scholarly journals General Practitioners’ adherence to prescribing guidelines for statins in the United Kingdoms

2019 ◽  
Author(s):  
Federico Ricciardi ◽  
Irwin Nazareth ◽  
Irene Petersen
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Statin Therapy ◽  
Risk Score ◽  
Smoking Status ◽  
Risk Scores ◽  
List Type ◽  
Cvd Risk ◽  
Nice Guideline ◽  
Clinical Records

ABSTRACTObjectiveIn this retrospective cohort study we aimed to assess, in 202,247 people who started a statin therapy between 2007-2014, the factors that led to the initiation of the drug. To do this we explored CVD risk factors singularly and in combinations as recorded in electronic health records in the year before they receive their first prescription and we compared the risk scores with that suggested by the NICE guideline at that time.MethodsWe summarised demographic characteristics and proportions of people with a risk score below the threshold. Regression-based analyses are performed to evaluate the association between the missingness of the risk score and relevant risk score components.Results45,364 individuals (22.4%) were prescribed statins without a record of a risk score being available in the year prior to the prescription date. When the risk score was available, 68,174 out of 156,883 patients were prescribed statins even with a score below the 20% threshold. Smoking status was the most frequently recorded variable (74.9% of the instances), followed by systolic blood pressure (71.6%) and total cholesterol (70%), while HDL cholesterol was the least recorded (34.1%). Cholesterol levels are positively associated with the missingness of the risk score, while systolic blood pressure shows a negative association.ConclusionsGPs often start statins on people with no risk score recorded in their clinical records or in those with risk scores below the recommended threshold. Higher cholesterol values may result in a GP starting statin therapy without recording the other relevant components required to calculate a risk score.STRENGTHS AND LIMITATIONS OF THIS STUDYOur cohort contains a large number of individuals: the study provide a representative picture of initiation of statins in UK primary care.We specifically focus on which variables and factors GPs record in electronic databases in the year prior statin treatment initiation: this is the first study to directly tackle the issue of statins prescribing in the absence of all the information required by the NICE guidelineWe are not able to verify if GPs actually used the records of the individual health indicators, when these were available, to calculate the risk score.

scholarly journals Evaluation of Cardiovascular Diseases Risk in the Iranian Population

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Meisam Akhlaghdoust ◽  
Davoud Pirani ◽  
Mohamad Nasiri ◽  
Sahar Lashkari Ahangarani ◽  
Nazgol Haghsetan ◽  
...  
Keyword(s):  
Family History ◽  
Cardiovascular Diseases ◽  
Risk Score ◽  
Smoking Status ◽  
Positive Family History ◽  
Iranian Population ◽  
Risk Scores ◽  
Cvd Risk ◽  
Assessment Scores ◽  
History Of

Background: Cardiovascular diseases (CVDs) are among the leading causes of death and morbidity around the world. Risk score assessment can assist in anticipating a person's CVD risk over the next five years. Objectives: This study aimed to investigate the risk of CVDs in the general Iranian population. Methods: This study was conducted in September 2020, and 5324 participants aged 35 to 74 years were registered from 95 metro stations throughout Tehran. Participants' demographics (ie, age, gender, current smoking and exercise habits, and family history of hypertension, CVDs, and diabetes) were collected by in-person interviews, and their body mass index (BMI) and systolic blood pressure (SBP) were measured. The five-year risk of CVDs was estimated and categorized into low (< 10%), some risk (10 - 20%), moderate (21 - 30%), increased (31 - 40%), and high (> 40%) groups, and its association with the participants’ demographics was evaluated by SPSS version 21. Results: The mean age of 5324 participants was 45.3 ± 14.8 years, and 64% were male. The frequency of CVD risk scores was as follows: low (54%), some risk (17.5%), moderate (15.4%), increased (5.7%), and high (3.5%), which were significantly associated with gender (P < 0.001), smoking status (P = 0.048), exercise (P = 0.014), and family history of diseases (all P < 0.001). Age (β = 0.774, P < 0.001) increased the odds of CVD, while other variables had small or no effects on CVD. Conclusions: This study found a high prevalence of high-risk CVD in the Iranian population, emphasizing the importance of risk score assessment, which should include not only basic non-laboratory risk assessment scores, but also exercise and a positive family history of associated diseases.

