Abstract 13354: Effectiveness of a Complex Intervention Based on Electronic Decision Support to Improve Management of Cardiovascular Disease Risk in Primary Healthcare: A Cluster-randomised Controlled Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ruth Webster ◽  
Tim Usherwood ◽  
Rohina Joshi ◽  
Bandana Saini ◽  
Carol Armour ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Decision Support ◽  
High Risk ◽  
Complex Intervention ◽  
Primary Healthcare ◽  
Ldl Cholesterol ◽  
Cvd Risk ◽  
Electronic Decision Support

Introduction: Cardiovascular disease (CVD) risk management is suboptimal in Australian primary healthcare. Following trials demonstrating efficacy of individual components, we developed a complex intervention comprised primarily of electronic point-of-care decision support, availability of cardiovascular polypills and a pharmacy-based adherence program. We sought to determine whether this combined multifaceted intervention, compared with usual care, would improve control of CVD risk factors in the Australian primary care setting. Methods and Results: In a parallel-arm cluster randomized trial, 71 general practices were allocated 1:1 either to the intervention or usual care. The primary outcome was the proportion of patients at high CVD risk and not on optimal preventive treatments at baseline (“high-risk under-treated”) achieving both blood pressure (BP) and low density lipoprotein (LDL) cholesterol targets at study end (BP ≤140/90 mmHg, or ≤130/80 mmHg in people with diabetes or albuminuria; LDL <2.0 mmol/L). All outcomes were evaluated using automated extracts from the electronic medical record. After a median period of 15 months follow-up, among 4477 high-risk under-treated patients in whom follow-up data were available, there was a negligible difference between randomized groups in the proportion achieving SBP and LDL cholesterol targets (19.6% vs. 20.1%; RR 1.06 [95% CI: 0.85 to 1.32]; p=0.59). There was also no major impact of the intervention on any pre-specified secondary outcomes, mostly relating to risk factor screening, preventive medication prescription and risk factor levels. Uptake of all components of the intervention was poor, with greatest use observed for the electronic decision support component (used at least once in 10.7% of high-risk under-treated patients) and minimal use of the other two interventions. Conclusions: Despite the proven efficacy of individual components, this complex multifaceted intervention was poorly adopted and did not lead to relevant improvements in cardiovascular risk factor outcomes.

scholarly journals LA HIPERTRIGLICERIDEMIA EN LA ENFERMEDAD CORONARIA ¿ES UN FACTOR DE RIESGO?

2016 ◽  
Vol 73 (1) ◽  
Author(s):  
L Sonzini ◽  
O Corzo ◽  
F Alfonso ◽  
M Yorio
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Triglyceride Level ◽  
Ldl Cholesterol ◽  
Control Group ◽  
Cvd Risk ◽  
Obesity And Overweight ◽  
The Difference ◽  
De Medicina

La asociación entre hipertrigliceridemia y enfermedad arterial coronaria (EAC) es controvertida. Objetivo: establecer la  relación entre  el nivel  de triglicéridos  en pacientes con  enfermedad  coronaria, relacionar los valores elevados de triglicéridos con colesterol total, colesterol HDL, colesterol LDL,   sobrepeso   y obesidad en pacientes coronarios. Material  Y Métodos: Se evaluaron retrospectivamente pacientes  con y sin enfermedad coronaria demostrable que fueron asistidos en la consulta pública y privada  en la Cátedra de Medicina I Unidad Académica de Medicina Interna Nº 3 del Hospital Córdoba  y el Servicio de Cardiología de la Clínica Sucre de la ciudad de Córdoba, entre en 1 de enero y 31 de diciembre de 2009. Se consideró pacientes con enfermedad coronaria (casos) aquellos que tuvieron lesiones coronarias significativas las que mostraron una disminución de la luz arterial >50% `por medio de cinecoronariografía. (15)(16) y un grupo control sin enfermedad coronaria objetivable. . Se incluyeron pacientes  entre 30 y 60 años de edad que tuvieran historia clínica completa. Resultados: El número total de pacientes incluidos fue de 100 casos,  64 casos en el grupo de  pacientes coronarios y  36 en los no coronarios. 74% de sexo  masculino, predominancia masculina en pacientes coronarios y femenina en no coronarios.  68%  era mayor de 50 años.  Los valores del lipidograma   no mostraron diferencias estadísticamente significativas en pacientes no coronarios y coronarios Los valores promedio  de TG fueron levemente más elevados en el grupo de no coronarios, aunque no mostraron diferencias estadísticamente significativas (p=0,7162). Conclusión: La hipertrigliceridemia no fue mayor en los pacientes coronarios y no se relacionó con  el índice de masa corporal, en pacientes con sobrepeso y obesos.  Summary: Hypercholesterolemia is a well known risk factor for  coronary cardiovascular disease (CVD). However, the role of triglycerides in CVD risk remains controversial. Objective: to study triglyceride level and its relationship with Cholesterol, HDL and LDL Cholesterol level, obesity and overweight in patients with and without CVD. Material and Methods: we retrospectively studied patients with and without CVD who attended to Córdoba Hospital  and Cardiology unit of Clínica Sucre  at Córdoba city between 1° January to 31 st of December of 2009. We included patients with age between 30 to 60 years old with CVD and a control group. Results: 100 patients were included, 64 with CVD and 36 as a control group. 74% were male and 68% older than 50 years old. Lipid values were not statistically significant in both groups. Triglyceride level was higher in the control group, although the difference was not statistically significant (p=0, 7162). Conclusion: Triglyceride level was not higher in patients with CVD.

