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Laszlo N. Perceptions and Proficiencies of Primary Care Physicians Treating Metabolic Syndrome: A Descriptive Survey-Based Study. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00083. [PMID: 37341573 DOI: 10.1097/ceh.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a chronic condition that has been implicated in adverse public health outcomes worldwide, including in the United States. It has been linked to diseases such as type 2 diabetes and heart disease. Little is known about the perceptions and practices of primary care physicians (PCPs) regarding MetS. The only studies examining this research topic were conducted outside the United States. The aim of this study was to evaluate the MetS knowledge, proficiency, training, and practices of American PCPs, for the purpose of informing future physician education initiatives directed at MetS. METHODS This was a descriptive correlational design using a Likert-scale questionnaire. The survey was distributed to more than 4000 PCPs. The first 100 completed surveys were evaluated using descriptive statistical analyses. RESULTS Cumulative survey results revealed that most PCPs perceived themselves as knowledgeable on MetS, but only a minority demonstrated an understanding of leading-edge MetS protocols. Ninety-seven percent agreed that MetS is a condition of concern, but only 22% reported possessing sufficient time and resources to fully address MetS. Only half indicated that they had received training in MetS. DISCUSSION Overall results suggested that a lack of time, training, and resources may pose the greatest obstacles to optimal MetS care. Future studies should aim to identify the specific reasons why these barriers exist.
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Affiliation(s)
- Nicholas Laszlo
- Dr. Laszlo : A.T. Still University, College of Graduate Health Studies, Kirksville, MO
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Athyros VG, Katsiki N, Rizzo M. Undertreatment of dyslipidemia: from the Arabian Gulf to the USA. Time to solve this problem! Curr Med Res Opin 2014; 30:2425-8. [PMID: 25233064 DOI: 10.1185/03007995.2014.966189] [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] [Indexed: 11/23/2022]
Abstract
Undertreatment of dyslipideamia is a universal problem and reduces the efficasy of hypolipidaemic drugs to reduce cardiovascular event rates. The means to face this problem are available and should be utilized to optimize dyslipidaemia control and clinical outcomes.
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Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
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Tziomalos K, Kirkineska L, Baltatzi M, Efthymiou E, Psianou K, Papastergiou N, Magkou D, Zervopoulos G, Kagelidis G, Karlafti E, Savopoulos C, Hatzitolios AI. Prevalence of resistant hypertension in 1810 patients followed up in a specialized outpatient clinic and its association with the metabolic syndrome. Blood Press 2013; 22:307-11. [PMID: 24059788 DOI: 10.3109/08037051.2013.765632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
UNLABELLED We aimed to assess the prevalence of resistant hypertension (RH) in patients attending hypertension outpatient clinics and to identify risk factors for RH. We studied the medical records of the last visit of all patients (n = 1810; 40.4% males, age 56.5 ± 13.5 years) who attended at least once our hypertension outpatient clinic during the last decade. RH was defined as blood pressure (BP) > 140/90 mmHg in patients without diabetes or chronic kidney disease (or BP > 130/80 mmHg in patients with the latter diseases) despite treatment with full doses of three antihypertensive agents from different classes or controlled BP on four or more different antihypertensive agents. The prevalence of RH was 12.3%, whereas 22.2% of the patients had well-controlled hypertension and 65.5% had uncontrolled hypertension but were on less than three antihypertensive agents. Independent predictors of RH were age (risk ratio, RR = 1.08, 95% confidence interval, CI 1.05-1.12, p < 0.001), body mass index (RR = 1.06, 95% CI 1.00-1.13, p < 0.05) and the presence of the metabolic syndrome (MetS) (RR = 2.01, 95% CI 1.03-3.91, p < 0.05). CONCLUSIONS RH is frequent in patients followed up in hypertension outpatient clinics. In addition to age and obesity, MetS appears to be associated with increased risk for RH. Clarification of the mechanisms underpinning the association between MetS and hypertension might reduce the prevalence of RH.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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Paspala I, Katsiki N, Kapoukranidou D, Mikhailidis DP, Tsiligiroglou-Fachantidou A. The role of psychobiological and neuroendocrine mechanisms in appetite regulation and obesity. Open Cardiovasc Med J 2012; 6:147-55. [PMID: 23346258 PMCID: PMC3549543 DOI: 10.2174/1874192401206010147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/01/2012] [Indexed: 12/19/2022] Open
Abstract
Obesity is a multifactorial disease. Among its causes are physical inactivity and overeating. In addition, other factors may play an important role in the development of overweight/obesity. For example, certain hormones including leptin, insulin and ghrelin, may influence appetite and consequently body weight. Obesity frequently co-exists with metabolic disorders including dyslipidemia, hypertension and insulin resistance, thus constituting the metabolic syndrome which is characterized by increased cardiovascular risk. Lack of comprehensive knowledge on obesity-related issues makes both prevention and treatment difficult. This review considers the psychobiological and neuroendocrine mechanisms of appetite and food intake. Whether these factors, in terms of obesity prevention and treatment, will prove to be relevant in clinical practice (including reducing the cardiovas-cular risk associated with obesity) remains to be established.
