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Blood pressure telemonitoring leads to improved control

15 Jul, 13 | by Alistair Lindsay

Only half of US adults have blood pressure levels that are controlled to recommended levels.  Home blood pressure monitoring has previously been shown to be a useful adjunct to team-based care for hypertension, and home BP readings can predict cardiovascular risk more accurately than office BP measurements.  Recent studies have suggested that a combined approach using telemedicine with nurse- or pharmacist-led care may be effective at improving blood pressure control, but these studies did not include follow-up. more…

Biomarker screening in primary prevention

8 Nov, 12 | by Alistair Lindsay

Risk prediction models are widely used in primary care to identify and initiate therapy in those at risk for future cardiovascular events. While conventional risk factors such as smoking and hypertension are reliably and robustly represented in these models, the value of newer emerging biomarkers such as C-reactive protein (CRP) and fibrinogen are of uncertain value. In this very large meta-analysis of data from 52 prospective studies, including 246,669 participants being evaluated for primary prevention, the value of adding CRP or fibrinogen levels to conventional risk factors was studied with the clinical implications being modelled on the initiation of statin therapy after reclassification of individuals on biomarker levels. more…

Novel risk markers – CT looks strong

2 Oct, 12 | by Alistair Lindsay

The primary prevention of cardiovascular disease involves classifying individuals according to their global cardiovascular risk. However, those at intermediate risk represent a particular challenge; while some may require aggressive treatment, others may be best managed by lifestyle measures alone. Biomarkers that have shown promise in improving risk discrimination include carotid intima-media thickness (CIMT), coronary artery calcium (CAC) scoring, brachial flow-mediated dilation (FMD), ankle-brachial index (ABI), high-sensitivity C-reactive protein (CRP) and, in addition, having a family history of coronary heart disease (CHD). Determining whether – and by how much – risk prediction can be improved by various markers could help to determine the most efficient strategy for the use of primary prevention drugs. more…

7 ‘Heart Healthy’ Factors Reduce Risk of Death

25 Apr, 12 | by Alistair Lindsay

In recent years an increasing emphasis has been placed on the need for improved primary prevention of cardiovascular disease.  To this end, using evidence from clinical trials and epidemiological studies, the American Heart Association (AHA) has suggested seven ideal cardiovascular health behaviours (metrics), including: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet.  However, no previous study has investigated the relationship between the prevalence of these lifestyle factors and cardiovascular mortality on a national scale. more…

JUPITER puts primary prevention into new orbit

17 Jan, 09 | by Alistair Lindsay

Current guidelines recommend statin treatment for patients with known vascular disease, diabetes or elevated lipid levels. Yet half of myocardial infarctions and strokes occur in apparently healthy individuals with levels of low density lipoprotein (LDL) cholesterol that are below current threshold levels for treatment. High sensitivity C-reactive protein (CRP) is an inflammatory biomarker which can predict future vascular events and improves risk classification independently of LDL cholesterol level. Statin therapy has been shown to decrease CRP levels. However a question remains to be answered: Would healthy individuals with levels of LDL cholesterol below current treatment levels but with elevated levels of high sensitivity CRP benefit from statin therapy? more…

Modest benefit from aspirin as primary prevention therapy in diabetics

17 Jan, 09 | by Alistair Lindsay

Although several large trials of aspirin for primary prevention have included diabetic subgroups, no trial has been specifically dedicated to looking at the effects of aspirin in this patient group. more…

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