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The 2003 Canadian recommendations for dyslipidemia management: revisions are needed.

https://arctichealth.org/en/permalink/ahliterature175311
Source
CMAJ. 2005 Apr 12;172(8):1027-31
Publication Type
Article
Date
Apr-12-2005
Author
Douglas G Manuel
Peter Tanuseputro
Cameron A Mustard
Susan E Schultz
Geoffrey M Anderson
Sten Ardal
David A Alter
Andreas Laupacis
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ont. doug.manuel@ices.on.ca
Source
CMAJ. 2005 Apr 12;172(8):1027-31
Date
Apr-12-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cholesterol, LDL - blood
Coronary Disease - mortality - prevention & control
Cost-Benefit Analysis
Health Expenditures
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hyperlipidemias - drug therapy
Hypolipidemic Agents - therapeutic use
Middle Aged
Practice Guidelines as Topic
Risk factors
Notes
Cites: Eur Heart J. 2003 Sep;24(17):1601-1012964575
Cites: CMAJ. 2003 Jun 24;168(13):1644-5; author reply 1645-612821610
Cites: Can J Cardiol. 2003 Nov;19(12):1359-6614631469
Cites: Can J Cardiol. 2003 Dec;19(13):1499-50214760440
Cites: Am J Med. 2004 Apr 15;116(8):540-515063816
Cites: JAMA. 2004 Apr 21;291(15):1864-7015100205
Cites: Am Heart J. 1991 Jan;121(1 Pt 2):293-81985385
Cites: N Engl J Med. 1998 Nov 5;339(19):1349-579841303
Cites: Can J Cardiol. 1999 Apr;15(4):445-5110322254
Cites: CMAJ. 2003 Oct 28;169(9):921-414581310
Cites: Fam Pract. 2003 Feb;20(1):16-2112509365
Cites: JAMA. 2002 Jul 24-31;288(4):462-712132976
Cites: JAMA. 2002 Jul 24-31;288(4):455-6112132975
Cites: JAMA. 1999 Dec 22-29;282(24):2340-610612322
Cites: CMAJ. 2000 May 16;162(10):1441-710834048
Cites: CMAJ. 2000 Aug 22;163(4):403-810976255
Cites: Lancet. 2002 Jul 6;360(9326):7-2212114036
Comment In: CMAJ. 2005 Nov 8;173(10):1210; author reply 121016275979
Comment In: CMAJ. 2005 Nov 8;173(10):1207; author reply 121016275976
Comment In: CMAJ. 2005 Apr 12;172(8):1033-4; discussion 103715824410
Erratum In: CMAJ. 2005 Jul 19;173(2):133
PubMed ID
15824409 View in PubMed
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The 2006 Canadian dyslipidemia guidelines will prevent more deaths while treating fewer people--but should they be further modified?

https://arctichealth.org/en/permalink/ahliterature155805
Source
Can J Cardiol. 2008 Aug;24(8):617-20
Publication Type
Article
Date
Aug-2008
Author
Douglas G Manuel
Sarah Wilson
Sarah Maaten
Author Affiliation
Institute for Clinical Evaluative Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada. doug.manuel@ices.on.ca
Source
Can J Cardiol. 2008 Aug;24(8):617-20
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Aged
Canada
Coronary Artery Disease - genetics - mortality - prevention & control
Cross-Cultural Comparison
Dyslipidemias - drug therapy - genetics - mortality
Health Services Accessibility - statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Middle Aged
Practice Guidelines as Topic - standards
Risk factors
Survival Analysis
Treatment Outcome
Abstract
When clinical guidelines affect large numbers of individuals or substantial resources, it is important to understand their benefits, harms and costs from a population perspective. Many countries' dyslipidemia guidelines include these perspectives.
To compare the effectiveness and efficiency of the 2003 and 2006 Canadian dyslipidemia guidelines for statin treatment in reducing deaths from coronary artery disease (CAD) in the Canadian population.
The 2003 and 2006 Canadian dyslipidemia guidelines were applied to data from the Canadian Heart Health Survey (weighted sample of 12,300,000 people), which includes information on family history and physical measurements, including fasting lipid profiles. The number of people recommended for statin treatment, the potential number of CAD deaths avoided and the number needed to treat to avoid one CAD death with five years of statin therapy were determined for each guideline.
Compared with the 2003 guidelines, 1.4% fewer people (20 to 74 years of age) are recommended statin treatment, potentially preventing 7% more CAD deaths. The number needed to treat to prevent one CAD death over five years decreased from 172 (2003 guideline) to 147 (2006 guideline).
From a population perspective, the 2006 Canadian dyslipidemia recommendations are an improvement of earlier versions, preventing more CAD events and deaths with fewer statin prescriptions. Despite these improvements, the Canadian dyslipidemia recommendations should explicitly address issues of absolute benefit and cost-effectiveness in future revisions.
Notes
Cites: CMAJ. 2005 Apr 12;172(8):1027-3115824409
Cites: Heart. 2005 Dec;91 Suppl 5:v1-5216365341
Cites: BMJ. 2006 Mar 18;332(7542):659-6216543339
Cites: BMJ. 2006 Jun 17;332(7555):141916737980
Cites: Can J Cardiol. 2006 Sep;22(11):913-2716971976
Cites: Lancet. 2007 Jan 20;369(9557):168-917240267
Comment In: Can J Cardiol. 2008 Aug;24(8):62118697284
PubMed ID
18685741 View in PubMed
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Aberrant circulating levels of purinergic signaling markers are associated with several key aspects of peripheral atherosclerosis and thrombosis.

