553 We have to rethink how to use risk tables when making treatment decisions, taking into consideration the medicalisation of healthy older people and the correct use of drugs.
554 NICE's simplified approach to lipids will not work.
555 Time to label sodium in drug treatments? A soluble paracetamol tablet contains 388 mmols of sodium. Could this be related to the relation between regular use of paracetamol and hypertension?
556 Regular users of paracetamol at risk of hypertension
557 Describes the develoment and validation of QRISK2, a new and perhaps more accurate risk assessment tool which takes account of ethnicity, deprivation and other clinical conditions.
558 A succint resumé of the cholesterol story. What is it? Who gets it? How to investigate.Treatment. Targets
559 A succint resumé of the familial hypercholesterolaemia story
560 A summary of the NICE guidelines for both assessing and modifying lipids in secondary prevention. The full guidelines can be found here.
561 Preventing CHD - three strategies. 'Population' reduce cholesterol by 2% in the whole population would reduce deaths from CHD by2.7%. 'Single risk factor' targetting patients with cholesterol greater than 6.2. 'Baseline risk' targetting those with a baseline risk greater than 15% over 5 years. Baseline risk most effective, it is estimated to prevent seven times more deaths from CHD than the population strategy.
562 Debate about prevention of CHD is polarised between evangelists for high risk and population-wide approaches. Cost effective high risk strategies must be complemented by cost effective population-wide interventions.
563 Telling patients their spirometric lung age significantly improves the likelihood of them quitting smoking.
564 Population approach? Only those at high risk? Drug treatment for entire populations (the polypill)? Are we medicalising healthy people?
565 The importance of communicating information about the pros and cons of screening so that people can make an informed choice.
566 Polypill to save 80% of heart attacks? Deploying it on a population basis? (Prof Wald) Better to concentrate on education? (Prof Fuster) "It's a mistake to think that when you can do things two ways it has to be done one way or the other" (Prof Wald). No studies yet on polypill in populations.
567 The Clinical metabolic syndrome and resting ECG do not enhance prognostic information b eyond traditional risk factors. Stress ECG, laboratory biomarkers not very helpful. Informing patients of their risk does not seem to improve outcomes.
568 In 85yr olds with no history of CVS disease classic risk factors not much good at 5 year prediction of CHD. Plasma homocysteine measurement may be a better marker in this age group.
569 Lower statin doses than currently advised reduced CHD risk by 80% in patients with familial hypercholesterolaemia. Statin treated patients older than55 had a similar risk of myocardial infarction as a similar sample from the general population.
570 As a group, African Americans have high rates of heart disease. This includes CAD, stroke, high blood pressure, and heart failure, among other conditions. The American Heart Association (AHA) says that about 40% of both African American men and women have some form of heart disease. In contrast, among white people, the numbers are about 30% for men and 24% for women. Heart disease affects more than one quarter of Mexican American men and women. (The data did not include all Latino or Hispanic groups.)
571 While racial groups may be useful, itís important to remember that they only give a general picture. For example, Asian Pacific Islanders are very diverse. People of South Asian descent are at high risk for heart disease, but people of Japanese descent are not.
572 Independent evaluation of QRISK showed an improvement in performance over the Framingham equations in a large external cohort of UK patients.
573 A QRISK based algorithm should repplace the currently recommended Framingham based algorithm for estimating cardiovascular risk in the UK. However it is just the first of many continuously updatable prediction algorithms.
574 The vast majority of patients with familial hypercholesterolaemia are unrecognised in general practice. Around 1 in 500 people are affected but only 15% of these attend lipid clinics. Primary care has a role in systematic and opportunistic case finding.
577 There is strong evidence to show that opportunistic early identification and brief advice administered by GPs and other health professionals is effective in reducing alcohol consumption.
578 New guidelines from USA indicate that once lifestyle interventions have been exhausted drugs should be started on the basis of patient risk, that only those drugs known to reduce risk should be used, and that a singular focus on cholesterol conentrations should be abandoned.
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