed in routine practice. The examples used are restricted to the discipline of clinical biochemistry, although the issues and principles apply to numerical (and indeed qualitative) results in other disciplines.Laboratories could provide more guidance on the likelihood of a result being significant to assist users. There is a need for discussion about how this is best done, and compatible with electronic result delivery. Options for providing this information are considered.
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Smellie WSA, Forth J, Smart SRS, Galloway MJ, Irving W, Bareford D, Collinson PO, Kerr KG, Summerfield G, Carey PJ, Minhas R. Best practice in primary care pathology: review 7. J Clin Pathol 2007; 60:458-65. [PMID: 17046843 PMCID: PMC1994553 DOI: 10.1136/jcp.2006.042994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2006] [Indexed: 11/04/2022]
Abstract
This seventh best-practice review examines four series of common primary care questions in laboratory medicine: (1) blood count abnormalities 2; (2) cardiac troponins; (3) high-density lipoprotein cholesterol; and (4) viral diseases 2. The review is presented in a question-answer format, with authorship attributed for each question series. The recommendations are a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. The recommendations are not standards, but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK.
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Abstract
Metabolic syndrome is a risk factor for cardiovascular disease. People with chronic schizophrenia are at risk for metabolic syndrome because of their diets, lifestyle, and (in some cases) their medication. The increased risk of metabolic syndrome has implications for the delivery of care to this population. This article provides an overview of metabolic syndrome in patients with schizophrenia and evidence-based criteria for monitoring this population. A recommendation is made to aggregate data collection in one place to facilitate follow-up. A sample form and letter are provided.
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Lin JW, Chu PL, Liou JM, Hwang JJ. Applying a multiple screening program aided by a guideline-driven computerized decision support system - a pilot experience in Yun-Lin, Taiwan. J Formos Med Assoc 2007; 106:58-68. [PMID: 17282972 DOI: 10.1016/s0929-6646(09)60217-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND/PURPOSE Although preventive tools decrease morbidity and mortality and promote health, these services are often underutilized. The purpose of this study was to create a workflow for an outpatient setting that incorporated a computerized decision support system to implement preventive recommendations as well as to evaluate its impacts on facilitating preventive care. METHODS Subjects visiting National Taiwan University Hospital Yun-Lin Branch were evaluated by a questionnaire, which contained items to trigger production rules to check the eligibility of screening for high coronary risk, diabetes mellitus, lipid disorder, hypertension, obesity, tobacco use, depression, colorectal cancer, breast cancer, cervical cancer, and osteoporosis. Patients were given health information about the diseases they were at risk for and the merits of preventive measures, scheduled for a clinic visit, and arranged to have access to screening tools. Physicians were prompted with clinical reminders on the encounter. The over-all effectiveness of 11 components in this screening program was evaluated in terms of expected life saving. The cost-effectiveness ratio was represented in US dollars per life-year saved. RESULTS A total of 283 men and 199 women were identified to need one to six preventive interventions during a 2-month period. Preventive consultation was arranged and screening tools were performed. It was estimated that 412-1014 subjects would be needed to attend the program so as to save one life. The cost-effectiveness ratio ranged from 30,000 US dollars to 40,000 US dollars per life-year saved. CONCLUSION A computer-aided screening program driven by the US Preventive Services Task Force recommendations has been successfully implemented in Yun-Lin, Taiwan, and provided useful information about local epidemiology and implications for future health policy making.