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Affiliation(s)
- Ioanna Paspala
- Laboratory of Hygiene & Sports Nutrition, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Athyros VG, Gossios TD, Katsiki N, Karagiannis A, Mikhailidis DP. The clinical benefit of implementing guidelines in cardiovascular disease prevention in real world settings. Arch Med Sci 2012; 8:6-10. [PMID: 22457666 PMCID: PMC3309428 DOI: 10.5114/aoms.2012.27272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 02/04/2012] [Accepted: 02/04/2012] [Indexed: 01/13/2023] Open
Affiliation(s)
- Vasilios G. Athyros
- 2 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Thomas D. Gossios
- 1 Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - Asterios Karagiannis
- 2 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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Russo I. The prothrombotic tendency in metabolic syndrome: focus on the potential mechanisms involved in impaired haemostasis and fibrinolytic balance. SCIENTIFICA 2012; 2012:525374. [PMID: 24278711 PMCID: PMC3820496 DOI: 10.6064/2012/525374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 08/27/2012] [Indexed: 05/09/2023]
Abstract
The metabolic syndrome is a clinical disorder characterized by impairment of glucose metabolism, increased arterial blood pressure, and abdominal obesity. The presence of these clinical features exposes patients to a high risk of atherothrombotic cardiovascular events. The pathogenesis of atherothrombosis in the metabolic syndrome is multifactorial, requiring a close relationship among the main components of the metabolic syndrome, including insulin resistance, alterations of glycaemic and lipid pattern, haemodynamic impairment, and early appearance of endothelial dysfunction. Furthermore, haemostatic alterations involving coagulation balance, fibrinolysis, and platelet function play a relevant role both in the progression of the arterial wall damage and in acute vascular events. The mechanisms linking abdominal obesity with prothrombotic changes in the metabolic syndrome have been identified and partially elucidated on the basis of alterations of each haemostatic variable and defined through the evidence of peculiar dysfunctions in the endocrine activity of adipose tissue responsible of vascular impairment, prothrombotic tendency, and low-grade chronic inflammation. This paper will focus on the direct role of adipose tissue on prothrombotic tendency in patients affected by metabolic syndrome, with adipocytes being able to produce and/or release cytokines and adipokines which deeply influence haemostatic/fibrinolytic balance, platelet function, and proinflammatory state.
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Affiliation(s)
- Isabella Russo
- Internal Medicine and Metabolic Disease Unit, Department of Clinical and Biological Sciences of the Turin University, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
- *Isabella Russo:
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Athyros VG, Hatzitolios AI, Karagiannis A, Savopoulos C, Katsiki N, Tziomalos K, Papagianni A, Kakafika A, Gossios TD, Mikhailidis DP. IMproving the imPlemEntation of cuRrent guidelines for the mAnagement of major coronary hearT disease rIsk factors by multifactorial interVEntion. The IMPERATIVE renal analysis. Arch Med Sci 2011; 7:984-92. [PMID: 22328881 PMCID: PMC3264990 DOI: 10.5114/aoms.2011.26610] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/02/2011] [Accepted: 10/20/2011] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The short-term effects of multifactorial intervention for cardiovascular disease (CVD) prevention on renal function and serum uric acid (SUA) levels in patients with stage 3 chronic kidney disease (CKD) and multiple CVD risk factors are unclear. The aim of the study was to prospectively assess these effects. MATERIAL AND METHODS This post hoc analysis of 5 "best practice" studies involved patients with multiple CVD risk factors. Estimated glomerular filtration rate (eGFR) was assessed using the Modification of Diet in Renal Disease (MDRD) formula. Among the 4,153 patients, 1,235 (29.7%) had stage 3 CKD (eGFR between 30 and 59 ml/min/1.73 m(2)). A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimize drug treatment, including a statin, for all vascular risk factors. After 6 months eGFR and SUA levels were re-evaluated. RESULTS The intervention improved compliance to lifestyle measures and increased the use of evidence-based medication, including a statin. There was also a 5.6% increase in eGFR (p < 0.001) in patients with stage 3 CKD and a 6.1% reduction in SUA levels (p < 0.001). Among patients with stage 3 CKD, 127 (10.3%) improved to stage 2 CKD and 9 (0.7%) advanced to stage 4 CKD by the end of the 6-month study period. There were no major side-effects. CONCLUSIONS Multitargeted intervention, including a statin, may improve renal function and reduce SUA levels within 6 months, thus offsetting 2 potential CVD risk factors in high-risk patients.