https://arctichealth.org/en/permalink/ahliterature263533
Source
Circ Res. 2015 Mar 27;116(7):1206-15
Publication Type
Article
Date
Mar-27-2015
Author
Juho Jalkanen
Gennady G Yegutkin
Maija Hollmén
Kristiina Aalto
Tuomas Kiviniemi
Veikko Salomaa
Sirpa Jalkanen
Harri Hakovirta
Source
Circ Res. 2015 Mar 27;116(7):1206-15
Date
Mar-27-2015
Language
English
Publication Type
Article
Keywords
5'-Nucleotidase - blood
Adenosine Diphosphate - blood
Adenosine Triphosphate - blood
Adult
Age Factors
Aged
Aged, 80 and over
Alkaline Phosphatase - blood
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Anoxia - blood
Antigens, CD - blood
Apyrase - blood
Artifacts
Atherosclerosis - blood - epidemiology
Biological Markers
Chronic Disease
Comorbidity
Disease Progression
Drug Utilization
Female
Finland - epidemiology
GPI-Linked Proteins - blood
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypertension - blood - drug therapy - epidemiology
Male
Middle Aged
Models, Cardiovascular
Peripheral Arterial Disease - blood - epidemiology
Purinergic P2Y Receptor Antagonists - therapeutic use
Risk factors
Second Messenger Systems
Smoking - adverse effects - blood - epidemiology
Thrombophilia - blood - epidemiology - etiology
Abstract
Purinergic signaling plays an important role in inflammation and vascular integrity, but little is known about purinergic mechanisms during the pathogenesis of atherosclerosis in humans.
The objective of this study is to study markers of purinergic signaling in a cohort of patients with peripheral artery disease.
Plasma ATP and ADP levels and serum nucleoside triphosphate diphosphohydrolase-1 (NTPDase1/CD39) and ecto-5'-nucleotidase/CD73 activities were measured in 226 patients with stable peripheral artery disease admitted for nonurgent invasive imaging and treatment. The major findings were that ATP, ADP, and CD73 values were higher in atherosclerotic patients than in controls without clinically evident peripheral artery disease (P
PubMed ID
25645301 View in PubMed
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Absolute risk reductions, relative risks, relative risk reductions, and numbers needed to treat can be obtained from a logistic regression model.

https://arctichealth.org/en/permalink/ahliterature152508
Source
J Clin Epidemiol. 2010 Jan;63(1):2-6
Publication Type
Article
Date
Jan-2010
Author
Peter C Austin
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5, Canada. peter.austin@ices.on.ca
Source
J Clin Epidemiol. 2010 Jan;63(1):2-6
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Data Interpretation, Statistical
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Logistic Models
Myocardial Infarction - drug therapy - mortality
Ontario - epidemiology
Risk Reduction Behavior
Treatment Outcome
Abstract
Logistic regression models are frequently used in cohort studies to determine the association between treatment and dichotomous outcomes in the presence of confounding variables. In a logistic regression model, the association between exposure and outcome is measured using the odds ratio (OR). The OR can be difficult to interpret and only approximates the relative risk (RR) in certain restrictive settings. Several authors have suggested that for dichotomous outcomes, RRs, RR reductions, absolute risk reductions, and the number needed to treat (NNT) are more clinically meaningful measures of treatment effect.
We describe a method for deriving clinically meaningful measures of treatment effect from a logistic regression model. This method involves determining the probability of the outcome if each subject in the cohort was treated and if each subject was untreated. These probabilities are then averaged across the study cohort to determine the average probability of the outcome in the population if all subjects were treated and if they were untreated.
Risk differences, RRs, and NNTs were derived using a logistic regression model.
Clinically meaningful measures of effect can be derived from a logistic regression model in a cohort study. These methods can also be used in randomized controlled trials when logistic regression is used to adjust for possible imbalance in prognostically important baseline covariates.
Notes
Comment In: J Clin Epidemiol. 2010 Jan;63(1):7-819762212
PubMed ID
19230611 View in PubMed
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Acute treatment of myocardial infarction in Canada 1999-2002.

