Estimating the Benefits of Modifying Risk Factors of Cardiovascular Disease

Grover, Steven A.; Paquet, Steve; Levinton, Carey; Coupal, Louis; Zowall, Hanna

doi:10.1001/archinte.158.6.655

Cited by 136 publications

(96 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The LDL/HDL cholesterol ratios are therefore in a very-high-risk range. According to Grover et al, 21 an LDL/HDL cholesterol ratio Ͼ4.9 defines high risk, and according to the model proposed by these authors, there should be an Ϸ4.3-fold difference in cardiovascular risk between apoA-I M carriers and control subjects. One of the carriers (53 years of age) actually underwent an episode of sudden cardiovascular death 6 months after the study.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Status of Carriers of the Apolipoprotein A-I _Milano Mutant

et al. 2001

View full text Add to dashboard Cite

Background-Carriers of the apolipoprotein A-I Milano (apoA-I M ) mutant present with very low plasma HDL cholesterol and moderate hypertriglyceridemia, apparently not leading to premature coronary heart disease. The objective of this study was to establish whether this high-risk lipid/lipoprotein profile is associated with structural changes in the carotid arteries and heart, indicative of preclinical atherosclerosis. Methods and Results-Twenty-one A-I M carriers were compared with age-and sex-matched control subjects from the same kindred and with 2 series of matched subjects with primary hypoalphalipoproteinemia (HA). Structural changes in the carotid arteries were defined as the intima-media thickness (IMT) measured by B-mode ultrasound. HA subjects, both recruited among patients attending our Lipid Clinic and blood donors, showed significant thickening of the carotids (average IMT, 0.86Ϯ0.25 and 0.88Ϯ0.29 mm, respectively) compared with control subjects (average IMT, 0.64Ϯ0.12 mm); the apoA-I M carriers instead showed normal arterial thickness (average IMT, 0.63Ϯ0.10 mm). Moreover, a significantly higher prevalence of atherosclerotic plaques was found in patients and blood donors with HA (both 57%) compared with apoA-I M carriers (33%) and control subjects (21%). Echocardiographic findings and maximal treadmill ECG did not differ significantly between apoA-I M carriers and control subjects, apart from a slight increase in left ventricular end-diastolic dimension in the carriers. Conclusions-Despite severe HA, carriers of the apoA-I M mutant do not show structural changes in the arteries and heart, in contrast to HA subjects, who are characterized by a marked increase in carotid IMT and increased prevalence of atherosclerotic plaques.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiovascular Status of Carriers of the Apolipoprotein A-I _Milano Mutant

et al. 2001

View full text Add to dashboard Cite

show abstract

“…The coronary risk profile is a one-page computer printout that displays a subject's probability of developing coronary disease 18,19 . For instance, a 50-year-old with a life expectancy of 25 more years (versus 30 years for the average Canadian) would be assigned a cardiovascular age of 55.…”

Section: The Coronary Risk Profilementioning

confidence: 99%

Discussing Coronary Risk with Patients to Improve Blood Pressure Treatment: Secondary Results from the CHECK-UP Study

et al. 2008

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: Hypertension is common among patients with dyslipidemia but is often poorly treated. The objective of this analysis was to evaluate how a decision aid, used by primary care physicians to improve lipid therapy, impacted on the treatment of hypertension.STUDY DESIGN: Data were analyzed from patients enrolled in a randomized trial focusing primarily on the treatment of dyslipidemia. Patients received usual care or a coronary risk profile every three months to monitor the risk reduction following lifestyle changes and/or pharmacotherapy to treat dyslipidemia. Hypertension management was assessed based on a post hoc analysis of individuals whose blood pressure exceeded current national hypertension guidelines.RESULTS: There were 2,631 subjects who completed the study. Among 1,352 patients without diagnosed hypertension, 30% were above target on at least three consecutive visits. Among 1,279 individuals with known hypertension, 69% were above target on at least two consecutive visits. Overall, patients receiving risk profiles were more likely to receive appropriate antihypertensive therapy (OR=1.40, 95% CI 1.11 -1.78) compared to those receiving usual care. After adjustment for inter-physician variability and potential confounders, the use of the risk profile was associated with an increased likelihood of starting therapy (OR=1.78, 95% CI 1.06 -3.00) or modifying therapy (OR=1.40, 95% CI 1.03 -1.91). CONCLUSIONS:In this clinical trial of dyslipidemia management, inadequately controlled hypertension was common, occurring in nearly 50% of individuals. Ongoing coronary risk assessment was associated with more appropriate blood pressure management. Cardiovascular risk assessment decision aids should be further evaluated in a randomized trial of hypertension therapy.

show abstract

“…In the model, there is a stronger association between cardiovascular events and blood lipids than blood pressure (6). This is particularly true for coronary artery disease, in which blood pressure is a relatively weak risk factor.…”

Section: Resultsmentioning

confidence: 96%

“…The Cardiovascular Life Expectancy Model is based on data from the Lipid Research Clinic's follow-up cohort, and the resulting multivariate equations assign a stronger risk to increases in LDL-C level than systolic or diastolic blood pressure (6). The same is true of the Framingham risk equations, in which the change in cardiovascular risk is greater with a one-unit change in TC or LDL-C level than in systolic or diastolic blood pressure (4).…”

Section: Discussionmentioning

confidence: 99%

“…The benefits associated with treating dyslipidemia and/or hypertension among Canadians free of cardiovascular disease and diabetes were estimated from population risk factor data collected by the Canadian Heart Health Surveys, current Canadian treatment guidelines and a previously published Markov model (the Cardiovascular Disease Life Expectancy Model) to calculate the increased life expectancy and decreased morbidity associated with treating risk factors to target (3)(4)(5)(6). Finally, the proportion of individuals treated who could realistically reach the target was also estimated.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation