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Baptiste PJ, Wong AYS, Schultze A, Cunnington M, Mann JFE, Clase C, Leyrat C, Tomlinson LA, Wing K. Effects of ACE inhibitors and angiotensin receptor blockers: protocol for a UK cohort study using routinely collected electronic health records with validation against the ONTARGET trial. BMJ Open 2022; 12:e051907. [PMID: 35260450 PMCID: PMC8905982 DOI: 10.1136/bmjopen-2021-051907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Cardiovascular disease is a leading cause of death globally, responsible for nearly 18 million deaths worldwide in 2017. Medications to reduce the risk of cardiovascular events are prescribed based on evidence from clinical trials which explore treatment effects in an indicated sample of the general population. However, these results may not be fully generalisable because of trial eligibility criteria that generally restrict to younger patients with fewer comorbidities. Therefore, evidence of effectiveness of medications for groups underrepresented in clinical trials such as those aged ≥75 years, from ethnic minority backgrounds or with low kidney function may be limited.Using individual anonymised data from the Ongoing Telmisartan Alone and the Ramipril Global Endpoint Trial (ONTARGET) trial, in collaboration with the original trial investigators, we aim to investigate clinical trial replicability within a real-world setting in the area of cardiovascular disease. If the original trial results are replicable, we will estimate treatment effects and risk in groups underrepresented and excluded from the original clinical trial. METHODS AND ANALYSIS We will develop a cohort analogous to the ONTARGET trial within the Clinical Practice Research Datalink between 1 January 2001 and 31 July 2019 using the trial eligibility criteria and propensity score matching. The primary outcome is a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalisation for congestive heart failure. If results from the cohort study fall within pre-specified limits, we will expand the cohort to include under represented and excluded groups. ETHICS AND DISSEMINATION Ethical approval has been granted by the London School of Hygiene & Tropical Medicine Ethics Committee (Ref: 22658). The study has been approved by the Independent Scientific Advisory Committee of the UK Medicines and Healthcare Products Regulatory Agency (protocol no. 20_012). Access to the individual patient data from the ONTARGET trial was obtained by the trial investigators. Findings will be submitted to peer-reviewed journals and presented at conferences.
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Affiliation(s)
- Paris J Baptiste
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angel Y S Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Schultze
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Marianne Cunnington
- Epidemiology, Value & Evidence Outcomes, GlaxoSmithKline Research and Development Welwyn, Stevenage, UK
| | - Johannes F E Mann
- Department of Medicine 4, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
- KfH-Nierenzentrum, München-Schwabing, Germany
| | - Catherine Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Clémence Leyrat
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Laurie A Tomlinson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Harper G, Stables D, Simon P, Ahmed Z, Smith K, Robson J, Dezateux C. Evaluation of the ASSIGN open-source deterministic address-matching algorithm for allocating unique property reference numbers to general practitioner-recorded patient addresses. Int J Popul Data Sci 2021; 6:1674. [PMID: 34970633 PMCID: PMC8678979 DOI: 10.23889/ijpds.v6i1.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Linking places to people is a core element of the UK government's geospatial strategy. Matching patient addresses in electronic health records to their Unique Property Reference Numbers (UPRNs) enables spatial linkage for research, innovation and public benefit. Available algorithms are not transparent or evaluated for use with addresses recorded by health care providers. OBJECTIVES To describe and quality assure the open-source deterministic ASSIGN address-matching algorithm applied to general practitioner-recorded patient addresses. METHODS Best practice standards were used to report the ASSIGN algorithm match rate, sensitivity and positive predictive value using gold-standard datasets from London and Wales. We applied the ASSIGN algorithm to the recorded addresses of a sample of 1,757,018 patients registered with all general practices in north east London. We examined bias in match results for the study population using multivariable analyses to estimate the likelihood of an address-matched UPRN by demographic, registration, and organisational variables. RESULTS We found a 99.5% and 99.6% match rate with high sensitivity (0.999,0.998) and positive predictive value (0.996,0.998) for the Welsh and London gold standard datasets respectively, and a 98.6% match rate for the study population.The 1.4% of the study population without a UPRN match were more likely to have changed registered address in the last 12 months (match rate: 95.4%), be from a Chinese ethnic background (95.5%), or registered with a general practice using the SystmOne clinical record system (94.4%). Conversely, people registered for more than 6.5 years with their general practitioner were more likely to have a match (99.4%) than those with shorter registration durations. CONCLUSIONS ASSIGN is a highly accurate open-source address-matching algorithm with a high match rate and minimal biases when evaluated against a large sample of general practice-recorded patient addresses. ASSIGN has potential to be used in other address-based datasets including those with information relevant to the wider determinants of health.
