Implications of the new US cholesterol guidelines in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background: The new US guidelines for the primary prevention of cardiovascular disease have substantially changed the approach to hyperlipidemia treatment. However, the impact of those recommendations in other populations is limited. In the present study,we evaluated the potential implications of those recommendations in the Brazilian population. Hypothesis: The new U.S. recommendations may increase the proportion of individuals who are candidates for statin therapy. Methods: Weincluded all participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)without known cardiovascular disease.Wecalculated the indication for statin therapy according to the current Brazilian recommendations and the new US guidelines, using both the 5.0% and the 7.5% risk cutoffs to recommend treatment, and compared their impact in the Brazilian population stratified by age, sex, and race. Results: Although the current guidelines would recommend treatment for 5499 (39.1%) individuals, the number of individuals eligible for statin therapy increased to 6014 (42.7%) and to 7130 (50.7%) using the 7.5% and 5% cutoffs, respectively (P 70 years would be eligible for statins, whereas the new guidelines would reduce the number of candidates for statin therapy in individuals age <45 years. Conclusions: The application of the new US guidelines for the use of lipid-lowering medications in a large middle-aged Brazilian cohort would result in a significant increase in the population eligible for statins. This is largely driven by males and older individuals. Additional cost-effectiveness analyses are needed to define the appropriateness of this strategy in the Brazilian population

Low Density Lipoprotein Cholesterol Target Goal Attainment Rate and Physician Perceptions about Target Goal Achievement in Korean Patients with Diabetes

BackgroundThis study aims to investigate the discrepancy between clinicians' perceptions and actual achievement rates of low density lipoprotein cholesterol (LDL-C) in Korean patients with diabetes according to updated American Diabetes Association (ADA)/American College of Cardiology Foundation (ACC) recommendations.MethodsThis is a multi-center, retrospective, non-interventional, observational study. Diabetic patients aged 18 years or older were eligible if they had been diagnosed with hypercholesterolemia or were receiving a lipid-lowering therapy between May 2010 and August 2010. The information was obtained by reviewing medical records and using a self-completed questionnaire to examine physician perceptions.ResultsA total of 2,591 subjects who satisfied the inclusion criteria were enrolled. Highest-risk and high-risk patients accounted for 61.9% and 38.1% of the patients, respectively. Although most (96.3%) underwent a statin monotherapy or a statin-based combination therapy, just 47.4% of patients attained the LDL-C target. However, the physicians' perceptions on target achievement rate (70.6%) were different from the actual results (47.4%). Many patients (65.3%) remained on the starting doses of statins, despite evidence of poor achievement of lipid goals.ConclusionOnly less than half of patients with diabetes attained the LDL-C goal. The surveys showed that poor physician performance might be due to the lack of recognition on ADA/ACC consensus causing a low LDL-C target attainment rate. Therefore, changes in doctor perception are needed to attain target LDL-C level and reduce cardiovascular risk in Korean patients with diabetes

The metabolic syndrome: in need of a global mission statement

Aims The value of clinical definitions of the metabolic syndrome has been questioned, with confusion surrounding their intended use and purpose. Our aim was to construct a mission statement that outlines the value of the metabolic syndrome in clinical and public health settings.Methods Case studies have been used to demonstrate three key points.Results We argue here for recognition of obesity as being a crucial element within the metabolic syndrome but perhaps even more important before its development. We also contend that the concept does indeed have a role as a risk prediction tool, and that it could provide a useful metric for the scale and progress of the looming global epidemic of diabetes and cardiovascular disease.Conclusions Through appreciation of its purpose, and recognition of both its limitations and those attributes that make it unique and valuable, we believe we have demonstrated here that the metabolic syndrome deserves its place in the global toolbox of diabetes and CVD prevention.<br /

Evaluation of Metabolic Syndrome in Patients with Chronic Low Back Pain: Using the Fourth Korea National Health and Nutrition Examination Survey Data

The aim of this study was to investigate the frequency of the metabolic syndrome in patients with chronic lower back pain in Korea and to evaluate the differences in clinical characteristics in chronic lower back pain patients with and without metabolic syndrome. This was a cross-sectional study using data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2008. The sample consisted of 1085 participants with chronic lower back pain. The diagnosis of metabolic syndrome was made according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the Korean Society for the Study of Obesity. The prevalence of metabolic syndrome among chronic lower back pain patients was 36.2% (30.2% male, 38.6% female). According to our results, female sex, advanced age, and high BMI were risk factors for metabolic syndrome. These results from a representative sample show that metabolic syndrome is common in chronic lower back pain patients in Korea. Clinicians managing chronic lower back pain should consider the risk factors for metabolic syndrome

The Influence of the Brain‐Derived Neurotropic Factor Val66Met ‐Genotype and HMG‐CoA Reductase Inhibitors on Insulin Resistance in the Schizophrenia and Bipolar Populations

Introduction: The brain‐derived neurotrophic factor (BDNF) Val66Met variant and HMG‐COA reductase inhibitors (statins) have been implicated in insulin resistance with a possible increased risk of diabetes. We sought to determine the effect of the BDNF Met variant and statin medication use on insulin resistance in schizophrenia and bipolar disorder using the homeostasis model assessment of insulin resistance (HOMA‐IR). Methods: A cross‐sectional design was used and patients with diabetes or on any medications affecting glucose regulation were ‐excluded. Associations between insulin resistance and genotype were then analyzed by ANOVA and regression analysis. Subjects were grouped by BDNF genotype as well as presence of statin. Results: Two hundred fifty‐two subjects with a mean age of 44 years were included. The group was 53% male and 41% had a diagnosis of bipolar disorder; 78% and 19% were receiving atypical antipsychotics (AAPs) and statin medications, respectively. Analysis showed schizophrenia subjects with the BDNF met allele as well as schizophrenia subjects with both the BDNF met allele and were receiving a statin had significantly higher HOMA‐IR values compared to the other groups ( p = 0.046 and p = 0.016, respectively). Conclusions: Our results suggest that in the metabolically high‐risk population of schizophrenia the BDNF met allele alone and in combination with statin medications is associated with higher insulin resistance values. This was not seen in the bipolar population. Further validation of these associations remains necessary. Clin Trans Sci 2012; Volume 5: 486–490Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95082/1/cts.12001.pd

Insulin resistance in hidradenitis suppurativa: a case-control study

Background: The association between chronic inflammatory diseases, such as rheumatoid arthritis and psoriasis, and insulin resistance (IR) has been well established. Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disease that affects the apocrine glandbearing areas of the body. Objective: We aimed to determine the prevalence of IR in patients with HS. Methods: This cross-sectional, case-control study enrolled 137 subjects, 76 patients with HS and 61 age- and gender-matched controls. Demographic data, clinical examination of HS patients, anthropometric measures, cardiovascular risk factors and laboratory studies were recorded. The homeostasis model assessment of IR (HOMA-IR) was calculated in all participants by measuring fasting plasma glucose and insulin levels. Results: The median (IQR) HOMA-IR value in HS patients was significantly higher [2.0 (1.0-3.6)] than in controls [1.5(0.9-2.3)] (p=0.01). The prevalence of IR was significantly higher in cases (43.4%) compared with controls (16.4%) (p=0.001). In the linear regression multivariable analysis after adjusting for age, sex and body mass index (BMI), HS remained as a significant factor for a higher HOMA-IR [2.51(0.18) vs 1.92(0.21); p=0.04]. The HOMA-IR value and the prevalence of IR did not differ significantly among HS patients grouped by severity of the disease. Conclusion: Our results show an increased frequency of IR in HS. Thus, we suggest HS patients to be evaluated for IR and managed accordingly