Perceptions of Canadian Primary Care Physicians Towards Cardiovascular Risk Assessment and Lipid Management

Gupta, Milan; Singh, Narendra; Tsigoulis, Michelle; Kajil, Mahesh; Hirjikaka, Sheriar; Quan, Adrian; Teoh, Hwee; Verma, Subodh

doi:10.1016/j.cjca.2011.09.014

Cited by 37 publications

(30 citation statements)

References 17 publications

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“…A further survey showed that 62% of physicians used a subjective assessment of risk factors rather than a specific risk calculator, with cardiologists being more likely than PCPs to use a subjective assessment [7]. A recent study done in Canada showed that 74% primary care physicians performed CV risk assessment in eligible patients annually [11]. Interestingly, we found that young, urban and family doctors more often assessed the risk than old, rural and general physicians.…”

Section: Discussionmentioning

confidence: 79%

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

Brotons¹,

Lobos

Royo-Bordonada

et al. 2013

BMC Fam Pract

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BackgroundThe successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs.MethodsA cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire.ResultsMore than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations.ConclusionsMost PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools.

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Section: Discussionmentioning

confidence: 79%

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

Brotons¹,

Lobos

Royo-Bordonada

et al. 2013

BMC Fam Pract

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“…Furthermore, the use of simplified diagnostic criteria with clinical relevance will be more accessible to the increasingly overburdened physician. 38 This study builds upon the evidence that nonfasting samples can accurately capture prognostic data for both triglycerides and cholesterol by establishing validated cutpoints that can now be used to help guide clinical decision-making. 12, 39 Indeed, a nonfasting lipid profile has been the standard in Denmark since 2009.…”

Section: Discussionmentioning

confidence: 99%

Identifying an Optimal Cutpoint for the Diagnosis of Hypertriglyceridemia in the Nonfasting State

et al. 2015

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Background Nonfasting triglycerides are similar to or superior to fasting triglycerides at predicting cardiovascular events. However, diagnostic cutpoints are based on fasting triglycerides. We examined the optimal cutpoint for increased nonfasting triglycerides. Methods Baseline nonfasting (<8 hours since last meal) samples were obtained from 6,391 participants in the Women’s Health Study, followed prospectively for up to 17 years. The optimal diagnostic threshold for nonfasting triglycerides, determined by logistic regression models using c-statistics and Youden index (sum of sensitivity and specificity minus one), was used to calculate hazard ratios for incident cardiovascular events. Performance was compared to thresholds recommended by the American Heart Association (AHA) and European guidelines. Results The optimal threshold was 175 mg/dL (1.98 mmol/L), corresponding to a c-statistic of 0.656 that was statistically better than the AHA cutpoint of 200 mg/dL (c-statistic of 0.628). For nonfasting triglycerides above and below 175 mg/dL, adjusting for age, hypertension, smoking, hormone use, and menopausal status, the hazard ratio for cardiovascular events was 1.88 (95% CI, 1.52–2.33, P<0.001), and for triglycerides measured at 0–4 and 4–8 hours since last meal, hazard ratios (95%CIs) were 2.05 (1.54– 2.74) and 1.68 (1.21–2.32), respectively. Performance of this optimal cutpoint was validated using ten-fold cross-validation and bootstrapping of multivariable models that included standard risk factors plus total and HDL cholesterol, diabetes, body-mass index, and C-reactive protein. Conclusions In this study of middle aged and older apparently healthy women, we identified a diagnostic threshold for nonfasting hypertriglyceridemia of 175 mg/dL (1.98 mmol/L), with the potential to more accurately identify cases than the currently recommended AHA cutpoint.

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“…Indeed, in a recently published study, Gupta et al (2012) surveyed Canadian primary care physicians and found that WC was routinely measured by only 6% of physicians [39]. This finding contrasts with the knowledge that 80% of surveyed physicians considered WC to be a vital sign [39].…”

Section: Discussionmentioning

confidence: 99%

The association between "hypertriglyceridemic waist" and sub-clinical atherosclerosis in a multiethnic population: a cross-sectional study

et al. 2014

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Background"Hypertriglyceridemic waist" (HTGW) phenotype, an inexpensive early screening tool for detection of individuals at risk for type 2 diabetes and cardiovascular disease was found to be associated with subclinical atherosclerosis in various patient populations such as those with diabetes mellitus, chronic kidney disease, and those infected with human immunodeficiency virus. However, less is known regarding an association between HTGW and subclinical atherosclerosis in the apparently healthy, multiethnic population. Therefore, the aim of the study was to explore the association between HTGW and sub-clinical atherosclerosis in an apparently healthy, multiethnic population; and to investigate whether the effect of HTGW on sub-clinical atherosclerosis persists over and above the traditional atherosclerosis risk factors.MethodsWe studied 809 individuals of Aboriginal, Chinese, European and South Asian origin who were assessed for indices of sub-clinical atherosclerosis (intima-media thickness (IMT), total area and presence of carotid plaques), socio-demographic and lifestyle characteristics, anthropometrics, lipids, glucose, blood pressure, and family history of cardiovascular disease.ResultsWe found that, compared to individuals without HTGW and after adjusting for age, ethnicity, smoking, and physical activity; men and women with HTGW had a significantly higher: IMT (men: B (95%CI = 0.084 (0.037, 1.133), p < 0.001; women: B (95%CI) = 0.041 (0.006, 0.077), p = 0.020); and total area (men: B (95%CI = 0.202 (0.058, 0.366), p = 0.005; women: B (95%CI) = 0.115 (0.006, 0.235), p = 0.037). The association between HTGW waist and presence of plaques was significant for men (OR (95%CI) = 1.904 (1.040, 3.486), p = 0.037 vs. men without HTGW), but not for women (p = 0.284). Once analyses were adjusted for additional, traditional risk factors for atherosclerosis, the effect of HTGW on sub-clinical atherosclerosis was no longer significant.ConclusionsIn conclusion, HTGW may serve as an early marker of subclinical atherosclerosis in men and women, irrespective of ethnicity. However, once individuals are assessed for all traditional risk factors for atherosclerosis, the additional assessment for HTGW is not warranted.

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Perceptions of Canadian Primary Care Physicians Towards Cardiovascular Risk Assessment and Lipid Management

Cited by 37 publications

References 17 publications

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

Identifying an Optimal Cutpoint for the Diagnosis of Hypertriglyceridemia in the Nonfasting State

The association between "hypertriglyceridemic waist" and sub-clinical atherosclerosis in a multiethnic population: a cross-sectional study

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