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Affiliation(s)
- Gill Harper
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
| | | | | | - Zaheer Ahmed
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
| | - Kelvin Smith
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
| | - John Robson
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
| | - Carol Dezateux
- Clinical Effectiveness Group, Centre for Primary Care, Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
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Nugawela MD, Gurudas S, Prevost AT, Mathur R, Robson J, Hanif W, Majeed A, Sivaprasad S. Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study. J Pers Med 2021; 11:jpm11080740. [PMID: 34442384 PMCID: PMC8400788 DOI: 10.3390/jpm11080740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007-January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02-1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16-1.32) and STDR (HR: 1.38 95% CI 1.17-1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.
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Affiliation(s)
- Manjula D. Nugawela
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK; (M.D.N.); (S.G.)
| | - Sarega Gurudas
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK; (M.D.N.); (S.G.)
| | - A Toby Prevost
- Department of Population Health Sciences, King’s College London, London WC2R 2LS, UK;
| | - Rohini Mathur
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - John Robson
- Institute of Population Health Sciences, Queen Mary University of London, London E1 4NS, UK;
| | - Wasim Hanif
- Birmingham City School of Nursing and Midwifery, Westbourne Road, Birmingham B15 3TN, UK;
| | - Azeem Majeed
- School of Public Health, Imperial College London, London SW7 2AZ, UK;
| | - Sobha Sivaprasad
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK; (M.D.N.); (S.G.)
- Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London EC1V 2PD, UK
- Correspondence:
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Sutaria S, Mathur R, Hull SA. Does the ethnic density effect extend to obesity? A cross-sectional study of 415 166 adults in east London. BMJ Open 2019; 9:e024779. [PMID: 31154296 PMCID: PMC6549644 DOI: 10.1136/bmjopen-2018-024779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine the prevalence of obesity by ethnic group and to examine the association between ethnic density and obesity prevalence. DESIGN AND SETTING Cross-sectional study utilising electronic primary care records of 128 practices in a multiethnic population of east London. PARTICIPANTS Electronic primary care records of 415 166 adults with a body mass index recorded in the previous 3 years. OUTCOME MEASURES (1) Odds of obesity for different ethnic groups compared with white British. (2) Prevalence of obesity associated with each 10% increase in own-group ethnic density, by ethnic group. RESULTS Using multilevel logistic regression models, we find that compared with white British/Irish males, the odds of obesity were significantly higher among black ethnic groups and significantly lower among Asian and white other groups. Among females, all ethnic groups except Chinese and white other were at increased odds of obesity compared with white British/Irish. There was no association between increasing ethnic density and obesity prevalence, except among black Africans and Indian females. A 10% increase in black ethnic density was associated with a 15% increase in odds of obesity among black African males (95% CI 1.07 to 1.24) and 18% among black African females (95% CI 1.08 to 1.30). Among Indian females, a 10% increase in Indian ethnic density was associated with a 7% decrease in odds of obesity (95% CI 0.88 to 0.99). CONCLUSION Wider environmental factors play a greater role in determining obesity than the ethnic composition of the area for most ethnic groups. Further research is needed to understand the mechanism through which increasing ethnic density is associated with increased odds of obesity among black Africans and decreased odds of obesity among Indian females.