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Affiliation(s)
- Vasilios G. Athyros
- 2 Propedeutic Department of Internal Medicine, Aristotelian University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- 1 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2 Propedeutic Department of Internal Medicine, Aristotelian University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- 1 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- 1 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- 1 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Aristotelian University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Anna Kakafika
- Department of Internal Medicine, Euro-Clinic, Thessaloniki, Greece
| | - Thomas D. Gossios
- Inherited Cardiovascular Disease Unit, The Heart Hospital, London, United Kingdom
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Vascular Prevention Clinic, Royal Free Hospital, University College Medical School, University College London, United Kingdom
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Athyros VG, Elisaf MS, Alexandrides T, Achimastos A, Ganotakis E, Bilianou E, Karagiannis A, Liberopoulos EN, Tziomalos K, Mikhailidis DP. Long-term impact of multifactorial treatment on new-onset diabetes and related cardiovascular events in metabolic syndrome: a post hoc ATTEMPT analysis. Angiology 2011; 63:358-66. [PMID: 22007026 DOI: 10.1177/0003319711421341] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This post hoc analysis of the Assessing The Treatment Effect in Metabolic Syndrome Without Perceptible diabeTes (ATTEMPT) study assesses the 3½ year incidence of new-onset diabetes (NOD) and related cardiovascular disease (CVD) events in patients with metabolic syndrome (MetS), after multifactorial (lifestyle and drug, including atorvastatin) intervention. Patients were randomized to group A (low-density lipoprotein cholesterol [LDL-C] target < 100 mg/dL) and group B (< 130 mg/dL). The incidence of NOD during the 42-month follow-up was very low, 0.83 to 1.00/100 patient-years in patients with MetS and MetS with impaired fasting glucose, respectively. Older age, increased waist circumference, and persistent MetS were determinants of NOD. One CVD nonfatal event occurred in the 28 patients with NOD. Our findings suggest that treating the characteristics of MetS is achievable and beneficial. New-onset diabetes incidence and CVD events were negligible and not different from what is expected in the general population.
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Affiliation(s)
- Vassilios G Athyros
- Department of Internal Medicine, Second Propedeutic Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Al-Rasadi K, Sulaiman K, Panduranga P, Al-Zakwani I. Prevalence, characteristics, and in-hospital outcomes of metabolic syndrome among acute coronary syndrome patients from Oman. Angiology 2011; 62:381-9. [PMID: 21596697 DOI: 10.1177/0003319710382419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated in-hospital outcomes of acute coronary syndrome (ACS) patients with metabolic syndrome (MetS) in Oman. We analyzed the records of 1392 patients admitted with a diagnosis of ACS as part of the Gulf Registry of Acute Coronary Events. The prevalence of MetS among patients with ACS was 66%, with female preponderance (80% vs 57%; P < .001). MetS was associated with several characteristics including diabetes (45% vs 19%; P < .001), hyperlipidemia (40% vs 23%; P < .001), hypertension (62% vs 34%; P < .001), renal impairment (9.3% vs 3.4%; P < .001), Killip score > II (13% vs 8%; P = .004), and non-ST segment elevation myocardial infarction (78% vs 68%; P < .001). After multivariate adjustment, MetS was associated with higher risk of in-hospital heart failure (odds ratio [OR], 1.37; 95% CI: 1.03-1.81; P = .028) and mortality (OR, 4.42; 95% CI: 1.25-15.5; P = .020). Prevalence of MetS among patients with ACS in Oman is high. MetS was associated with higher in-hospital heart failure and mortality.
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Affiliation(s)
- Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman.
