A Practical and Evidence-Based Approach to Cardiovascular Disease Risk Reduction

Gluckman, Ty J.; Baranowski, Bryan; Ashen, M. Dominique; Henrikson, Charles A.; McAllister, Marc W; Braunstein, Joel B.; Blumenthal, Roger S.

doi:10.1001/archinte.164.14.1490

Cited by 56 publications

(34 citation statements)

References 157 publications

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“…Only 64.7% of the physicians interviewed claimed to check for the presence of diabetes mellitus, and only 56.4% for dyslipidemia in hypertensive patients. This point will therefore be approached differently in future guidelines for hypertension, in accordance with previous suggestions of other authors 14 .…”

Section: Discussionmentioning

confidence: 74%

Os médicos brasileiros seguem as diretrizes brasileiras de hipertensão?

Mion¹,

Silva²,

Gusmão³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: To evaluate whether procedures adopted by Brazilian physicians in the diagnosis and treatment of hypertension are in compliance with those advocated by the IV Brazilian Hypertension Guidelines.Method: Survey carried out by means of telephone interviews with Brazilian physicians. The survey featured application of a questionnaire aimed to assess receipt of and compliance with the guidelines, and to evaluate various aspects regarding the treatment of hypertensive patients.Results: 68.3% of the respondents had received the guidelines and answered the questionnaire in full. The total sample consisted of 483 physicians -47% cardiologists, 31.7% internists, and 21.3% nephrologists. The survey showed high compliance with certain guideline topics such as more than one measurement at different times for the diagnosis of hypertension (94%), and providing guidance regarding lifestyle changes as a therapeutic strategy. As to arterial pressure levels used for diagnosis and therapeutic target, compliance with guideline recommendations lacks uniformity. The survey showed a clear preference for pressure levels lower than those recommended, especially in patients with comorbidities. Attempts to assess cardiovascular risk also proved to be low. Only 64.7% of the respondents reported that they seek to determine the presence of diabetes mellitus, and 56.4% check for dyslipidemia. The majority (59.3%) mentioned diuretics as the preferred drug class for initial drug treatment of hypertension. Conclusion:We concluded that there is only partial compliance with Brazilian Hypertension Guidelines and that certain factors should be taken into consideration when drawing up future guidelines, such as: improved distribution; standardization of values for diagnosis and therapeutic target; more extensive coverage of ways for physicians to approach hypertensive patients to better evaluate their overall cardiovascular risk.

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Section: Discussionmentioning

confidence: 74%

Os médicos brasileiros seguem as diretrizes brasileiras de hipertensão?

Mion¹,

Silva²,

Gusmão³

et al. 2007

Arq. Bras. Cardiol.

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“…Clopidogrel with ASA for at least 1 month is also recommended for patients with a recent non-ST-segment elevation-ACS, with a preference of 12 months if the bleeding risk is not high. 2,64 In patients who have received drug-eluting stents, at least 12 months of uninterrupted dual antiplatelet therapy is recommended. 65 Data from the CURE, 66 MATCH (Management of Atherothrombosis with Clopidogrel in High-Risk Patients), 67 and CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance) studies 68 provide confirmatory evidence that combined ASA and clopidogrel therapy is associated with significantly increased risk of UGIE complications when compared with either agent alone.…”

Section: Gi Effects Of Clopidogrelmentioning

confidence: 99%

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Bhatt¹,

Scheiman²,

Abraham³

et al. 2008

Circulation

580

200

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“…Preventive strategies utilise risk assessment to identify those most likely to benefit from medical interventions to reduce the risk of CVD events [1].…”

mentioning

confidence: 99%

Forced vital capacity paired with Framingham Risk Score for prediction of all-cause mortality

Lee

Le²,

Lee³

et al. 2010

Eur Respir J

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Forced vital capacity (FVC) measures lung function and predicts coronary heart disease (CHD); whether it provides additive prediction over CHD risk factors has not been established. We examined whether FVC adds to the prediction of all-cause mortality provided by Framingham Risk Score (FRS) alone.We examined 5,485 (61.1 million projected) nonsmoking adults from the USA who were aged 20-79 yrs. Subjects were from the Third National Health and Nutrition Examination Survey, were without obstructive lung disease, had FVC measurements and had f12 yrs (mean 8.8 yrs) mortality follow-up. We performed Cox regression analysis to examine whether FVC and forced expiratory volume in 1 s (FEV1) (categorised as low f85% predicted, borderline 86-94% predicted and normal o95% predicted) within FRS groups (10-yr risk of cardiovascular disease low ,10%, intermediate 10-20%, high 20%) predict mortality. Receiver operator characteristic analysis examined whether FVC and FEV1 added to the prediction provided by FRS.Low-, intermediate-and high-risk FRS groups had 79.5% (n54,361), 10.1% (n5555) and 10.4% (n5569) persons, respectively. Only the intermediate FRS group showed a graded increase in mortality (10.7, 18.2 and 42.8% per 1,000 person-yrs from highest to lowest FVC categories, respectively); those with low FVC had an almost three-fold greater risk of mortality (hazard ratio 2.64; p,0.01) than those with normal FVC. FVC provided incremental additive value for predicting mortality in addition to FRS for only this group (area under curve 0.65 versus 0.58; p,0.05). Similar results were obtained for FEV1.Evaluation of lung function may be useful to improve risk stratification in persons with intermediate CHD risk where it adds to prediction of mortality over global risk assessment.

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A Practical and Evidence-Based Approach to Cardiovascular Disease Risk Reduction

Cited by 56 publications

References 157 publications

Os médicos brasileiros seguem as diretrizes brasileiras de hipertensão?

Os médicos brasileiros seguem as diretrizes brasileiras de hipertensão?

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use

Forced vital capacity paired with Framingham Risk Score for prediction of all-cause mortality

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