Abstract P338: Medical Cost Hardship and Incident Cardiovascular Disease (CVD) Among High Risk Individuals in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Lindsay R Pool ◽  
Jared P Reis ◽  
Reto Auer ◽  
David R Jacobs ◽  
Catarina I Kiefe ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Medical Cost ◽  
Proportional Hazards ◽  
Hospital Admissions ◽  
Cox Proportional Hazards ◽  
Time Varying ◽  
Cvd Risk ◽  
Risk Factor Control

Introduction: Having trouble paying for medical care (i.e., medical cost hardship) may impair disease management and thus increase risk of clinical CVD events among adults with CVD risk factor conditions. Hypothesis: We hypothesized medical cost hardship was associated with incidence of CVD among individuals with diagnosed hypertension, hypercholesterolemia, or diabetes. Methods: CARDIA recruited 5,115 individuals aged 18-30 years in 1985-6 (year 0); we included 2,273 participants who self-reported hypertension, hypercholesterolemia, or diabetes or were taking prescription medications for these conditions at years 10, 15, 20, or 25 (45.2% of all participants). At these visits, medical cost hardship was also queried. CVD events were adjudicated from records of hospital admissions, outpatient procedures, and deaths through 2013. Median follow-up time from initial risk factor diagnosis was 12.4 years. Adjusted Cox proportional hazards models determined hazard ratios (HRs) for the first incident CVD event, examining initial and time-varying medical cost hardship. Results: At first report of hypertension, hypercholesterolemia, or diabetes, 27% of subjects reported medical cost hardship, while 51% did so at subsequent examinations. There were 131 CVD events during follow-up. Adjusting for demographic and socioeconomic factors, initial medical cost hardship was a more robust predictor of incident CVD than time-varying cost hardship, HRs 1.54 (95% CI: 1.03, 2.30) and 1.36 (0.88, 2.12), respectively (Table). Risk factor control partially attenuated the association between medical cost hardship and CVD, as did access to healthcare. We found no significant interaction by race and sex. Conclusions: Medical cost hardship was associated with incident CVD in this sample of high-risk individuals, possibly via risk factor control or access to care. Identification of cost hardship at the time of high-risk diagnosis may facilitate connection to low-cost care, improving risk factor control and preventing clinical CVD.

scholarly journals Prediction of Cardiovascular Disease Risk Accounting for Future Initiation of Statin Treatment

2021 ◽  
Author(s):  
Zhe Xu ◽  
Matthew Arnold ◽  
David Stevens ◽  
Stephen Kaptoge ◽  
Lisa Pennells ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Prediction ◽  
Prediction Models ◽  
Predictive Performance ◽  
Statin Treatment ◽  
Clinical Practice Research Datalink ◽  
Cvd Risk ◽  
Risk Prediction Models

