Abstract W P369: International Variability in Stroke Preventive Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jason Sico ◽  
Catherine Viscoli ◽  
Ashis Tayal ◽  
David Spence ◽  
Gary Ford ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Statin Therapy ◽  
Preventive Care ◽  
Care Delivery ◽  
Heart Association ◽  
Diabetic Patients ◽  
Secondary Prevention Trial ◽  
Research Implementation ◽  
The Us ◽  
The Uk

Introduction: Research protocols for stroke prevention trials commonly specify goals for preventive care. We report variability in goal achievement between 3 countries participating in an on-going stroke secondary prevention trial. Methods: The Insulin Resistance Intervention after Stroke (IRIS) trial is testing pioglitazone, compared with placebo, for prevention of stroke and myocardial infarction among non-diabetic patients with a recent ischemic stroke/TIA. Preventive care is provided by personal physicians, although achievement of prevention goals is monitored and reported to participants and their physicians annually. Goals are from the American Heart Association guidelines: blood pressure (BP) <140/90 mmHg, statin therapy, and anti-platelet or anticoagulation depending on clinical indications. At baseline and year 1, we compared the proportions of participants meeting these goals in the largest enrolling countries: Canada (CA), United Kingdom (UK) and United States (US). Results: Participant characteristics were similar across countries, except the proportions of women and blacks were lower in the UK and CA than the US, and self-reported hypertension was more common in US than CA or UK. At baseline, achievement of BP goal was lower in the UK (53%) compared with the US (66%) and CA (75%) (Chi 2 p<0.0001). Statin therapy was used more commonly in the UK (91%) and CA (88%) compared with the US (80%) (Chi 2 p<0.0001). Differences persisted at year 1. At baseline, use of antithrombotic therapy was high (99%) in all countries. However, at year 1, use fell in US (96%) compared to CA and UK (p=0.02). Conclusions: Secondary preventive care for stroke varied among 3 countries for BP, statin therapy and antithrombotic therapies despite the IRIS protocol specifying uniform goals. These findings may be the result of disagreement among practitioners in the 3 countries for secondary prevention goals, variability in care delivery, or variability in research implementation. Understanding and resolving variability may lead to more efficient research and improved care for patients.

scholarly journals THE PROBLEM OF STATINS DIABETOGENIC POTENTIAL AND WAYS OF ITS SOLUTION (review)

2020 ◽  
Vol 74 (4) ◽  
pp. 147-154
Author(s):  
V. Buheruk ◽  
O. Voloshyna ◽  
O. Dukova ◽  
I. Lysij ◽  
E. Naydionova ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Clinical Trials ◽  
High Risk ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
High Intensity ◽  
Randomized Clinical Trials ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Primary And Secondary Prevention

Aim. Current review summarized and analysed existing evidence of diabetogenic effect of statins and potential ways to overcome this problem in non-diabetic and diabetic patients. Materials and methods. Systematic literature review included results of experimental and clinical studies, multi-center placebo-controlled trials (JUPITER, ТNТ, IDEAL, SPARCL, METSIM, WOSCOPS, ALLHAT-LLT, PROSPER, etc.), systematic reviews and meta-analyses, current guidelines on statin prescription in high-risk patients and non-diabetic patients.Results of the reviewed clinical trials assessing the effects of long-term statin administration, data from randomized clinical trials and genetic studies provide convincing evidence of small, yet significant increase in absolute risk of new-onset diabetes (1 case of diabetes per 1000 patients per 1 year of treatment), concurrently preventing 5 new cases of cardiovascular disease. Diabetogenic properties are identified as probable class-effect of statins, with risk increased in high-intensity statin therapy. Diabetogenic effects are mediated through reduction in pancreatic β-cell function and impaired insulin resistance. Based on current international guidelines (ESC 2019, ADA 2020), the article highlights that despite modest diabetogenic potential, statins are recommended for primary and secondary prevention in patients with high risk of cardiovascular complications, including patients with diabetes. Conclusions. Statin therapy, especially high-intensity dosing can promote new cases of diabetes, particularly in patients with pre-existing metabolic syndrome and insulin resistance. Despite moderate diabetogenic effect statins are routinely recommended (ESC 2019, ADA 2020) for primary and secondary prevention in patients at high risk of cardiovascular complications, including diabetic patients. Statin therapy should be tailored to patient’s age, sex, concomitant diseases, parameters of lipid and glucose metabolism and presence of additional diabetogenic risk factors. Patients require lifestyle modification to reduce the risk of diabetes.

‘To see oursels as ithers see us’: Reflections on Scottish Independence from the United States

2014 ◽  
Vol 23 (3) ◽  
pp. 381-388 ◽  
Author(s):  
Euan Hague ◽  
Alan Mackie
Keyword(s):  
United States ◽  
The United States ◽  
The Us ◽  
Scottish Independence ◽  
The Uk ◽  
Scottish Diaspora

The United States media have given rather little attention to the question of the Scottish referendum despite important economic, political and military links between the US and the UK/Scotland. For some in the US a ‘no’ vote would be greeted with relief given these ties: for others, a ‘yes’ vote would be acclaimed as an underdog escaping England's imperium, a narrative clearly echoing America's own founding story. This article explores commentary in the US press and media as well as reporting evidence from on-going interviews with the Scottish diaspora in the US. It concludes that there is as complex a picture of the 2014 referendum in the United States as there is in Scotland.

Identity Politics and Migration

2008 ◽  
Vol 17 (1) ◽  
pp. 155-158
Author(s):  
Vytis Čiubrinskas
Keyword(s):  
National Identity ◽  
Identity Politics ◽  
Host Country ◽  
Social Anthropology ◽  
The Us ◽  
And Migration ◽  
The Uk ◽  
A Current ◽  
Respective Host

The Centre of Social Anthropology (CSA) at Vytautas Magnus University (VMU) in Kaunas has coordinated projects on this, including a current project on 'Retention of Lithuanian Identity under Conditions of Europeanisation and Globalisation: Patterns of Lithuanian-ness in Response to Identity Politics in Ireland, Norway, Spain, the UK and the US'. This has been designed as a multidisciplinary project. The actual expressions of identity politics of migrant, 'diasporic' or displaced identity of Lithuanian immigrants in their respective host country are being examined alongside with the national identity politics of those countries.

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