https://arctichealth.org/en/permalink/ahliterature176049
Source
Can J Cardiol. 2005 Feb;21(2):145-52
Publication Type
Article
Date
Feb-2005
Author
Cynthia A Jackevicius
David Alter
Jafna Cox
Paul Daly
Shaun Goodman
Woganee Filate
Alice Newman
Jack V Tu
Author Affiliation
Pharmacy Department, University Health Network-Toronto General Hospital, Toronto, Ontario M5G 2C4. Cynthia.Jackevicius@uhn.on.ca
Source
Can J Cardiol. 2005 Feb;21(2):145-52
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Adult
Age Distribution
Aged
Angioplasty, Balloon
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Drug Utilization - statistics & numerical data
Emergency Service, Hospital
Female
Fibrinolytic Agents - contraindications - therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Myocardial Infarction - epidemiology - therapy
Myocardial Reperfusion - utilization
Patient Discharge
Physician's Practice Patterns - statistics & numerical data
Registries
Sex Distribution
Time Factors
Abstract
Therapy for management of acute myocardial infarction (AMI) varies according to patient, prescriber and geographical characteristics.
To describe the in-hospital use of reperfusion therapy for ST elevation MI (STEMI) and discharge use of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) and statins in patients presenting with either STEMI or non-STEMI in Canada from 1999 to 2002.
Four Canadian registries (FASTRAK II, Canadian Acute Coronary Syndromes, Enhanced Feedback for Effective Cardiac Treatment and Improving Cardiovascular Outcomes in Nova Scotia) were used to identify patients with AMI in Canada and to measure in-hospital reperfusion and medication use. Use rates were compared by age, sex, time period and geographical area, according to available data.
Use rates for reperfusion in STEMI patients ranged from 60% to 70%, primarily representing fibrinolytic therapy. A delay in presentation to hospital after symptom onset represented an impediment to timely therapy, which was particularly pronounced for women and elderly patients. Overall, less than 50% of patients met the door-to-needle target of less than 30 min. Medication use rates at discharge increased from 1999/2000 to 2000/2001 across the different data sources: acetylsalicylic acid, 83% to 88%; beta-blockers, 74% to 89%; ACEIs, 54% to 67%; statins, 41% to 53%; and calcium antagonists, 21% to 32%.
Canadian and provincial rates of use of evidence-based medications for the treatment of AMI have increased over time, although there remains room for improvement. A single, comprehensive data source would supply better insights into the management of AMI in Canada.
PubMed ID
15729413 View in PubMed
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Adherence to statins, beta-blockers and angiotensin-converting enzyme inhibitors following a first cardiovascular event: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature174577
Source
Can J Cardiol. 2005 May 1;21(6):485-8
Publication Type
Article
Date
May-1-2005
Author
David F Blackburn
Roy T Dobson
James L Blackburn
Thomas W Wilson
Mary Rose Stang
William M Semchuk
Author Affiliation
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. d.blackburn@usask.ca
Source
Can J Cardiol. 2005 May 1;21(6):485-8
Date
May-1-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Age Factors
Angina, Unstable - drug therapy
Angioplasty, Balloon, Coronary
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Cohort Studies
Coronary Artery Bypass
Databases as Topic
Drug Prescriptions - statistics & numerical data
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Linear Models
Male
Middle Aged
Myocardial Infarction - drug therapy
Patient Compliance - statistics & numerical data
Retrospective Studies
Saskatchewan
Severity of Illness Index
Time Factors
Abstract
Population studies of statin adherence are generally restricted to one to two years of follow-up and do not analyze adherence to other drugs.
To report long-term adherence rates for statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers in patients who recently experienced a first cardiovascular event.
Linked administrative databases in the province of Saskatchewan were used in this retrospective cohort study. Eligible patients received a new statin prescription within one year of their first cardiovascular event between 1994 and 2001. Adherence to statins, beta-blockers and ACE inhibitors was assessed from the first statin prescription to a subsequent cardiovascular event.
Of 1221 eligible patients, the proportion of patients adherent to statin medications dropped to 60.3% at one year and 48.8% at five years. The decline in the proportion of adherent patients was most notable during the first two years (100% to 53.7%). Several factors were associated with statin adherence, including age (P = 0.012), number of physician service days (P = 0.037), chronic disease score (P = 0.032), beta-blocker adherence (P
PubMed ID
15917876 View in PubMed
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The analysis by Manuel and colleagues creates controversy with headlines, not data.