Abstract P371: Incremental Changes in Systolic Blood Pressure Post-mild Exercise, in Normotensive Subjects, is Associated With Significant Structural and Functional Cardiovascular Abnormalities

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Susan Tucker ◽  
Arjun Byju ◽  
Mahfouz El Shahawy
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Risk Score ◽  
Health Care Practitioner ◽  
Cvd Risk ◽  
Cardiovascular Abnormalities ◽  
Artery Stiffness ◽  
Normotensive Subjects ◽  
Asymptomatic Subjects ◽  
Retinal Photography

Background: Abnormal rise in systolic blood pressure (SBP) post-mild exercise (PME) has been associated with early structural and functional cardiovascular abnormalities. Purpose: To determine if the differential amount of rise in SBP PME, in normotensive subjects, effected the risk of early structural and functional cardiovascular abnormalities. Methods: 1416 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro-BNP. 996 subjects were normotensive. Of those subjects, 30 subjects had an abnormal rise in SBP PME between 30-40mmHg and 14 had an abnormal rise in SBP PME >40 mmHg. Focus was placed on the three tests recommended for early CVD assessment; C1, C2 and CIMT. Results: As seen in Figure 1.0, an abnormal rise in SBP PME greater than 40mmHg is associated with a statistically significant increase in risk of early structural and functional cardiovascular abnormalities in untreated, asymptomatic, normotensive subjects opposed to those who only had an increase between 30-40mmHg. Conclusion: Assessment of SBP PME is an easy, noninvasive, inexpensive test that can be performed by any health care practitioner to evaluate the risk of CVD in patients. Based on the severity of the increase in SBP PME should warrant physicians on the urgency to further investigate and treat patients to divert the progression of CVD.

scholarly journals The Relationship between Cardiovascular Risk Scores and Several Markers of Subclinical Atherosclerosis in an Asymptomatic Population

2021 ◽  
Vol 10 (5) ◽  
pp. 955
Author(s):  
Ovidiu Mitu ◽  
Adrian Crisan ◽  
Simon Redwood ◽  
Ioan-Elian Cazacu-Davidescu ◽  
Ivona Mitu ◽  
...  
Keyword(s):  
Risk Score ◽  
Subclinical Atherosclerosis ◽  
Ankle Brachial Index ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Risk Scores ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Single Center Study ◽  
Asymptomatic Individuals

Background: The current cardiovascular disease (CVD) primary prevention guidelines prioritize risk stratification by using clinical risk scores. However, subclinical atherosclerosis may rest long term undetected. This study aimed to evaluate multiple subclinical atherosclerosis parameters in relation to several CV risk scores in asymptomatic individuals. Methods: A cross-sectional, single-center study included 120 asymptomatic CVD subjects. Four CVD risk scores were computed: SCORE, Framingham, QRISK, and PROCAM. Subclinical atherosclerosis has been determined by carotid intima-media thickness (cIMT), pulse wave velocity (PWV), aortic and brachial augmentation indexes (AIXAo, respectively AIXbr), aortic systolic blood pressure (SBPao), and ankle-brachial index (ABI). Results: The mean age was 52.01 ± 10.73 years. For cIMT—SCORE was more sensitive; for PWV—Framingham score was more sensitive; for AIXbr—QRISK and PROCAM were more sensitive while for AIXao—QRISK presented better results. As for SBPao—SCORE presented more sensitive results. However, ABI did not correlate with any CVD risk score. Conclusions: All four CV risk scores are associated with markers of subclinical atherosclerosis in asymptomatic population, except for ABI, with specific particularities for each CVD risk score. Moreover, we propose specific cut-off values of CV risk scores that may indicate the need for subclinical atherosclerosis assessment.

scholarly journals Urinary sodium excretion and the risk of cardiovascular disease: A community-based cohort study in Taiwan

2021 ◽  
pp. 1-42
Author(s):  
Yi-Jie Wang ◽  
Kuo-Lioug Chien ◽  
Hsiu-Ching Hsu ◽  
Hung-Ju Lin ◽  
Ta-Chen Su ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Systolic Blood Pressure ◽  
Sodium Excretion ◽  
Urinary Sodium Excretion ◽  
Salt Sensitivity ◽  
Urinary Sodium ◽  
Mediating Effect ◽  
Cvd Risk ◽  
Media Thickness

Abstract Urinary sodium excretion is a potential risk factor for cardiovascular diseases (CVD). However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterize the relative contribution of biological factors to the sodium-CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour sodium excretion was estimated using a single overnight urine sample. Hypertension, metabolic syndrome, and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary sodium excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (standard deviation) of the 2112 participants was 54.5 (12.2) years, and they were followed up for a mean of 14.1 [8.1] years. Compared with those in the lowest quartile, the highest baseline urinary sodium excretion (>4.2g/24 hours) was associated with a 43% higher CVD risk (hazard ratio, 1.43; 95% confidence interval, 1.02-1.99). Participants with high urinary sodium excretion, hypertension, or metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35% of the sodium-CVD association), followed by systolic blood pressure (33%), left ventricular mass (28%), and diastolic blood pressure (14%). Higher urinary sodium excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic blood pressure.

