Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies

BACKGROUND: The aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies. METHODS: Electronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions. RESULTS: Seventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program-Adult Treatment Panel III\u27s LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals. CONCLUSION: In patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified

Primera aproximació a una llista vermella dels fongs d'Andorra

S'ha avaluat el grau d'amenaça d'un total de 502 fongs d'Andorra, basant-nos en dades de la bibliografia i en observacions de camp. La informació obtinguda en aquests treballs ha estat comparada amb la de les bases de dades de biodiversitat i les llistes vermelles dels països veïns. Posteriorment s'han avaluat els diferents tàxons amb la metodologia de la IUCN, per determinar el seu grau d'amenaça. S'ha comprovat que moltes de les espècies que cal incloure en les categories més amenaçades formen part de la micoflora de les congesteres, tant pel seu grau d'aïllament com per l'amenaça que suposa el canvi climàtic per les comunitats vegetals de les congesteres. El resultat de l'avaluació de 502 espècies ha estat el següent: en Perill Crític (CR) no s'ha detectat cap espècie; En Perill (EN) hi ha 7 espècies, que és 1,39% del total; com Vulnerables (VU) hi ha 23 (4,58% del total); com Quasi Amenaçades (NT) hi ha 30 (5,97%). Hi ha 392 espècies en la categoria de Preocupació Menor (LC) que són un 78,08%. En la categoria de Dades Insuficients (DD) i No Avaluades (NE) hi ha 44 espècies (8,76%). Finalment, hi ha 6 espècies (1,19%), la presència de les quals no ha estat confirmada.Se ha evaluado el grado de amenaza de un total de 502 hongos de Andorra basándonos en datos de la bibliografía y en observaciones de campo. La información obtenida en estos trabajos ha sido cotejada con las bases de datos de biodiversidad y las listas rojas de los países vecinos. Posteriormente se han evaluado los diferentes taxones con la metodología de la IUCN para determinar su grado de amenaza. Se ha comprobado que muchas de las especies a incluir en las categorías más amenazadas forman parte de la micoflora de los neveros, tanto por su grado de aislamiento como por la amenaza que supone el cambio climático para las comunidades vegetales que los pueblan. El resultado de la evaluación de 502 especies ha sido el siguiente: en Peligro Crítico (CR) no se ha detectado ninguna especie; En Peligro (EN) hay 7 especies, que es 1,39% del total; como Vulnerables (VU) hay 23 (4,58% del total); como Casi Amenazadas (NT) hay 30 (5,97%). Hay 392 especies en la categoría de Preocupación Menor (LC) que son un 78,08%. En la categoría de Datos Insuficientes (DD) y No Evaluadas (NE) hay 44 especies (8,76%). Finalmente, hay 6 (1,19%), la presencia de las cuales no ha sido confirmada.The level of threat of 502 fungi from Andorra has been evaluated according to the data obtained from the bibliography and field observations. The information from these works has been compared with the biodiversity databases and the red lists of neighbouring countries. Subsequently, the different taxa were determined with the IUCN methodology in order to assess their level of threat. It has been found that many of the species in the highest threatened categories are part of the mycoflora of the snowbeds, both because of their degree of isolation and the effect of the climate warming. The result of the evaluation of 502 species is: in Critically Endangered (CR) no species has been detected; Endangered (EN) 7 species, which is 1.39% of the total; Vulnerable (VU) 23 (4.58% of the total); Near Threatened (NT) 30 (5.97%). There are 392 species in the category of Least Concern (LC) that are 78.08%. In the category of Data Deficient (DD) and Not Evaluated (NE) there are 44 species (8.76%). Finally, there are 6 species (1.19%), whose presence has not been confirmed