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Katsiki N, Elisaf M. Multifactorial treatment for improvement of renal function and cardiovascular risk: an ATTEMPT for patients with metabolic syndrome and chronic kidney disease. Curr Med Res Opin 2011; 27:1669-72. [PMID: 21718096 DOI: 10.1185/03007995.2011.596410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Athyros VG, Karagiannis A, Ganotakis ES, Paletas K, Nicolaou V, Bacharoudis G, Tziomalos K, Alexandrides T, Liberopoulos EN, Mikhailidis DP. Association between the changes in renal function and serum uric acid levels during multifactorial intervention and clinical outcome in patients with metabolic syndrome. A post hoc analysis of the ATTEMPT study. Curr Med Res Opin 2011; 27:1659-68. [PMID: 21714711 DOI: 10.1185/03007995.2011.595782] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM To assess the effects of long-term multifactorial intervention on renal function and serum uric acid (SUA) levels and their association with estimated cardiovascular disease (eCVD) risk and actual CVD events. METHODS This prospective, randomized, target-driven study included 1123 subjects (45.6% men, age 45-65 years) with metabolic syndrome (MetS) but without diabetes or CVD. Patients were randomized to multifactorial treatment. Atorvastatin was titrated from 10-80 mg/day aiming at a low density lipoprotein cholesterol (LDL-C) target of <100 mg/dl (group A) or an LDL-C target of <130 mg/dl (group B). Changes in estimated glomerular filtration rate (eGFR) and SUA levels were recorded in all patients and in the subgroup with stage 3 chronic kidney disease (CKD; eGFR = 30-59 ml/min/1.73 m(2); n = 349). We used ANOVA to compare changes within the same group, unpaired Student t-test to compare results between groups at specific time points, and log-rank test to compare event free survival. RESULTS The eCVD-risk reduction was greater in group A. In the overall study population, eGFR increased by 3.5% (p < 0.001) and SUA levels fell by 5.6% (p < 0.001). In patients from group A with stage 3 CKD (group A1; n = 172), eGFR increased by 11.1% (p < 0.001) from baseline and by 7.5% (p < 0.001) in group B1 (n = 177; p < 0.001 vs. the change in group A1). The corresponding fall in SUA levels was 10.7% in group A1 (p < 0.001 vs. baseline) and 8.3% in group B1 (p < 0.001 vs. baseline and group A1). These changes were mainly attributed to atorvastatin treatment. Among the CKD stage 3 patients there were no CVD events in group A1, while 6 events occurred in group B1 (p = 0.014). CONCLUSIONS Multifactorial intervention in patients with MetS without established CVD improved renal function and reduced SUA levels. These changes were more prominent in stage 3 CKD patients and might have contributed to the reduction in eCVD risk and clinical events. Original study registration number [ClinicalTrials.gov ID: NCT00416741].
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Affiliation(s)
- Vassilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ntaios G, Savopoulos C, Chatzopoulos S, Mikhailidis D, Hatzitolios A. Iatrogenic hyperhomocysteinemia in patients with metabolic syndrome: A systematic review and metaanalysis. Atherosclerosis 2011; 214:11-9. [DOI: 10.1016/j.atherosclerosis.2010.08.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 06/04/2010] [Accepted: 08/02/2010] [Indexed: 11/28/2022]
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Katsiki N, Mikhailidis DP, Athyros VG, Hatzitolios AI, Karagiannis A, Banach M. Are we getting to lipid targets in real life? Arch Med Sci 2010; 6:639-41. [PMID: 22419917 PMCID: PMC3298327 DOI: 10.5114/aoms.2010.17073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 09/04/2010] [Indexed: 11/17/2022] Open
Affiliation(s)
- Niki Katsiki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, London, United Kingdom
- 1 Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, London, United Kingdom
| | - Vasilis G Athyros
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- 1 Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
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Athyros VG, Ganotakis ES, Tziomalos K, Papageorgiou AA, Anagnostis P, Griva T, Kargiotis K, Mitsiou EK, Karagiannis A, Mikhailidis DP. Comparison of four definitions of the metabolic syndrome in a Greek (Mediterranean) population. Curr Med Res Opin 2010; 26:713-9. [PMID: 20078335 DOI: 10.1185/03007991003590597] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a need to evaluate the prevalence of metabolic syndrome (MetS) diagnosed by the new Joint Interim Societies (JIS) MetS definition. The JIS definition was compared with three previous definitions to assess their ability to predict cardiovascular disease (CVD) risk. METHODS A cross-sectional analysis of a representative sample of Greek adults (n = 9669) was performed to estimate the prevalence of MetS and CVD using the JIS vs. the three older definitions of MetS: the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATP-III), the International Diabetes Federation (IDF) and the American Heart Association/National Heart Lung and Blood Institute (AHA/NHLBI) definitions. RESULTS The age-adjusted MetS prevalence was 45.7%, 43.4%, 24.5% and 26.3% (ANOVA p < 0.001) with the JIS, IDF, NCEP and AHA/NHLBI definitions. The prevalence of CVD was 11.4% in the whole study population and 17.6%, 18.3%, 23.3%, 22.6% and in subjects with MetS according to the JIS, IDF, NCEP and AHA/NHLBI definitions (ANOVA p < 0.001). The prevalence of CVD was only 10.4% (i.e., lower than in the whole study population) in subjects with MetS according to the JIS but not according to the NCEP-ATP-III and AHA/NHLBI definitions (p < 0.001 vs. subjects with MetS as defined by NCEP-ATP-III or AHA/NHLBI). CONCLUSIONS When diagnosed according to the new JIS definition, the prevalence of MetS was high in a Greek Mediterranean cohort (nearly half of the adult population). The NCEP-ATP-III and AHA/NHLBI definitions were more predictive of CVD risk than the new JIS definition. These findings, though limited by the cross sectional analysis, may have implications regarding the choice of the definition to diagnose MetS.
