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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2002;162:385.
Impact of a Targeted Intervention on Lipid-Lowering Therapy in Patients
With Coronary Artery Disease in the Hospital Setting
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.
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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.
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(SEE ARTICLE)
Association of Tobacco Smoking With Goiter in a Low-Iodine-Intake Area
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.
(SEE ARTICLE)
What Is C-Reactive Protein Telling Us About Coronary Artery Disease?
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.
(SEE ARTICLE)
Modifiable Cardiovascular Risk Factors in Adults With Diabetes: Prevalence
and Missed Opportunities for Physician Counseling
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.
(SEE ARTICLE)
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