Abstract Cardiovascular disease (CVD) risk prediction models are used to identify high-risk individuals and guide statin-initiation. However, these models are usually derived from individuals who may initiate statins during follow-up. We present a simple approach to address statin-initiation to predict “statin-naïve” CVD risk. We analyzed primary care data (2004-2017) from the UK Clinical Practice Research Datalink for 1,678,727 individuals (40-85 years) without CVD or statin treatment history at study entry. We derived age- and sex-specific prediction models including conventional risk factors and a time-dependent effect of statin-initiation constrained to 25% risk reduction (from trial results). We compared predictive performance and measures of public-health impact (e.g., numbers-needed-to-screen to prevent one case) against models ignoring statin-initiation. During a median follow-up of 8.9 years, 103,163 individuals developed CVD. In models accounting for versus ignoring statin initiation, 10-year CVD risk predictions were slightly higher; predictive performance was moderately improved. However, few individuals were reclassified to a high-risk threshold, resulting in negligible improvements in numbers-needed-to-screen to prevent one case. In conclusion, incorporating statin effects from trial results into risk prediction models enables statin-naïve CVD risk estimation, provides moderate gains in predictive ability, but had a limited impact on treatment decision-making under current guidelines in this population.

Abstract P381: Impact Of Switching From Different Treatment Regimens To A Fixed-dose Combination Pill (Polypill) In Patients With Cardiovascular Disease Or Similarly High Risk

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Melvin Lafeber ◽  
Wilko Spiering ◽  
Diederick E Grobbee ◽  
Michiel L Bots ◽  
Ruth Webster ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Relative Risk ◽  
High Risk ◽  
Usual Care ◽  
Ldl Cholesterol ◽  
Fixed Dose ◽  
Lowering Therapy ◽  
Dose Combination

Aims: Cardiovascular fixed-dose combination (FDC) pills, or polypills, may help address the large treatment gaps that exist among patients with cardiovascular disease or similarly high risk. Initiation of polypill-based care in this group typically entails switching from current separately taken medications. Given the heterogeneity in usual care, there is interest in the impact of polypill treatment across different prior medication regimens. Methods: This abstract describes effects of a polypill-based treatment strategy, according to baseline anti platelet, statin and blood pressure (BP)-lowering therapy, in a randomized clinical trial among 2004 participants from India and Europe. The main eligibility criteria were established cardiovascular disease or estimated five year cardiovascular risk of ≥15%. Participants were randomly assigned to a polypill-based treatment strategy or usual care. In the polypill group, physicians could use a polypill that contained aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Baseline medication was reviewed and coded into categories. Statin therapy was defined as less potent than the polypill if estimated LDL-cholesterol reduction was 40%. Estimated cardiovascular risk reduction was calculated by combining risk factor changes with results seen in meta-analyses of previous randomized trials. Results: The effect of the polypill at twelve months was relatable to baseline statin usage, with LDL differences of -0.37, -0.22, -0.14 and -0.07 mmol/L compared to continuing usual care among patients taking no statin, less potent, equipotent and more potent statin at baseline, respectively. Similarly there were differences in systolic BP of -5.4, -6.2, -3.3 and -1.8 mmHg among patients taking 0, 1, 2 or ≥3 BP-lowering agents. Among patients taking more potent statins at baseline, there was no significant difference in LDL-cholesterol but there were benefits for BP and aspirin adherence. Similarly, among patients taking ≥3 BP-lowering agents, there were no differences in BP, but benefits for LDL-cholesterol and aspirin adherence. As a result, there were estimated cardiovascular relative risk reductions across all subgroups defined by baseline medication usage. Conclusion: Adherence benefits from switching to a polypill resulted in risk factor changes that were at least as good as usual care, even when usual care involved more potent regimens. More importantly, switching to a polypill-based strategy resulted in estimated cardiovascular relative risk reductions across a wide range of usual care patterns of antiplatelet, statin and BP-lowering therapy prescribing.

Abstract 55: Kidney Measures Beyond Conventional Risk Factors for Predicting Incident Cardiovascular Disease: A Collaborative Meta-Analysis of 16 Cohorts

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Kunihiro Matsushita ◽  
Josef Coresh ◽  
Yingying Sang ◽  
John Chalmers ◽  
Caroline Fox ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
High Risk ◽  
General Population ◽  
Meta Analysis ◽  
Cvd Risk ◽  
History Of ◽  
Conventional Risk Factors ◽  
Cvd Mortality