https://arctichealth.org/en/permalink/ahliterature175310
Source
CMAJ. 2005 Apr 12;172(8):1033-4; discussion 1037
Publication Type
Article
Date
Apr-12-2005
Author
Jacques Genest
Ruth McPherson
Jiri Frohlich
George Fodor
Author Affiliation
Division of Cardiology, Royal Victoria Hospital, McGill University, Montréal, Que. jacques.genest@muhc.mcgill.ca
Source
CMAJ. 2005 Apr 12;172(8):1033-4; discussion 1037
Date
Apr-12-2005
Language
English
Publication Type
Article
Keywords
Canada
Cholesterol, LDL - blood
Coronary Disease - mortality - prevention & control
Health Expenditures
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hyperlipidemias - drug therapy
Hypolipidemic Agents - therapeutic use
Practice Guidelines as Topic
Risk factors
Notes
Cites: Circulation. 2003 Apr 22;107(15):2059-6512707251
Cites: JAMA. 1999 Dec 22-29;282(24):2340-610612322
Cites: JAMA. 2001 May 16;285(19):2486-9711368702
Cites: Circulation. 2001 Nov 27;104(22):2746-5311723030
Cites: Circulation. 2001 Dec 4;104(23):2855-6411733407
Cites: Lancet. 2002 Jul 6;360(9326):7-2212114036
Cites: CMAJ. 2005 Apr 12;172(8):1027-3115824409
Cites: CMAJ. 2003 Oct 28;169(9):921-414581310
Cites: Can J Public Health. 2004 Jan-Feb;95(1):16-2014768735
Cites: Circulation. 2004 Jul 13;110(2):227-3915249516
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: BMJ. 1992 Jul 4;305(6844):15-91638188
Comment On: CMAJ. 2005 Apr 12;172(8):1027-3115824409
PubMed ID
15824410 View in PubMed
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Aorta of young and middle-aged heterozygous familial hypercholesterolemia patients shows no functional or morphological impairment assessed by MRI.

https://arctichealth.org/en/permalink/ahliterature90900
Source
Vasc Health Risk Manag. 2008;4(4):923-9
Publication Type
Article
Date
2008
Author
Soljanlahti Sami
Autti Taina
Vuorio Alpo F
Keto Pekka
Turtola Hannu
Lauerma Kirsi
Author Affiliation
Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. sami.soljanlahti@hus.fi
Source
Vasc Health Risk Manag. 2008;4(4):923-9
Date
2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aorta - pathology - physiopathology
Atherosclerosis - genetics - pathology - physiopathology
Cardiovascular Diseases - etiology - pathology - physiopathology
Carotid Artery, Common - ultrasonography
Case-Control Studies
Child
Female
Finland
Heterozygote
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hyperlipoproteinemia Type II - drug therapy - genetics - pathology
Magnetic Resonance Angiography
Male
Middle Aged
Predictive value of tests
Risk factors
Young Adult
Abstract
In familial hypercholesterolemia (FH) the level of LDL cholesterol is 2-3 times that of the normal population and leads to accelerated atherosclerosis. Improved care for risk factors has decreased cardiovascular mortality of these patients. We studied subclinical atherosclerotic changes with morphologic and functional aortic magnetic resonance imaging (MRI) in FH patients under the age of 50.39 DNA test-verified heterozygous FH-North Karelia patients, aged 6-48, 28 of them treated with statins, and 25 healthy controls, aged 12 to 50, underwent aortic MRI, carotid ultrasound (US), and risk-factor assessment. No differences in any of the morphologic or functional aortic parameters appeared between patients and controls. Age and gender were independent predictors of the majority of the morphologic and functional measures. Carotid intima-media thickness assessed by US was greater in patients (0.57 mm +/- 0.13 vs. 0.48 +/- 0.13 mm, p = 0.005) as was cholesterol-years score (243 +/- 122 vs. 137 +/- 74, p
PubMed ID
19066011 View in PubMed
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277 records – page 1 of 28.