Primera aproximació a una llista vermella dels fongs d'Andorra

S'ha avaluat el grau d'amenaça d'un total de 502 fongs d'Andorra, basant-nos en dades de la bibliografia i en observacions de camp. La informació obtinguda en aquests treballs ha estat comparada amb la de les bases de dades de biodiversitat i les llistes vermelles dels països veïns. Posteriorment s'han avaluat els diferents tàxons amb la metodologia de la IUCN, per determinar el seu grau d'amenaça. S'ha comprovat que moltes de les espècies que cal incloure en les categories més amenaçades formen part de la micoflora de les congesteres, tant pel seu grau d'aïllament com per l'amenaça que suposa el canvi climàtic per les comunitats vegetals de les congesteres. El resultat de l'avaluació de 502 espècies ha estat el següent: en Perill Crític (CR) no s'ha detectat cap espècie; En Perill (EN) hi ha 7 espècies, que és 1,39% del total; com Vulnerables (VU) hi ha 23 (4,58% del total); com Quasi Amenaçades (NT) hi ha 30 (5,97%). Hi ha 392 espècies en la categoria de Preocupació Menor (LC) que són un 78,08%. En la categoria de Dades Insuficients (DD) i No Avaluades (NE) hi ha 44 espècies (8,76%). Finalment, hi ha 6 espècies (1,19%), la presència de les quals no ha estat confirmada.The level of threat of 502 fungi from Andorra has been evaluated according to the data obtained from the bibliography and field observations. The information from these works has been compared with the biodiversity databases and the red lists of neighbouring countries. Subsequently, the different taxa were determined with the IUCN methodology in order to assess their level of threat. It has been found that many of the species in the highest threatened categories are part of the mycoflora of the snowbeds, both because of their degree of isolation and the effect of the climate warming. The result of the evaluation of 502 species is: in Critically Endangered (CR) no species has been detected; Endangered (EN) 7 species, which is 1.39% of the total; Vulnerable (VU) 23 (4.58% of the total); Near Threatened (NT) 30 (5.97%). There are 392 species in the category of Least Concern (LC) that are 78.08%. In the category of Data Deficient (DD) and Not Evaluated (NE) there are 44 species (8.76%). Finally, there are 6 species (1.19%), whose presence has not been confirmed.Se ha evaluado el grado de amenaza de un total de 502 hongos de Andorra basándonos en datos de la bibliografía y en observaciones de campo. La información obtenida en estos trabajos ha sido cotejada con las bases de datos de biodiversidad y las listas rojas de los países vecinos. Posteriormente se han evaluado los diferentes taxones con la metodología de la IUCN para determinar su grado de amenaza. Se ha comprobado que muchas de las especies a incluir en las categorías más amenazadas forman parte de la micoflora de los neveros, tanto por su grado de aislamiento como por la amenaza que supone el cambio climático para las comunidades vegetales que los pueblan. El resultado de la evaluación de 502 especies ha sido el siguiente: en Peligro Crítico (CR) no se ha detectado ninguna especie; En Peligro (EN) hay 7 especies, que es 1,39% del total; como Vulnerables (VU) hay 23 (4,58% del total); como Casi Amenazadas (NT) hay 30 (5,97%). Hay 392 especies en la categoría de Preocupación Menor (LC) que son un 78,08%. En la categoría de Datos Insuficientes (DD) y No Evaluadas (NE) hay 44 especies (8,76%). Finalmente, hay 6 (1,19%), la presencia de las cuales no ha sido confirmada

Cardiovascular risk associated with the use of glitazones, metformin and sufonylureas: meta-analysis of published observational studies

BACKGROUND: The results of observational studies evaluating and comparing the cardiovascular safety of glitazones, metformin and sufonylureas are inconsistent.To conduct and evaluate heterogeneity in a meta-analysis of observational studies on the risk of acute myocardial infarction (AMI) or stroke in patients with type 2 diabetes using non-insulin blood glucose-lowering drugs (NIBGLD). METHODS: We systematically identified and reviewed studies evaluating NIBGLD in patients with type 2 diabetes indexed in Medline, Embase, or the Cochrane Library that met prespecified criteria. The quality of included studies was assessed with the RTI item bank. Results were combined using fixed- and random-effects models, and the Higgins I(2) statistic was used to evaluate heterogeneity. Sensitivity analyses by study quality were conducted. RESULTS: The summary relative risk (sRR) (95% CI) of AMI for rosiglitazone versus pioglitazone was 1.13 (1.04-1.24) [I(2) = 55%]. In the sensitivity analysis, heterogeneity was reduced [I(2) = 16%]. The sRR (95% CI) of stroke for rosiglitazone versus pioglitazone was 1.18 (1.02-1.36) [I(2)  = 42%]. There was strong evidence of heterogeneity related to study quality in the comparisons of rosiglitazone versus metformin and rosiglitazone versus sulfonylureas (I (2) ≥ 70%). The sRR (95% CI) of AMI for sulfonylurea versus metformin was 1.24 (1.14-1.34) [I(2) = 41%] and for pioglitazone versus metformin was 1.02 (0.75-1.38) [I(2) = 17%]. Sensitivity analyses decreased heterogeneity in most comparisons. CONCLUSION/INTERPRETATION: Sulfonylureas increased the risk of AMI by 24% compared with metformin; an imprecise point estimate indicated no difference in risk of AMI when comparing pioglitazone with metformin. The presence of heterogeneity precluded any conclusions on the other comparisons. The quality assessment was valuable in identifying methodological problems in the individual studies and for analysing potential sources of heterogeneity