Introduction: Despite the high risk of cardiovascular disease (CVD) in those with chronic kidney disease (CKD), there are conflicting data as to whether two key kidney measures, estimated glomerular filtration rate (eGFR) and albuminuria, contribute to better CVD prediction, beyond conventional risk factors, warranting a more comprehensive investigation over a broad range of populations. Methods: We studied 127,825 participants without history of CVD from 12 general population, 3 high risk and 1 CKD cohorts with data on eGFR (based on the CKD-EPI creatinine equation) and urinary albumin-creatinine ratio (ACR) and at least 4 years of median follow-up for CVD mortality (4,133 deaths from 15 cohorts), coronary heart disease (CHD) (5,420 events from 9 cohorts), stroke (2,651 events from 9 cohorts), or heart failure (2,507 events from 8 cohorts). To compare eGFR and ACR with conventional predictors independently of the order of modeling, we examined the worsening of 5-year prediction of CVD outcomes by omitting each predictor in turn compared to a full model with all kidney and conventional predictors. Results: C-statistics for full models ranged from 0.759-0.836 in general population and high risk cohorts and 0.712-0.796 in the CKD population (Table). All the conventional and kidney measures contributed to better prediction of CVD outcomes. The contribution of ACR was greater than that of any conventional modifiable risk factors except in predicting CHD in both general/high-risk cohorts and CKD population. Although weaker than ACR, eGFR also contributed significantly to better prediction of CVD mortality (especially in CKD populations) and CHD. Largely similar results were observed for categorical net reclassification index. Conclusion: The two key kidney measures (particularly albuminuria) contribute as much as some or all of the conventional risk factors to CVD prediction, supporting their use for CVD risk classification in certain circumstances.

Abstract 17412: Vital Exhaustion and Incident Cardiovascular Disease: a Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jincy Thankachen ◽  
Chirag Bavishi ◽  
Randy Cohen ◽  
Alan Rozanski
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Significant Risk ◽  
Cvd Risk ◽  
Vital Exhaustion ◽  
Increased Risk ◽  
Psychosocial Conditions

Background: A number of psychosocial conditions are associated with cardiovascular disease (CVD) events. One such condition is vital exhaustion (VE), defined as a combination of fatigue, increased irritability and feelings of demoralization. To date, a number of studies have examined the association between VE, fatigue (as a stand-alone entity) and subsequent cardiovascular events with varying results. In order to evaluate the potency of VE/fatigue as a CVD risk factor, we conducted a meta-analysis of existing studies concerning these factors in the literature. Methods: A systematic search of PubMed, EMBASE and PsychINFO (1972-May, 2014) was performed to identify all prospective studies involving subjects without baseline CVD, investigating the relationship between VE/fatigue and incident CVD. Unadjusted and adjusted effect estimates were extracted from individual studies. Pooled effect estimates were calculated with DerSimonian and Laird random effects models. Results: Eleven prospective studies with a total of 60, 610 participants and a mean follow-up period of 6.5 years were included in the analysis. A significant association was observed between VE/fatigue and incident CVD, using both unadjusted estimates [Pooled Relative Risk: 1.69 (CI: 1.31-2.18), p<0.001] and adjusted estimates from individual studies [Pooled RR: 1.36 (CI: 1.14-1.63), p=0.001]. Subgroup analysis by years of follow-up and type of VE/fatigue questionnaire yielded similar increased risk of incident CVD. Conclusions: VE/fatigue is a significant risk factor for incident CVD in healthy subjects, comparable in potency to some of the other common psychosocial risk factors for cardiac disease.

scholarly journals Vitamin D and Cardiovascular Disease: An Updated Narrative Review

2021 ◽  
Vol 22 (6) ◽  
pp. 2896
Author(s):  
Armin Zittermann ◽  
Christian Trummer ◽  
Verena Theiler-Schwetz ◽  
Elisabeth Lerchbaum ◽  
Winfried März ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Vitamin D ◽  
High Risk ◽  
General Population ◽  
Vitamin D Deficiency ◽  
Specific Gene ◽  
Vitamin D Status ◽  
Cvd Risk ◽  
Severe Vitamin ◽  
Increased Risk

During the last two decades, the potential impact of vitamin D on the risk of cardiovascular disease (CVD) has been rigorously studied. Data regarding the effect of vitamin D on CVD risk are puzzling: observational data indicate an inverse nonlinear association between vitamin D status and CVD events, with the highest CVD risk at severe vitamin D deficiency; however, preclinical data and randomized controlled trials (RCTs) show several beneficial effects of vitamin D on the surrogate parameters of vascular and cardiac function. By contrast, Mendelian randomization studies and large RCTs in the general population and in patients with chronic kidney disease, a high-risk group for CVD events, largely report no significant beneficial effect of vitamin D treatment on CVD events. In patients with rickets and osteomalacia, cardiovascular complications are infrequently reported, except for an increased risk of heart failure. In conclusion, there is no strong evidence for beneficial vitamin D effects on CVD risk, either in the general population or in high-risk groups. Whether some subgroups such as individuals with severe vitamin D deficiency or a combination of low vitamin D status with specific gene variants and/or certain nutrition/lifestyle factors would benefit from vitamin D (metabolite) administration, remains to be studied.

