Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level

Daria Roccatagliata1, Fausto Avanzini1, Lara Monesi1, Vittorio Caimi2, Davide Lauri1, Paolo Longoni3, Roberto Marchioli4, Massimo Tombesi2, Gianni Tognoni1, Maria Carla Roncaglioni1, on behalf of the Collaborative Group Risk and Prevention Study*1Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy; 2CSeRMEG Centro Studi e Ricerca in Medicina Generale, Monza, Italy; 3CoS Consorzio Sanità, Milano, Italy; 4Consorzio Mario Negri Sud, S. Maria Imbaro, Italy *A full list of investigators is reported in the AppendixObjectives: To assess the pharmacological treatment and the control of major modifiable cardiovascular risk factors in everyday practice according to the patients’ cardiovascular risk level.Methods: In a cross-sectional study general practitioners (GPs) had to identify a random sample of their patients with cardiovascular risk factors or diseases and collect essential data on the pharmacological treatment and control of hypertension, hyperlipidemia, and diabetes according to the patients’ cardiovascular risk level and history of cardiovascular disease. Participants were subjects of both sexes, aged 40–80 years, with at least one known cardiovascular risk factor or a history of cardiovascular diseases.Results: From June to December 2000, 162 Italian GPs enrolled 3120 of their patients (2470 hypertensives, 1373 hyperlipidemics, and 604 diabetics). Despite the positive association between the perceived level of global cardiovascular risk and lipid-lowering drug prescriptions in hyperlipidemic subjects (from 26% for lowest risk to 56% for highest risk p < 0.0001) or the prescription of combination therapy in hypertensives (from 41% to 70%, p < 0.0001) and diabetics (from 24% to 43%, p = 0.057), control was still inadequate in 48% of diabetics, 77% of hypertensives, and 85% of hyperlipidemics, with no increase in patients at highest risk. Trends for treatment and control were similar in patients with cardiovascular diseases.Conclusions: Even in high-risk patients, despite a tendency towards more intensive treatment, pharmacological therapy is still under used and the degree of control of blood pressure, cholesterol level and diabetes is largely unsatisfactory.Keywords: global cardiovascular risk, hypertension, hyperlipideamia, diabetes, general practice

La fragilit\ue0 e la vulnerabilit\ue0 in sanit\ue0. Sintesi dei risultati di un progetto di ricerca sul campo per identificare determinanti di fragilit\ue0 e vulnerabilit\ue0 sociale e suggerire approcci migliorativi in popolazioni a maggiore rischio.

Obiettivi. Identificare i determinanti di disuguaglianza nella domanda/offerta di salute, in particolare quelli dovuti a fattori di natura sociale, al fine di offrire un contributo concettuale, metodologico ma soprattutto empirico ai fornitori dell\u2019assistenza sanitaria della Regione Lombardia. Metodi. Sono stati coinvolti tutti i medici di medicina generale della ASL-Citt\ue0 di Milano. Lo studio prevedeva due fasi: una \u201cdescrittiva\u201d per quantificare la frequenza di vulnerabilit\ue0 e fragilit\ue0, e una seconda \u201canalitica\u201d, in un campione pi\uf9 selezionato di pazienti per individuare la mancata esecuzione di interventi di screening e riabilitazione (eventi sentinella). Risultati. I valori di fragilit\ue0 e vulnerabilit\ue0 (da 0 a 10) indicati dai medici per i 10.798 pazienti reclutati per la fase descrittiva erano rispettivamente di 3,7 e 3,1. Per la fase analitica dello studio sono stati reclutati 794 pazienti per un totale di 261 eventi sentinella, di cui il pi\uf9 frequente \ue8 stato la mancata esecuzione di riabilitazione post-infarto. Conclusioni. Questo studio, grazie alla buona partecipazione dei medici coinvolti, ha permesso di ottenere una stima di fragilit\ue0 e vulnerabilit\ue0 nella popolazione di assistiti dai medici di medicina generale di Milano e di studiare la prevalenza di alcuni eventi sentinella sul mancato accesso ai servizi del SSN forniti dalla Citt\ue0 di Milano

Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level-3

<p><b>Copyright information:</b></p><p>Taken from "Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level"</p><p></p><p>Vascular Health and Risk Management 2006;2(4):507-514.</p><p>Published online Jan 2006</p><p>PMCID:PMC1994019.</p><p>© 2006 Dove Medical Press Limited. All rights reserved</p

Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level-4

<p><b>Copyright information:</b></p><p>Taken from "Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level"</p><p></p><p>Vascular Health and Risk Management 2006;2(4):507-514.</p><p>Published online Jan 2006</p><p>PMCID:PMC1994019.</p><p>© 2006 Dove Medical Press Limited. All rights reserved</p>ase (CVD) (B

Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level-1

<p><b>Copyright information:</b></p><p>Taken from "Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level"</p><p></p><p>Vascular Health and Risk Management 2006;2(4):507-514.</p><p>Published online Jan 2006</p><p>PMCID:PMC1994019.</p><p>© 2006 Dove Medical Press Limited. All rights reserved</p>ase (CVD) (B

Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level-0

<p><b>Copyright information:</b></p><p>Taken from "Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level"</p><p></p><p>Vascular Health and Risk Management 2006;2(4):507-514.</p><p>Published online Jan 2006</p><p>PMCID:PMC1994019.</p><p>© 2006 Dove Medical Press Limited. All rights reserved</p

Human leukocyte antigen polymorphisms in Italian primary biliary cirrhosis: A multicenter study of 664 patients and 1992 healthy controls

Genetic factors are critical in determining susceptibility to primary biliary cirrhosis (PBC), but there has not been a clear association with human leukocyte antigen (HLA) genes. We performed a multicenter case-control study and analyzed HLA class II DRB1 associations using a large cohort of 664 well-defined cases of PBC and 1992 controls of Italian ancestry. Importantly, healthy controls were rigorously matched not only by age and sex, but also for the geographical origin of the proband four grandparents (Northern, Central, and Southern Italy). After correction for multiple testing, DRB1*08 [odds ratio (OR), 3.3; 95% confidence interval (CI), 2.4-4.5] and DRB1*02 (OR 0.9; 95% CI 0.8-1.2) were significantly associated with PBC, whereas alleles DRB1*11 (OR 0.4; 95% CI 0.3-0.4) and DRB1*13 (OR 0.7; 95% CI 0.6-0.9) were protective. When subjects were stratified according to their grandparental geographical origin, only the associations with DRB1*08 and DRB1*11 were common to all three areas. Associated DRB1 alleles were found only in a minority of patients, whereas an additive genetic model is supported by the gene dosage effect for DRB1*11 allele and the interaction of DRB1*11,*13, and *08. Lastly, no significant associations were detected between speci fic DRB1 alleles and relevant clinical features represented by the presence of cirrhosis or serum autoantibodies. In conclusion, we confirm the role for HLA to determine PBC susceptibility and suggest that the effect of HLA is limited to patient subgroups. We suggest that a large whole-genome approach is required to identify further genetic elements contributing to the loss of tolerance in this disease. Copyright © 2008 by the American Association for the Study of Liver Diseases