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Affiliation(s)
- Jou-Wei Lin
- National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Taiwan
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Zigman WB, Schupf N, Jenkins EC, Urv TK, Tycko B, Silverman W. Cholesterol level, statin use and Alzheimer's disease in adults with Down syndrome. Neurosci Lett 2007; 416:279-84. [PMID: 17353095 PMCID: PMC1892238 DOI: 10.1016/j.neulet.2007.02.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 01/26/2007] [Accepted: 02/06/2007] [Indexed: 11/29/2022]
Abstract
Adults with Down syndrome (DS) are at significantly higher risk of Alzheimer's disease (AD) than the general population, but there is considerable variability in age at onset. This study tested the hypothesis that total cholesterol (TC) levels are related to vulnerability, and that the use of statins may decrease risk. The relation of TC level and statin use to risk of AD was investigated in 123 Caucasian adults with DS. Evaluations included serial assessments of cognitive, adaptive and maladaptive behavior, medical records, and neurological examinations. Mean length of follow-up was 5.5 years [1.2-7.1] for the entire sample, 5.1 years [1.2-7.1] for subjects who developed dementia, and 5.6 years [1.5-7.1] for those who did not develop dementia. Controlling for covariates, participants with TC>or=200mg/dL were more than two times as likely to develop AD than subjects with lower TC [hazard rate (HR)=2.59, p=.029, 95% CI: 1.1, 6.1]. In contrast, participants with higher TC levels who used statins during the study, had less than half the risk of developing AD than participants with higher TC levels who did not use statins (HR=.402, p=.095, 95% CI: .138, 1.173). If the protective effects of statins can be further validated, these findings suggest that their use may delay or prevent AD onset in vulnerable populations.
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Affiliation(s)
- Warren B Zigman
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314, United States.
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Murasko JE. Gender differences in the management of risk factors for cardiovascular disease: the importance of insurance status. Soc Sci Med 2006; 63:1745-56. [PMID: 16762471 DOI: 10.1016/j.socscimed.2006.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Indexed: 10/24/2022]
Abstract
Despite cardiovascular disease (CVD) being the leading killer of both sexes in the US, there are indications that men and women have different experiences in the health system with prevention and treatment practices. Beyond largely descriptive findings, little research exists that addresses how men and women may differ in their response to certain key influences on CVD health services utilization. This paper examines gender differentials in the effect of insurance coverage on CVD preventive health services in the US. An economics framework is used to model individual demand for preventive services as a function of insurance status, while controlling for a comprehensive set of explanatory variables. The services analyzed include cholesterol and blood pressure screening, pharmaceutical use for hypertension and lipid disorders, and CVD-related physician visits. Both general and high-risk samples are evaluated. The results show that while a lack of insurance is associated with lower rates of utilization in both men and women, there are no observed gender differences in insurance-effects for recommended intervals of risk factor screening in the general population. However, for individuals with previously diagnosed heart disease or stroke, a lack of coverage is more strongly associated with lower rates of screening, pharmaceutical management, and physician contact in women than men. Potential reasons for these findings are discussed and policy implications are noted.
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Feig DS, Palda VA, Lipscombe L. Screening for type 2 diabetes mellitus to prevent vascular complications: updated recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2005; 172:177-80. [PMID: 15655234 PMCID: PMC543976 DOI: 10.1503/cmaj.1041197] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Chen THH, Chiu YH, Luh DL, Yen MF, Wu HM, Chen LS, Tung TH, Huang CC, Chan CC, Shiu MN, Yeh YP, Liou HH, Liao CS, Lai HC, Chiang CP, Peng HL, Tseng CD, Yen MS, Hsu WC, Chen CH. Community-based multiple screening model: design, implementation, and analysis of 42,387 participants. Cancer 2004; 100:1734-43. [PMID: 15073864 DOI: 10.1002/cncr.20171] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multiple disease screening may have several advantages over single disease screening because of the economics of scale, with the high yield of detecting asymptomatic diseases, the identification of multiple diseases or risk factors simultaneously, the enhancement of the attendance rate, and the efficiency of follow-up. METHODS An integrated model of community-based multiple screening was designed and conducted between 1999 and 2001 in Keelung, Taiwan. The authors used a Papanicolaou (Pap) smear screening program as a base to integrate other screening regimens encompassing four other neoplastic diseases and three nonneoplastic chronic diseases. Screening methods, the interscreening interval, and the follow-up for each screening regimen were designed based on evidence-based literature and current national screening policy. RESULTS A total of 42,387 subjects participated in the screening activities. A 25% increase in the attendance rate for Pap smear screening was demonstrated after the introduction of multiple disease screening programs. At the first screen, this program yielded a total of 677 asymptomatic neoplasms (16.0 per 1000), including a large proportion of precancerous lesions and small presymptomatic tumors without lymph node involvement. The association between the occurrence of neoplasm and the presence of comorbid nonneoplastic chronic disease was found to be statistically significant (odds ratio, 1.64; 95% confidence interval, 1.38-1.94 [P < 0.05]). The authors also identified 5314 subjects with metabolic syndrome who were at a greater risk for colorectal and oral neoplasias. CONCLUSIONS The results of the current study demonstrate that an outreach and community-based multiple screening program not only enhances attendance rates but also has a high yield of early cases of various diseases simultaneously, and provides a natural opportunity to elucidate the correlation between neoplastic disease and nonneoplastic chronic disease.