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Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece
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Athyros VG, Hatzitolios A, Karagiannis A, Didangelos TP, Iliadis F, Dolgyras S, Vosnakidis T, Vasiliadis P, Malias I, Tziomalos K, Samouilidou M, Mikhailidis DP. Initiative for a new diabetes therapeutic approach in a Mediterranean country: the INDEED study. Curr Med Res Opin 2009; 25:1931-40. [PMID: 19558210 DOI: 10.1185/03007990903073035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM To assess the efficacy of a strategy to improve vascular risk management in patients with type 2 diabetes mellitus (T2DM). METHODS This was a pilot best practice implementation enhancement programme that enrolled 578 patients with T2DM. A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimise drug treatment for all vascular risk factors. The patients were followed-up for 6 months. The UKPDS risk engine was used to estimate vascular risk in patients without established coronary heart disease (CHD) (n = 279). RESULTS There was an improvement in compliance to lifestyle measures and increased prescription of evidence-based medication. In patients without established CHD there was a 37% reduction in estimated risk for CHD, 44% for fatal CHD, 10% for stroke and 25% for fatal stroke (p < or = 0.003 for all comparisons vs. baseline). There was also a substantial increase in the proportion of patients with established CHD who achieved their vascular risk factor targets. CONCLUSIONS This is the first study to increase the adherence to multiple interventions in patients with T2DM in both primary care and hospital settings. Education of physicians and patients, distribution of guidelines/brochures, and the completion of a one-page form, motivated both physicians and patients to achieve multiple vascular risk factor goals.
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Affiliation(s)
- V G Athyros
- Atherosclerosis and Metabolic Syndrome Units, 2nd Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece
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Karagiannis A, Hatzitolios AI, Athyros VG, Deligianni K, Charalambous C, Papathanakis C, Theodosiou G, Drakidis T, Chatzikaloudi V, Kamilali C, Matsiras S, Matziris A, Savopoulos C, Baltatzi M, Rudolf J, Tziomalos K, Mikhailidis DP. Implementation of guidelines for the management of arterial hypertension. The impulsion study. Open Cardiovasc Med J 2009; 3:26-34. [PMID: 19557149 PMCID: PMC2701277 DOI: 10.2174/1874192400903010026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 04/06/2009] [Accepted: 04/07/2009] [Indexed: 11/22/2022] Open
Abstract
This study assessed the effects of a pilot best practice implementation enhancement program on the control of hypertension. We enrolled 697 consecutive known hypertensive patients with other vascular risk factors but free from overt vascular disease. There was no “control” group because it was considered unethical to deprive high-risk patients from “best medical treatment”. Following a baseline visit, previously trained physicians aimed to improve adherence to lifestyle measures and drug treatment for hypertension and other vascular risk factors. Both at baseline and at study completion (after 6 months), a 1-page form was completed showing if patients achieved treatment targets. If not, the reasons why were recorded. This program enhanced compliance with lifestyle measures and increased the use of evidence-based medication. There was a substantial increase in the number of patients who achieved treatment targets for blood pressure (p<0.0001) and other vascular risk factors. In non-diabetic patients (n=585), estimated vascular risk (PROCAM risk engine) was significantly reduced by 41% (p<0.0001). There was also a 12% reduction in vascular risk according to the Framingham risk engine but this did not achieve significance (p=0.07). In conclusion, this is the first study to increase adherence to multiple interventions in hypertensive patients on an outpatient basis, both in primary care and teaching hospitals. Simple, relatively low cost measures (e.g. educating physicians and patients, distributing printed guidelines/brochures and completing a 1-page form) motivated both physicians and patients to achieve multiple treatment goals. Further work is needed to establish if the improvement observed is sustained. [ClinicalTrials.gov NCT00416611].
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Affiliation(s)
- Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
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