Although lipid-lowering therapy according to guidelines by the National Cholesterol Education Program (NCEP) decreases mortality and morbidity in patients with coronary artery disease, significant undertreatment of hyperlipidemia continues to exist. This study demonstrated that a cardiac case manager intervention targeted at improving the use of lipid lowering therapy in patients with coronary artery disease in the hospital setting significantly increased physicians' adherence to the NCEP treatment guidelines. Programs of this nature implemented nationally can result in a significant positive impact on clinical and economic cardiovascular outcomes.
Process algorithm for patients with coronary artery disease who were admitted for percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, or myocardial infarction. Testing and treatment interventions indicate periods when cardiac case managers prompted physicians to test or treat lipid levels according to the National Cholesterol Education Program guidelines.
The association between tobacco smoking and goiter prevalence was investigated in 4649 Danish subjects from the general population. The thyroid was investigated by ultrasonography and clinical examination. A higher goiter prevalence was found among smokers after adjustment for age, sex, and other possible confounding factors. The association was significantly stronger in the area with the most pronounced iodine deficiency, suggesting a synergistic effect of smoking and iodine deficiency on goiter prevalence. It was estimated that 50% of goiter cases in these areas could be ascribed to tobacco smoking.
The authors ask several questions regarding a recent series of articles promoting C-reactive protein (CRP) as a test to assess risk for coronary artery disease, including the following: Can CRP provide meaningful information about coronary artery disease at the low levels indicated? Can CRP have specificity for predicting risk of coronary artery disease? Is CRP useful for predicting risk in a symptomatic population? Although published studies address relative risk in an epidemiological fashion, they do not address the predictive value for clinical care. Based on published studies, the authors conclude that reference intervals must be stratified by age, sex, body mass, and smoking history, and that estimated calculations indicate that the positive predictive values are very low. The authors conclude that CRP measurement has limited value for predicting coronary artery disease in the general population or in symptomatic patients.
Persons with diabetes mellitus (DM) have a 2- to 4-fold greater risk of death from cardiovascular disease (CVD) than adults in the general population of similar age, and the onset of CVD in patients with DM dramatically worsens prognosis and increases the cost of care. Certain CVD risk factors are amenable to lifestyle modification if physicians provide counseling. This study compared 9496 adults with DM with 150 493 adults without DM using respondents from the 1999 Behavioral Risk Factor Surveillance System to determine the prevalence of modifiable CVD risk factors among adults with DM and the prevalence of counseling by physicians about such risk factors. Persons with DM had significantly higher prevalence of hypertension, high cholesterol, insufficient physical activity, and overweight or obesity than persons without DM. Among persons with DM, women, older adults (>55 years), blacks, and Hispanics were at high risk. The prevalence of CVD risk factor counseling by physicians among persons with DM ranged from 50% (weight loss) to 78% (smoking cessation). The authors conclude that primary care physicians need to improve on counseling about lifestyle modification for adults with DM.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2002;162(4):385. doi:10.1001/archinte.162.4.385