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Affiliation(s)
- Shailen Sutaria
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
| | - Rohini Mathur
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
| | - Sally A Hull
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
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Sándor J, Pálinkás A, Vincze F, Kovács N, Sipos V, Kőrösi L, Falusi Z, Pál L, Fürjes G, Papp M, Ádány R. Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091835. [PMID: 30149586 PMCID: PMC6163424 DOI: 10.3390/ijerph15091835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
Abstract
Roma is the largest ethnic minority of Europe with deprived health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health indicators for adults living in segregated Roma settlements (SRS), representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54,682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and all-cause premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR = 1.152, 95% CI: 1.136–1.167). The proportion of subjects hospitalized (RR = 1.286, 95% CI: 1.177–1.405) and the reimbursement for inpatient care (RR = 1.060, 95% CI: 1.057–1.064) were elevated for SRS. All-cause premature mortality was significantly higher in SRSs (RR = 1.711, 1.085–2.696). Our study demonstrated that it is possible to compute the SRS-specific version of routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue into a non-sensitive small-area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of all-cause premature death.
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Affiliation(s)
- János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - Zsófia Falusi
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - László Pál
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - Gergely Fürjes
- National Institute for Health Development, Diószegi St 64, Budapest H-1113, Hungary.
| | - Magor Papp
- National Institute for Health Development, Diószegi St 64, Budapest H-1113, Hungary.
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
- MTA-DE-Public Health Research Group, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
- WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
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Venkatason P, Zaharan NL, Ismail MD, Wan Ahmad WA, Mahmood Zuhdi AS. Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia. Eur J Clin Pharmacol 2018; 74:953-960. [PMID: 29582106 PMCID: PMC5999133 DOI: 10.1007/s00228-018-2451-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Information is lacking on prescribing of preventative cardiovascular pharmacotherapies for patients with non-ST elevation myocardial infarction (NSTEMI) in the Asian region. This study examined the prescribing rate of these pharmacotherapies, comparing NSTEMI to STEMI, and variations across demographics and clinical factors within the NSTEMI group in the multi-ethnic Malaysian population. METHODS This is a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry from year 2006 to 2013 (n = 30,873). On-discharge pharmacotherapies examined were aspirin, ADP-antagonists, statins, ACE-inhibitors, angiotensin-II-receptor blockers, and beta-blockers. Multivariate logistic regression was used to calculate adjusted odds ratio of receiving individual pharmacotherapies according to patients' characteristics in NSTEMI patients (n = 11,390). RESULTS Prescribing rates for cardiovascular pharmacotherapies had significantly increased especially for ADP-antagonists (76%) in NSTEMI patients. More than 85% were prescribed statins and antiplatelets but rates remained significantly lower compared to STEMI. Women and those over 65 years old were less likely to be prescribed these pharmacotherapies compared to men and younger NSTEMI patients. Chinese and Indians were more likely to receive selected pharmacotherapies compared to Malays (main ethnicity). Geographical variations were observed; East Malaysian (Malaysian Borneo) patients were less likely to receive these compared to Western region of Malaysian Peninsular. Underprescribing in patients with risk factors such as diabetes were observed with other co-morbidities influencing prescribing selectively. CONCLUSION This study uncovers demographic and clinical variations in cardiovascular pharmacotherapies prescribing for NSTEMI. Concerted efforts by policy makers, specialty societies, and physicians are required focusing on elderly, women, Malays, East Malaysians, and high-risk patients.