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Affiliation(s)
- Tony Hsiu-Hsi Chen
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Sheridan S, Pignone M, Mulrow C. Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians. J Gen Intern Med 2003; 18:1039-52. [PMID: 14687264 PMCID: PMC1494957 DOI: 10.1111/j.1525-1497.2003.30107.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the features of available Framingham-based risk calculation tools and review their accuracy and feasibility in clinical practice. DATA SOURCES medline, 1966-April 2003, and the google search engine on the Internet. TOOL AND STUDY SELECTION: We included risk calculation tools that used the Framingham risk equations to generate a global coronary heart disease (CHD) risk. To determine tool accuracy, we reviewed all articles that compared the performance of various Framingham-based risk tools to that of the continuous Framingham risk equations. To determine the feasibility of tool use in clinical practice, we reviewed articles on the availability of the risk factor information required for risk calculation, subjective preference for 1 risk calculator over another, or subjective ease of use. DATA EXTRACTION Two reviewers independently reviewed the results of the literature search, all websites, and abstracted all articles for relevant information. DATA SYNTHESIS Multiple CHD risk calculation tools are available, including risk charts and computerized calculators for personal digital assistants, personal computers, and web-based use. Most are easy to use and available without cost. They require information on age, smoking status, blood pressure, total and HDL cholesterol, and the presence or absence of diabetes. Compared to the full Framingham equations, accuracy for identifying patients at increased risk was generally quite high. Data on the feasibility of tool use was limited. CONCLUSIONS Several easy-to-use tools are available for estimating patients' CHD risk. Use of such tools could facilitate better decision making about interventions for primary prevention of CHD, but further research about their actual effect on clinical practice and patient outcomes is required.
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Affiliation(s)
- Stacey Sheridan
- Division of General Internal Medicine, University of North Carolina, Chapel Hill, NC 27599-7110, USA.
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Abstract
Evidence for the effectiveness of lipid-lowering therapy in reducing CHD risk continues to emerge. In primary prevention, clinical trials have demonstrated a benefit for middle-aged, high-risk men with high LDL cholesterol and, more recently, for men and women with "average" LDL and low HDL cholesterol. Although low HDL cholesterol, small dense LDL particles, elevated lipoprotein (a), elevated apolipoprotein B, and the dyslipidemia of the metabolic syndrome pose an increased in CHD risk in some patients, the risk reduction with lipid-lowering therapy has not been fully investigated. The CHD risk of isolated hypertriglyceridemia remains uncertain. Very high triglyceride levels, however, should be treated to prevent pancreatitis. A lipid-lowering diet and other appropriate lifestyle changes constitute safe advice for all patients with dyslipidemia. In initiating pharmacologic therapy, physicians should view potential risk reduction in the context of a patient's overall CHD risk. The selection of particular medications can be individualized, considering effectiveness evidence from clinical trials, lipid-lowering potency, adverse effects, drug interactions, costs, and patient preferences.
