21 research outputs found
Association of cardiovascular emerging risk factors with acute coronary syndrome and stroke: A case-control study
"This is the pre-peer reviewed version of the following article: "MartĂnez Linares, J.M.; et al. Association of cardiovascular emerging risk factors with acute coronary syndrome and stroke: A case control study. Nursing and Health Sciences, 18(4): 488-495 (2016)", which has been published in final form at http://dx.doi.org/10.1111/nhs.12299 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."In this study, we estimated the risk of acute coronary syndrome and stroke associated with several emerging
cardiovascular risk factors. This was a case-control study, where an age - and sex-matched acute coronary
syndrome group and stroke group were compared with controls. Demographic and clinical data were collected
through patient interviews, and blood samples were taken for analysis. In the bivariate analysis, all cardiovascular
risk factors analyzed showed as predictors of acute coronary syndrome and stroke, except total cholesterol and
smoking. In the multivariate logistic regression model for acute coronary syndrome, hypertension and body mass
index, N-terminal section brain natriuretic peptide and pregnancy-associated plasma protein-Awere independent
predictors. For stroke, the predictors were hypertension, diabetes mellitus, body mass index, and N-terminal
section brain natriuretic peptide. Controlling for age, sex, and classical cardiovascular risk factors, N-terminal
section brain natriuretic peptide and pregnancy-associated plasma protein-A were independent emerging
cardiovascular risk factors for acute coronary syndrome, but pregnancy-associated plasma protein-A was not
for stroke. High levels of cardiovascular risk factors in individuals with no episodes of cardiovascular disease
requires the implementation of prevention programs, given that at least half of them are modifiable.Health Agency of Health South of Granada.Project from "Ministerio de EconomĂa y Competitividad. DirecciĂłn General de InvestigaciĂłn CientĂfica y TĂ©cnica". Grant Number: MTM2013-47929-
Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement
Improving identification of familial hypercholesterolaemia in primary care: Derivation and validation of the familial hypercholesterolaemia case ascertainment tool (FAMCAT)
Objective: Heterozygous familial hypercholesterolaemia (FH) is a common autosomal dominant disorder. The vast majority of affected individuals remain undiagnosed, resulting in lost opportunities for preventing premature heart disease. Better use of routine primary care data offers an opportunity to enhance detection. We sought to develop a new predictive algorithm for improving identification of individuals in primary care who could be prioritised for further clinical assessment using established diagnostic criteria.
Methods: Data were analysed for 2,975,281 patients with total or LDL-cholesterol measurement from 1 Jan 1999 to 31 August 2013 using the Clinical Practice Research Datalink (CPRD). Included in this cohort study were 5050 documented cases of FH. Stepwise logistic regression was used to derive optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy (area under receiver operating curve [AUC]).
Results: The FH prediction model (FAMCAT), consisting of nine diagnostic variables, showed high discrimination (AUC 0.860, 95% CI 0.848–0.871) for distinguishing cases from non-cases. Sensitivity analysis demonstrated no significant drop in discrimination (AUC 0.858, 95% CI 0.845–0.869) after excluding secondary causes of hypercholesterolaemia. Removing family history variables reduced discrimination (AUC 0.820, 95% CI 0.807–0.834), while incorporating more comprehensive family history recording of myocardial infraction significantly improved discrimination (AUC 0.894, 95% CI 0.884–0.904).
Conclusion: This approach offers the opportunity to enhance detection of FH in primary care by identifying individuals with greatest probability of having the condition. Such cases can be prioritised for further clinical assessment, appropriate referral and treatment to prevent premature heart disease