IDENTIFICATION OF PATIENTS AT HIGH CARDIOVASCULAR RISK: A CLINICAL PRACTICE STUDY IN PRIMARY CARE SETTINGS

2011 ◽  
Vol 29 ◽  
pp. e439
Author(s):  
F. Valls-Roca ◽  
V. Pallares-Carratala ◽  
V. Gil-Guillen ◽  
D. Orozco-Beltran ◽  
J. L. Llisterri-Caro ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Cardiovascular Risk ◽  
High Cardiovascular Risk ◽  
Primary Care Settings ◽  
Practice Study

scholarly journals Hyperuricemia, gout and high cardiovascular risk - how to manage them in clinical practice

2019 ◽  
Vol 91 (12) ◽  
pp. 75-83
Author(s):  
V V Fomin ◽  
T E Morosova ◽  
V V Tsurko
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Practice ◽  
Cardiovascular Risk ◽  
High Risk ◽  
High Cardiovascular Risk ◽  
Relationship Of ◽  
The Relationship

In recent years, the relationship of hyperuricemia and gout with a high risk of cardiovascular disease has been widely discussed. Therefore, it is important to systematically examine patients in order to diagnose comorbidities, among which cardiovascular disease and its complications occupy a leading place and consider mandatory treatment of patients with hyperuricemia and gout with high cardiovascular risk with lowering drugs, which fully reflects the provisions of the latest European recommendations for the management and treatment of patients with gout.

scholarly journals Features and main problems of treating patients with high and very high cardiovascular risk with statins in real clinical practice (according to the data of the “PRIORITET” research)

2018 ◽  
Vol 17 (6) ◽  
pp. 52-60 ◽  
Author(s):  
S. Yu. Martsevich ◽  
Yu. V. Lukina ◽  
N. P. Kutishenko ◽  
N. A. Dmitrieva ◽  
T. A. Gomova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Working Group ◽  
Target Level ◽  
High Cardiovascular Risk ◽  
Lipid Pattern ◽  
Very High ◽  
Real Clinical Practice ◽  
Group 1

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians.Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines.Skibitsky V. V. on behalf of the working group of the “PRIORITET” researchWorking Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

scholarly journals Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
FU Leung Chan ◽  
Yim Chu Li ◽  
Xiao Rui Catherine Chen
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Clinical Practice ◽  
Stepwise Logistic Regression ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Case Register ◽  
Negatively Associated ◽  
Therapeutic Inertia ◽  
Primary Care Settings

Abstract Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

scholarly journals Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case)

2021 ◽  
Vol 23 (1) ◽  
pp. 70-73
Author(s):  
Daria Yu. Sedykh ◽  
◽  
Natalia V. Fedorova ◽  
Vasily V. Kashtalap ◽  
◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Cardiovascular Risk ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
High Cardiovascular Risk ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Lipid Metabolism Disorders ◽  
Very High

The article demonstrates the possibility of prescribing an effective and safe lipid-lowering combination of the most tolerated doses of statins in combination with ezetimibe, using the example of a patient with severe lipid metabolism disorders in the post-infarction period. It has been shown that in real clinical practice, patients with acute coronary syndrome and persisting high LDL values are quite common, despite of the prescription of statins. These patients need closer follow-up and wider use of combined lipid-lowering therapy by adding ezetimibe to maximally tolerated doses of statins. Current clinical guidelines allow this to be done when patients fail to achieve target LDL values (>1.4 mmol/L) with statins monotherapy. This approach is effective and safe, which is illustrated by this hereditary clinical case. In routine clinical practice mandatory lipids control is required 4–6 weeks after patient’s discharge from the hospital for acute coronary syndrome. If the target lipids values were not achieved with the maximum dosage of statins, a mandatory using the combination therapy with ezetimibe is required. Keywords: myocardial infarction, dyslipidemia, improved prognosis, statins, ezetimibe For citation: Sedykh DYu, Fedorova NV, Kashtalap VV. Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case). Consilium Medicum. 2021; 23 (1): 70–73. DOI: 10.26442/20751753.2021.1.200604

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