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Affiliation(s)
- Michael L Green
- Yale Primary Care Residency Program, Department of Internal Medicine, Yale University School of Medicine, Waterbury Hospital, 64 Robbins Street, Waterbury, CT 06721, USA.
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32
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Pignone M, Phillips CJ, Elasy TA, Fernandez A. Physicians' ability to predict the risk of coronary heart disease. BMC Health Serv Res 2003; 3:13. [PMID: 12857356 PMCID: PMC183837 DOI: 10.1186/1472-6963-3-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2003] [Accepted: 07/11/2003] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of death in the United States. Previous research examining physicians ability to estimate cardiovascular risk has shown that physicians' generally overestimate the absolute risk of CHD events. This question has, however, only studied risk prediction for a limited number of patient care scenarios. The aim of this study is to measure the ability of physicians to estimate the risk of CHD events in patients with no previous history of coronary heart disease. METHODS Twelve primary prevention scenarios with a 5-year risk of CHD events were developed. This questionnaire was surveyed at 3 university teaching hospitals where the participants were a convenience sample of internal medicine residents and fellows or attending physicians in general internal medicine or cardiology. For each scenario, physicians were asked to estimate the baseline 5-year risk of a coronary heart disease event and the revised risk if the patient were to receive lipid-lowering drug therapy. Estimates of the baseline 5-year risk were compared with values calculated from Framingham risk equations. Inaccurate responses were defined as those with a ratio of estimated to actual risk of more than 1.5 or less than 0.67. Physicians' estimates of the relative risk reduction with therapy were considered to be accurate if they were between 25% and 40%. RESULTS 79 physicians (53 residents, 8 fellows, 18 attending physicians) completed the survey. Only 24% of physicians' risk estimates were accurate. In most cases, physicians overestimated the absolute risk of cardiovascular events without therapy (proportion overestimating ranged from 32-92% for the 12 individual scenarios). Physicians made larger errors in patient scenarios involving patients with high total or LDL cholesterol levels. Physicians' estimates of the relative risk reduction from treatment were more accurate: 43% of estimates were between 25 and 40%. Over 85% of physicians recommended treatment in 10 of 12 scenarios. CONCLUSIONS Physicians overestimate the absolute risk of CHD events and the potential absolute benefit of drug therapy.
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Affiliation(s)
- Michael Pignone
- Division of General Internal Medicine and Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Christopher J Phillips
- Population Health Support Division, Air Force Medical Operations Agency, Brooks AFB, TX, USA
| | - Tom A Elasy
- Division of General Internal Medicine and Center for Health Services Research, Vanderbilt University, Nashville, TN, USA
| | - Alicia Fernandez
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
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Abstract
Despite the publication of the American Heart Association/American College of Cardiology (AHA/ACC) "Guide to Preventive Cardiology for Women" primary care screening and treatment of women at risk for coronary heart disease risk is not optimal. The purpose of this article is to apply a framework of physician behavior to describe specific challenges in implementing clinical practice guidelines for women's cardiovascular health in the primary care setting. Specifically, we illustrate 1) underlying barriers to adherence, 2) attempts and interventions to overcome these barriers, and 3) future areas of research to improve physician adherence to guidelines for the prevention and treatment of heart disease in women.
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Affiliation(s)
- Michael D Cabana
- Division of General Pediatrics, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0456, USA.