scholarly journals Biomarker-estimated flavan-3-ol intake is associated with lower blood pressure in cross-sectional analysis in EPIC Norfolk

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Javier I. Ottaviani ◽  
Abigail Britten ◽  
Debora Lucarelli ◽  
Robert Luben ◽  
Angela A. Mulligan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Vascular Function ◽  
Cardiovascular Health ◽  
Vascular Diseases ◽  
Inverse Association ◽  
Cvd Risk ◽  
Lower Systolic Blood Pressure ◽  
Cross Sectional ◽  
Salt Reduction

Abstract Flavan-3-ols are a group of bioactive compounds that have been shown to improve vascular function in intervention studies. They are therefore of great interest for the development of dietary recommendation for the prevention of cardio-vascular diseases. However, there are currently no reliable data from observational studies, as the high variability in the flavan-3-ol content of food makes it difficult to estimate actual intake without nutritional biomarkers. In this study, we investigated cross-sectional associations between biomarker-estimated flavan-3-ol intake and blood pressure and other CVD risk markers, as well as longitudinal associations with CVD risk in 25,618 participants of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort. High flavan-3-ol intake, achievable as part of an habitual diet, was associated with a significantly lower systolic blood pressure (− 1.9 (− 2.7; − 1.1) mmHg in men and − 2.5 (− 3.3; − 1.8) mmHg in women; lowest vs highest decile of biomarker), comparable to adherence to a Mediterranean Diet or moderate salt reduction. Subgroup analyses showed that hypertensive participants had stronger inverse association between flavan-3-ol biomarker and systolic blood pressure when compared to normotensive participants. Flavanol intake could therefore have a role in the maintenance of cardiovascular health on a population scale.

scholarly journals Risk score to stratify miscarriage risk levels in preconception women

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xin Hui Choo ◽  
Chee Wai Ku ◽  
Yin Bun Cheung ◽  
Keith M. Godfrey ◽  
Yap-Seng Chong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Smoking Status ◽  
Characteristic Curve ◽  
Lifestyle Changes ◽  
Risk Scores ◽  
Risk Level ◽  
Multivariable Logistic Regression Model ◽  
Spontaneous Miscarriage ◽  
Risk Levels

AbstractSpontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.

Abstract 086: Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes: International Insights From the TECOS Trial

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Neha J Pagidipati ◽  
Ann Marie Navar ◽  
Karen S Pieper ◽  
Jennifer B Green ◽  
M. A Bethel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Latin America ◽  
North America ◽  
Secondary Prevention ◽  
Eastern Europe ◽  
Statin Therapy ◽  
Smoking Status ◽  
Pressure Control ◽  
Patients With Diabetes

Background: Intensive risk factor modification significantly improves outcomes for patients with diabetes and cardiovascular disease (CVD). However, the degree to which secondary prevention treatment targets are achieved in international clinical practice is unknown. Methods: Attainment of 5 secondary prevention targets—aspirin use, lipid control (low-density lipoprotein cholesterol (LDL-C) <70 mg/dL or statin therapy), blood pressure control (<140 mmHg systolic, <90 mmHg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and non-smoking status—was evaluated among 14,671 patients from 38 countries with diabetes and known CVD at entry into TECOS. Logistic regression was used to evaluate the association between individual and regional factors and target achievement. Results: Overall, 29.9% of patients with diabetes and CVD had all 5 secondary prevention measures at target. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of approximately 25%. The likelihood of having individual prevention components at target also varied by region: compared with North America, individuals in all other regions were less likely to have blood pressure at goal, and individuals in Eastern Europe and Latin America were less likely to have LDL-C at target or to be on statin therapy (see Figure). Overall, blood pressure control (57.9%) had the lowest overall attainment while non-smoking status had the highest (89%). Conclusions: On a global scale, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients with diabetes and CVD, which in turn could lead to reduced risk of downstream cardiovascular events.

Abstract P261: Intensive Systolic Blood Pressure Lowering Will Prevent Over 100,000 Deaths Annually

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Holly Kramer ◽  
Adam Bress ◽  
Srinivasan Beddhu ◽  
Paul Muntner ◽  
Richard S Cooper
Keyword(s):  
Blood Pressure ◽  
Mortality Rate ◽  
Systolic Blood Pressure ◽  
Mortality Rates ◽  
Mortality Data ◽  
Blood Pressure Lowering ◽  
Cvd Risk ◽  
Pressure Lowering ◽  
Annual Mortality ◽  
The U.S