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Affiliation(s)
- Padmaa Venkatason
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Lisa Zaharan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Muhammad Dzafir Ismail
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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van Leeuwen J, van Middelkoop M, Paulis WD, Bueving HJ, Bindels PJE, Koes BW. Overweight and obese children do not consult their general practitioner more often than normal weight children for musculoskeletal complaints during a 2-year follow-up. Arch Dis Child 2018; 103:149-154. [PMID: 28821502 DOI: 10.1136/archdischild-2017-313118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Childhood obesity is associated with self-reported musculoskeletal complaints, injuries and fractures. In the current study, we investigated the association between weight status of children and the frequency and type of musculoskeletal consultations at the general practitioner (GP) during a 2-year follow-up. METHODS Data from a prospective longitudinal cohort study including children aged 2-18 years presenting in general practices in the Netherlands were used. Height and weight were measured at baseline, at 6-month, 1-year and 2-year follow-ups. Electronic medical files were used to collect information on the frequency and type of consultations at the GP during the 2-year follow-up period. Associations between weight status and frequency and type of GP consultations were calculated. RESULTS Of the 617 included children, 111 (18%) were overweight or obese and 506 (82%) were non-overweight. Overweight children were significantly older (mean age in years (SD): 9.8 (3.6)vs7.8 (4.0), p=0.004). Overweight children consulted the GP in general significantly more frequent during the 2-year follow-up than non-overweight children (mean (SD): 7.3 (5.7)vs6.7 (5.4), OR 1.09, 95% CI 1.01 to 1.18). No significant difference was seen in the number of overweight and non-overweight children consulting their GP for musculoskeletal complaints (OR 1.20 (0.86 to 1.68)). Additionally, no significant difference between overweight and non-overweight children was seen for the number of consultations for further specified musculoskeletal disorders. CONCLUSION No association was seen between childhood weight status and the frequency and type of musculoskeletal consultations at the GP during a 2-year follow-up.
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Affiliation(s)
- Janneke van Leeuwen
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Winifred D Paulis
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Herman J Bueving
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Mathur R, Pérez-Pinar M, Foguet-Boreu Q, Ayis S, Ayerbe L. Risk of incident cardiovascular events amongst individuals with anxiety and depression: A prospective cohort study in the east London primary care database. J Affect Disord 2016; 206:41-47. [PMID: 27466741 DOI: 10.1016/j.jad.2016.07.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/15/2016] [Accepted: 07/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is unknown how risk of myocardial infarction and stroke differ for patients with and without anxiety or depression, and whether this risk can be explained by demographics, medication use, cardiovascular risk factors. The aim of this study is to quantify differences in risk of non-fatal MI or stroke among patients with anxiety or depression. METHODS Prospective cohort study examining risk of incident MI and stroke between March 2005 and March 2015 for 524,952 patients aged 30 and over from the east London primary care database for patients with anxiety or depression. RESULTS Amongst 21,811 individuals with depression at baseline, 1.2% had MI and 0.4% had stroke. Of 22,128 individuals with anxiety at baseline, 1.1% had MI and 0.3% had stroke. Depression was independently associated with both MI and stroke, whereas anxiety was associated with MI only before adjustment for cardiovascular risk factors. Antidepressant use increased risk for MI but not stroke. Mean age at first MI was lower in those with anxiety, while mean age at first stroke was lower in those with depression. LIMITATIONS The study was limited to patients currently registered in the database and thus we did not have any patients that died during the course of follow-up. CONCLUSIONS Patients with depression have increased risk of cardiovascular events. The finding of no increased cardiovascular risk in those with anxiety after adjusting for cardiovascular risk factors is of clinical importance and highlights that the adequate control of traditional risk factors is the cornerstone of cardiovascular disease prevention. Targeting management of classical cardiovascular risk factors and evaluating the risks of antidepressant prescribing should be prioritized.
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Affiliation(s)
- R Mathur
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK.
| | - M Pérez-Pinar
- The Westborough Road Health Centre, Westcliff on Sea, UK
| | - Q Foguet-Boreu
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - S Ayis
- Division of Health and Social Care Research, King's College London, London, UK
| | - L Ayerbe
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK; The Westborough Road Health Centre, Westcliff on Sea, UK
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