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Okamura T, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H. What cause of mortality can we predict by cholesterol screening in the Japanese general population? J Intern Med 2003; 253:169-80. [PMID: 12542557 DOI: 10.1046/j.1365-2796.2003.01080.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In a population with a markedly lower coronary mortality such as in Japan, the benefit of cholesterol screening may be different from Western populations. We attempted to assess the importance of cholesterol screening in Japan. DESIGN A 13.2-year cohort study for cause-specific mortality. SETTING Three hundred randomly selected districts throughout Japan in which the National Survey on Circulatory Disorders 1980 was performed. SUBJECTS A total of 9216 community dwelling persons aged 30 years and over, with standardized serum cholesterol measurement and without a past history of cardiovascular disease. RESULTS There were 1206 deaths, which included 462 deaths due to cardiovascular disease with 79 coronary heart diseases. Hypercholesterolemia (>6.21 mmol L-1) showed a significant positive relation to coronary mortality (relative risk; 2.93, 95% confidence interval; 1.52-5.63) but not to stroke. Although hypocholesterolemia (<4.14 mmol L-1) was significantly associated with an increased risk of liver cancer, noncardiovascular, noncancer disease and all-cause mortality, these associations, except for liver cancer, disappeared after excluding deaths in the first 5 years of the follow-up. The multivariate adjusted attributable risk of hypercholesterolaemia for coronary disease was 0.98 per 1000 person-years, which was threefold higher than that of hypocholesterolemia for liver cancer: 0.32 per 1000 person-years. The attributable risk percentage of hypercholesterolaemia was 66% for coronary heart disease. CONCLUSION Similar to Western populations, it is recommended to provide screening for hypercholesterolaemia in Japan, especially for males, although its attributable risk for coronary disease might be small.
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Affiliation(s)
- T Okamura
- Department of Health Science, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga 520-2192, Japan.
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García-Viejo MA, Ruíz M, Martínez E. Strategies for treating HIV-related lipodystrophy. Expert Opin Investig Drugs 2001; 10:1443-56. [PMID: 11772261 DOI: 10.1517/13543784.10.8.1443] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
HIV-related lipodystrophy has emerged as one of the most prevalent problems for patients with HIV, since this infection can now be seen as a chronic disease. Despite its growing importance, crucial issues such as aetiopathogenesis, diagnosis, prevention and therapy remain largely unknown and unexplored. Current evidence suggests that aetiology is multifactorial. HIV infection, antiretroviral therapy and patient-related factors probably all contribute to the development of lipodystrophy. The lack of a formal definition and the nature of wasting syndromes that affect HIV-infected patients can hinder the diagnosis and treatment of lipodystrophy. Body fat changes have a major negative impact on the quality of life of patients. Metabolic abnormalities are also well known cardiovascular risk factors that can increase the morbidity and mortality due to cardiovascular disorders in a relatively young population. As yet, we do not know whether lipodystrophy is preventable or reversible. Several therapeutic approaches have been tested with limited success, however potential complications must be considered. These therapeutic approaches include general health measures (diet, exercise and discontinuation of smoking), switching antiretrovirals (from protease inhibitors to non-nucleoside reverse transcriptase inhibitors or abacavir, or from stavudine to other nucleoside reverse transcriptase inhibitors) and use of drugs with metabolic effects (metformin, thiazolidinediones, recombinant growth hormone and anabolic steroids). A judicious use of available data, and opting for an individualised approach seems the best option for management of this problem at present.
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Affiliation(s)
- M A García-Viejo
- Infectious Diseases Unit, Clinical Institute of Infectious Diseases and Immunology, IDIBAPS-Hospital Clinic University, C/Villarroel, 170, E-08036-Barcelona, Spain
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Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 2001; 20:21-35. [PMID: 11306229 DOI: 10.1016/s0749-3797(01)00261-6] [Citation(s) in RCA: 1101] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). The Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. Once assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive service. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. The Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. The third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications.
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Affiliation(s)
- R P Harris
- School of Medicine and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina 27599-7590, USA.
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Affiliation(s)
- A O Berg
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Affiliation(s)
- N Calonge
- Kaiser Permanente Colorado, Denver, Colorado 80231, USA.
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Eisenberg JM, Kamerow DB. The Agency for Healthcare Research and Quality and the U.S. Preventive Services Task Force: public support for translating evidence into prevention practice and policy. Am J Prev Med 2001; 20:1-2. [PMID: 11306223 DOI: 10.1016/s0749-3797(01)00270-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J M Eisenberg
- US Public Health Service, Agency for Healthcare Research and Quality, Rockville, Maryland 20852, USA
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Affiliation(s)
- L B Russell
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA.
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