Analysis of the association between chondrocalcinosis and osteoarthritis: a community based study

To analyse the association between chondrocalcinosis and osteoarthritis (OA) of the hands and knees in an unselected elderly rural population. METHODS--A community based cross sectional study was performed in individuals randomly selected from a previous epidemiological survey on the prevalence of chondrocalcinosis in people older than 60 years from Osona county, Catalonia, northeastern Spain. Radiological OA (grade 2 or more of Kellgren's classification) was evaluated in 26 individuals with chondrocalcinosis and in 104 controls. A total of 18 articular areas of both knees (medial and lateral tibiofemoral compartments) and hands (first, second and third metacarpophalangeal (MCP), first carpometacarpal, trapezium-scaphoid, radiocarpal and distal radioulnar joints) were studied. RESULTS--Radiological changes of OA in the knees were more common in subjects with chondrocalcinosis than in those without it, with an odds ratio adjusted for age and gender (aOR) of 4.3 (95% confidence interval (CI) 1.6 to 11.8, p = 0.005). OA was also more frequent in almost all areas of the hands in individuals with chondrocalcinosis, though the difference reached statistical significance only in the MCP joints (aOR 3.1; 95% CI 1.1 to 8.8; p = 0.033). However, taking into account the side and the different joint compartments analysed, the association between chondrocalcinosis and OA was significant only in the lateral tibiofemoral compartment and the left MCP joints. CONCLUSIONS--In an elderly population unselected for their rheumatic complaints, there was a real association between OA and chondrocalcinosis. This association was particularly relevant in the lateral tibiofemoral compartment of the knee and in the first three left MCP joints

Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence among Adults with Asthma

Rationale: Adherence to inhaled corticosteroid (ICS) medication is known to be low overall, but tends to be lower among African-American patients when compared with white patients

The risk of heart failure associated with the use of noninsulin blood glucose-lowering drugs: Systematic review and meta-analysis of published observational studies

Background: Patients with type 2 diabetes mellitus (T2DM) are at high risk of heart failure. A summary of the effects of blood glucose-lowering drugs other than glitazones on the risk of heart failure in routine clinical practice is lacking. The objective of this study was to conduct a systematic review and meta-analysis of observational studies on the risk of heart failure when using blood glucose-lowering drugs. Methods: We systematically identified and reviewed cohort and case-control studies in which the main exposure of interest was noninsulin blood glucose-lowering medications in patients with T2DM. We searched Medline, Embase, and the Cochrane Library to identify publications meeting prespecified eligibility criteria. The quality of included studies was assessed with the Newcastle-Ottawa Scale and the RTI item bank. Results were combined using fixed and random-effects models when at least 3 independent data points were available for a drug-drug comparison. Results: The summary relative risk of heart failure in rosiglitazone users versus pioglitazone users (95% CI) was 1.16 (1.05-1.28) (5 cohort studies). Heterogeneity was present (I2 = 66%). For new users (n = 4) the summary relative risk was 1.21 (1.14-1.30) and the heterogeneity was reduced (I2 = 31%);. The summary relative risk for rosiglitazone versus metformin was 1.36 (95% CI, 1.17-1.59) (n=3). The summary relative risk (95% CI) of heart failure in sulfonylureas users versus metformin users was 1.17 (95% CI, 1.06-1.29) (5 cohort studies; I2 = 24%) and 1.22 (1.02-1.46) when restricted to new users (2 studies). Information on other comparisons was very scarce. Information on dose and duration of treatment effects was lacking for most comparisons. Few studies accounted for disease severity; therefore, confounding by indication might be present in the majority of the within-study comparisons of this meta-analysis. Conclusions: Use of glitazones and sulfonylureas was associated with an increased risk of heart failure compared with metformin use. However, indication bias cannot be ruled out. Ongoing large multidatabase studies will help to evaluate the risk of heart failure in treated patients with diabetes, including those using newer blood glucose-lowering therapies.</p