scholarly journals Association between Soy Food and Dietary Soy Isoflavone Intake and the Risk of Cardiovascular Disease in Women: A Prospective Cohort Study in Korea

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1407
Author(s):  
Jihyun Im ◽  
Kyong Park
Keyword(s):  
Cardiovascular Disease ◽  
Postmenopausal Women ◽  
Premenopausal Women ◽  
Soy Isoflavones ◽  
Korean Women ◽  
Cvd Risk ◽  
Soy Isoflavone ◽  
Soy Foods ◽  
Cardiovascular Disease In Women

The association between soy food and soy isoflavone intake and cardiovascular disease (CVD) risk is uncertain, especially in women. We aimed to investigate this association in Korean women. We analyzed data from the Korean Genome and Epidemiology Study, including 4713 Korean women aged 40–69 years with no CVD or cancer at baseline. Dietary information was obtained using a validated semi-quantitative food frequency questionnaire, and the incidence of CVD was assessed using biennial self-reported questionnaires on medical history. The mean follow-up time was 7.4 years, during which 82 premenopausal and 200 postmenopausal women reported CVD incidence. The highest tofu, total soy foods, and dietary soy isoflavone intake groups were significantly associated with a decreased CVD risk in premenopausal women (tofu: hazard ratio (HR) 0.39; 95% confidence interval (CI), 0.19–0.80; total soy food: HR 0.36; 95% CI, 0.18–0.70; dietary soy isoflavones: HR 0.44; 95% CI, 0.22–0.89), whereas no association was observed in postmenopausal women. Other soy foods showed no association with CVD incidence. Dietary soy isoflavones and total soy foods are associated with a decreased CVD risk in premenopausal women. Among soy foods, only tofu showed significant health benefits.

scholarly journals Multi-trajectories of lipid indices with incident cardiovascular disease, heart failure, and all-cause mortality: 23 years follow-up of two US cohort studies

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Fatemeh Koohi ◽  
Davood Khalili ◽  
Mohammad Ali Mansournia ◽  
Farzad Hadaegh ◽  
Hamid Soori
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cohort Studies ◽  
Significant Risk ◽  
Density Lipoprotein ◽  
Lipid Levels ◽  
Cvd Risk ◽  
All Cause Mortality ◽  
Over Time

Abstract Background Understanding the distinct patterns (trajectories) of variation in blood lipid levels before diagnosing cardiovascular disease (CVD) might carry important implications for improving disease prevention or treatment. Methods We investigated 14,373 participants (45.5% men) aged 45–84 from two large US prospective cohort studies with a median of 23 years follow-up. First, we jointly estimated developmental trajectories of lipid indices, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations using group-based multi-trajectory modeling. Then, the association of identified multi-trajectories with incident CVD, heart failure, and all-cause mortality were examined using Cox proportional hazard model. Results Seven distinct multi-trajectories were identified. The majority of participants (approximately 80%) exhibited decreasing LDL-C but rising TG levels and relatively stable HDL-C levels. Compared to the individuals with healthy and stable LDL-C, HDL-C, and TG levels, those in other groups were at significant risk of incident CVD after adjusting for other conventional risk factors. Individuals with the highest but decreasing LDL-C and borderline high and rising TG levels over time were at the highest risk than those in other groups with a 2.22-fold risk of CVD. Also, those with the highest and increased triglyceride levels over time, over optimal and decreasing LDL-C levels, and the lowest HDL-C profile had a nearly 1.84 times CVD risk. Even individuals in the multi-trajectory group with the highest HDL-C, optimal LDL-C, and optimal TG levels had a significant risk (HR, 1.45; 95% CI 1.02–2.08). Furthermore, only those with the highest HDL-C profile increased the risk of heart failure by 1.5-fold (95% CI 1.07–2.06). Conclusions The trajectories and risk of CVD identified in this study demonstrated that despite a decline in LDL-C over time, a significant amount of residual risk for CVD remains. These findings suggest the impact of the increasing trend of TG on CVD risk and emphasize the importance of assessing the lipid levels at each visit and undertaking potential interventions that lower triglyceride concentrations to reduce the residual risk of CVD, even among those with the optimal LDL-C level.

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