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) trial randomized 9,361 adults aged ≥50 years at high cardiovascular disease (CVD) risk without diabetes or stroke to intensive systolic blood pressure (SBP) lowering (≤120 mmHg) or standard SBP lowering (≤140 mmHg). After a median follow up of 3.26 years, all-cause mortality was 27% (95% CI 40%, 10%) lower with intensive SBP lowering. We estimated the potential number of prevented deaths with intensive SBP lowering in the U.S. population meeting SPRINT criteria. Methods: SPRINT eligibility criteria were applied to the National Health and Nutrition Examination Survey 1999-2006, a representative survey of the U.S. population, linked with the mortality data through December 2011. Eligibility included (1) age ≥50 years with (2) SBP 130-180 mmHg depending on number of antihypertensive classes being taken, and (3) presence of ≥1 CVD risk conditions (history of coronary heart disease, estimated glomerular filtration rate (eGFR) 20 to 59 ml/min/1.73 m 2 , 10-year Framingham risk score ≥15%, or age ≥75 years). Adults with diabetes, stroke history, >1 g/day proteinuria, heart failure, on dialysis, or eGFR<20 ml/min/1.73m 2 were excluded. Annual mortality rates for adults meeting SPRINT criteria were calculated using Kaplan-Meier methods and the expected reduction in mortality rates with intensive SBP lowering in SPRINT was used to determine the number of potential deaths prevented. Analyses accounted for the complex survey design. Results: An estimated 18.1 million U.S. adults met SPRINT criteria with 7.4 million taking blood pressure lowering medications. The mean age was 68.6 years and 83.2% and 7.4% were non-Hispanic white and non-Hispanic black, respectively. The annual mortality rate was 2.2% (95% CI 1.9%, 2.5%) and intensive SBP lowering was projected to prevent 107,453 deaths per year (95% CI 45,374 to 139,490). Among adults with SBP ≥145 mmHg, the annual mortality rate was 2.5% (95% CI 2.1%, 3.0%) and intensive SBP lowering was projected to prevent 60,908 deaths per year (95% CI 26, 455 to 76, 792). Conclusions: We project intensive SBP lowering could prevent over 100,000 deaths per year of intensive treatment.

Abstract P052: Circulating Natural Killer Cells and Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nancy S Jenny ◽  
Nels C Olson ◽  
Alicia M Ellis ◽  
Margaret F Doyle ◽  
Sally A Huber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Nk Cells ◽  
Nk Cell ◽  
Agatston Score ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Race Ethnicity

Introduction: Clinically, natural killer (NK) cells are important in inflammatory and autoimmune diseases. As part of innate immunity, NK cells produce chemokines and inflammatory cytokines, potentially linking them to cardiovascular disease (CVD) development and progression as well. However, their role in human CVD is not clear. Hypothesis: NK cells are proatherogenic in humans and are associated with CVD risk factors and subclinical CVD measures. Methods: We examined cross-sectional associations of circulating NK cell levels with CVD risk factors, subclinical CVD measures and coronary artery calcium (CAC) in 891 White, Black, Chinese and Hispanic men and women (mean age 66 y) in the Multi-Ethnic Study of Atherosclerosis (MESA) at Exam 4 (2005-07). NK cell percent, percent of circulating lymphocytes that were CD3 - CD56 + CD16 + , was measured in whole blood by flow cytometry. CAC presence was defined as Agatston score > 0. Results: Mean (standard deviation) NK percent differed by race/ethnicity; 8.2% (4.7) in Whites, 11.3% (7.5) in Chinese (p<0.001 compared to Whites), 7.1 (4.2) in Blacks (p=0.007) and 8.4 (5.2) in Hispanics (p=0.6). NK cell percent was positively associated with age (p<0.001) and systolic blood pressure (P=0.003) in the full group. However, NK cell percent was lower in current smokers than in never smokers (p=0.002). Adjusting for age, sex, race/ethnicity, smoking, body mass index, systolic blood pressure, diabetes and dyslipidemia, NK cell percent was negatively associated with common carotid intima media thickness (IMT; β coefficient -0.01; 95% confidence interval -0.03, -0.003) but was not associated with internal carotid IMT (-0.002; -0.037, 0.033). Likewise, NK cell percent was not associated with the presence of CAC (compared those with no detectable CAC; relative risk 1.02; 95% confidence interval 0.96, 1.08) or continuous Agatston score in those with a positive score (β coefficient 0.16, 95% confidence interval -0.003, 0.32) in the full group (models adjusted as above). Results were similar across race/ethnic groups. Conclusions: Of clinical interest, CD3 - CD56 + CD16 + NK cell percent varied significantly by race/ethnicity in these men and women from MESA. However, NK cell percent was inconsistently associated with CVD risk factors; positively with age and systolic blood pressure, and negatively with smoking. NK cell percent was also negatively associated with common carotid IMT. Larger sample sizes and longitudinal analyses will be required to clarify the potential relationship between NK cells and atherosclerosis in humans.

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