Objective: To summarize the knowledge on the use of comprehensive family history taking for common, multifactorial diseases in primary health care. Design and data sources: Systematic review of MEDLINE (1966MEDLINE ( -2008, EMBASE (1986EMBASE ( -2008 and Cochrane Library. Methods: Search terms refl ected 'primary care', 'family history' and 'genetics'. Included were original studies, published in the English language, from a primary care setting, investigating family history taking for multifactorial disorders. Methodological criteria (design, size, response rate) were not used to exclude papers. Out of 116 potentially eligible papers, 27 papers were selected: nine studies on opinions, eight studies on actual practice, seven studies on family history tools, and three studies on the patient perspective. Two authors independently extracted the data, and consequently discussed and summarized them. Given the heterogeneity of the studies, outcomes were presented in a qualitative way. Results: Among family physicians, the general opinion was that taking a family history is the task of the primary care physician. However, observational studies of consultations and analyses of medical records showed wide variability and low regular updating. There are no family history tools yet, that are suffi ciently feasible and reproducible. Patients and doctors may perceive a positive family history differently, which may cause miscommunication. Conclusion:There is a need for research into feasible and high quality tools for detailed family history taking for multifactorial disorders.

This study was designed to examine the contribution of six polymorphisms to the occurrence of cardiovascular disease (CVD) in a Dutch primary care population with a high prevalence of cardiovascular risk factors. In this cross-sectional case-control study, 232 patients with CVD and 571 event-free controls were studied. Patients were genotyped for the AGTR1 (A1166C), AGT (M235T), ACE (4656rpt), NOS3 (E298D), GNB3 (C825T) and ADD1 (G460W) polymorphisms. Univariate and multivariate odds ratios (ORs) were calculated to assess the relationship between genotypes and CVD. Receiver operating characteristic (ROC) analysis was used to quantify the contribution of the polymorphisms to the prediction of CVD. No differences in either genotype or allele frequencies were found between CVD cases and controls. Multivariate analyses, corrected for multiple testing according to Bonferroni, showed significant protective associations for the T-allele of AGT (OR ¼ 0.55 (0.34-0.84)) and for the T-allele of ADD1 (OR ¼ 0.52 (0.31-0.82)). ROC analysis showed only a very small improvement of CVD risk prediction by adding the six polymorphisms to a model with traditional risk factors. Our data suggest that a major attribution of the six polymorphisms to the cardiovascular risk prediction in a primary care population such as HIPPOCRATES is unlikely.

A larger proportion of patients reached cholesterol lipid goals with simvastatin 40 mg/day. Cholesterol level goals were achieved by many patients using the recommended simvastatin 40 mg/day, but by fewer patients among those using the more commonly prescribed simvastatin 20 mg/day. Therefore, especially in high-risk patients, the choice of statin should be based on baseline cholesterol levels and expected reductions in these levels, and treatment should be adapted if targets are not met. Improved cholesterol level monitoring may increase adherence and cholesterol management.

The majority of patients with established CVD or DM2 were not treated with statins on 1 January 2007. Eligibility for statin treatment may have been overestimated due to unavailability of cholesterol levels among many non-treated patients. Implementation of care programmes for CVD patients may increase treatment rates among eligible CVD patients.

Objective To explore the 'real-life' therapy of type 2 diabetes mellitus with oral antidiabetic drugs (OADs). Methods From the PHARMO Record Linkage System comprising linked drug dispensing and clinical laboratory data from approximately 2.5 million individuals in the Netherlands, among others, new users of OADs were identified in the period 1999-2004. New users, aged 30 years and older, without insulin use before cohort entry date and with at least one year follow-up were included. We determined per initial therapy patient characteristics and first therapy change. Results Overall 35,514 patients were included. Metformin and sulfonylureas (SU) were the most frequent initial therapy. Patients on thiazolidinedione (TZD) monotherapy had lower percentages baseline HbA1c C 7% compared to patients on metformin and SU. The proportion of patients still on initial therapy after one year ranged from 46% (TZDs) to around 60% (SU). Among patients starting on monotherapy, add-on (15-20%) and discontinuation (16-25%) of therapy occurred most frequently. In patients starting on combination therapy, a switch occurred in 30% of the patients. Conclusion In more than 40% of the patients a change in initial OAD-therapy is already observed in the first year of therapy. Maintaining patients on initial therapy remains a challenge.