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Paul M Ridker - One of the best experts on this subject based on the ideXlab platform.
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novel risk factors for systemic atherosclerosis a comparison of c reactive protein fibrinogen homocysteine lipoprotein a and standard Cholesterol Screening as predictors of peripheral arterial disease
JAMA, 2001Co-Authors: Paul M Ridker, Nader RifaiAbstract:ContextSeveral novel risk factors for atherosclerosis have recently been proposed, but few comparative data exist to guide clinical use of these emerging biomarkers.ObjectiveTo compare the predictive value of 11 lipid and nonlipid biomarkers as risk factors for development of symptomatic peripheral arterial disease (PAD).Design, Setting, and ParticipantsNested case-control study using plasma samples collected at baseline from a prospective cohort of 14 916 initially healthy US male physicians aged 40 to 84 years, of whom 140 subsequently developed symptomatic PAD (cases); 140 age- and smoking status–matched men who remained free of vascular disease during an average 9-year follow-up period were randomly selected as controls.Main Outcome MeasureIncident PAD, as determined by baseline total Cholesterol, high-density lipoprotein Cholesterol (HDL-C), low-density lipoprotein Cholesterol (LDL-C), total Cholesterol–HDL-C ratio, triglycerides, homocysteine, C-reactive protein (CRP), lipoprotein(a), fibrinogen, and apolipoproteins (apo) A-I and B-100.ResultsIn univariate analyses, plasma levels of total Cholesterol (P<.001), LDL-C (P = .001), triglycerides (P = .001), apo B-100 (P = .001), fibrinogen (P = .02), CRP (P = .006), and the total Cholesterol–HDL-C ratio (P<.001) were all significantly higher at baseline among men who subsequently developed PAD compared with those who did not, while levels of HDL-C (P = .009) and apo A-I (P = .05) were lower. Nonsignificant baseline elevations of lipoprotein(a) (P = .40) and homocysteine (P = .90) were observed. In multivariable analyses, the total Cholesterol–HDL-C ratio was the strongest lipid predictor of risk (relative risk [RR] for those in the highest vs lowest quartile, 3.9; 95% confidence interval [CI], 1.7-8.6), while CRP was the strongest nonlipid predictor (RR for the highest vs lowest quartile, 2.8; 95% CI, 1.3-5.9). In assessing joint effects, addition of CRP to standard lipid Screening significantly improved risk prediction models based on lipid Screening alone (P<.001).ConclusionsOf 11 atherothrombotic biomarkers assessed at baseline, the total Cholesterol–HDL-C ratio and CRP were the strongest independent predictors of development of peripheral arterial disease. C-reactive protein provided additive prognostic information over standard lipid measures.
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high sensitivity c reactive protein potential adjunct for global risk assessment in the primary prevention of cardiovascular disease
Circulation, 2001Co-Authors: Paul M RidkerAbstract:Inflammation plays a major role in atherothrombosis, and measurement of inflammatory markers such as high-sensitivity C-reactive protein (HSCRP) may provide a novel method for detecting individuals at high risk of plaque rupture. Several large-scale prospective studies demonstrate that HSCRP is a strong independent predictor of future myocardial infarction and stroke among apparently healthy men and women and that the addition of HSCRP to standard lipid Screening may improve global risk prediction among those with high as well as low Cholesterol levels. Because agents such as aspirin and statins seem to attenuate inflammatory risk, HSCRP may also have utility in targeting proven therapies for primary prevention. Inexpensive commercial assays for HSCRP are now available; they have shown variability and classification accuracy similar to that of Cholesterol Screening. Risk prediction algorithms using a simple quintile approach to HSCRP evaluation have been developed for outpatient use. Thus, although limitations inherent to inflammatory Screening remain, available data suggest that HSCRP has the potential to play an important role as an adjunct for global risk assessment in the primary prevention of cardiovascular disease.
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high sensitivity c reactive protein potential adjunct for global risk assessment in the primary prevention of cardiovascular disease
Circulation, 2001Co-Authors: Paul M RidkerAbstract:Abstract—Inflammation plays a major role in atherothrombosis, and measurement of inflammatory markers such ashigh-sensitivity C-reactive protein (HSCRP) may provide a novel method for detecting individuals at high risk of plaquerupture. Several large-scale prospective studies demonstrate that HSCRP is a strong independent predictor of futuremyocardial infarction and stroke among apparently healthy men and women and that the addition of HSCRP to standardlipid Screening may improve global risk prediction among those with high as well as low Cholesterol levels. Becauseagents such as aspirin and statins seem to attenuate inflammatory risk, HSCRP may also have utility in targeting proventherapies for primary prevention. Inexpensive commercial assays for HSCRP are now available; they have shownvariability and classification accuracy similar to that of Cholesterol Screening. Risk prediction algorithms using a simplequintile approach to HSCRP evaluation have been developed for outpatient use. Thus, although limitations inherent toinflammatory Screening remain, available data suggest that HSCRP has the potential to play an important role as anadjunct for global risk assessment in the primary prevention of cardiovascular disease. (Circulation. 2001;103:1813-1818.)Key Words: risk factors n inflammation n cardiovascular diseases n prevention n Screening
Tracy L Skaer - One of the best experts on this subject based on the ideXlab platform.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia. The aim of this study was to examine the extent of racial/ethnic disparities in the provision of pharmacotherapy, Cholesterol Screening and diet/nutrition or exercise counseling during US office-based physician-patient encounters (visits) by patients with hyperlipidemia. We examined data from the 2005 US National Ambulatory Medical Care Survey for office-based visits for hyperlipidemia for patients aged ≥20 years in terms of prescribing for hyperlipidemia, and the ordering/provision of Cholesterol testing, diet/nutrition counseling, and exercise counseling. Use of pharmacotherapy for hyperlipidemia varied by ethnicity/race (χ2, p<0.05). Physician-ordered/provided Cholesterol Screening occurred in 44.2% of all office-based visits; 46.5% for Whites, 35.4% for Blacks, and 30.3% for Hispanics (χ2, p< 0.05). Diet/nutrition counseling was ordered/provided in 39.7% of office-based visits; 40.4% for Whites, 32.6% for Blacks, and 39.0% for Hispanics (χ2, p<0.05). Exercise counseling was ordered/provided in 32.1% of office-based visits; 32.7% for Whites, 27.2% for Blacks, and 30.6% for Hispanics (χ2, p<0.05). These findings reveal a disparity in use of pharmacotherapy for hyperlipidemia, physicianordered/provided Cholesterol Screening, diet/nutrition counseling, and exercise counseling by ethnicity/race. Further research is required to discern, in greater detail, reasons for the observed differences reported, and to ensure equitable access to established standards of care.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Background Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia.
Megan N Willson - One of the best experts on this subject based on the ideXlab platform.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia. The aim of this study was to examine the extent of racial/ethnic disparities in the provision of pharmacotherapy, Cholesterol Screening and diet/nutrition or exercise counseling during US office-based physician-patient encounters (visits) by patients with hyperlipidemia. We examined data from the 2005 US National Ambulatory Medical Care Survey for office-based visits for hyperlipidemia for patients aged ≥20 years in terms of prescribing for hyperlipidemia, and the ordering/provision of Cholesterol testing, diet/nutrition counseling, and exercise counseling. Use of pharmacotherapy for hyperlipidemia varied by ethnicity/race (χ2, p<0.05). Physician-ordered/provided Cholesterol Screening occurred in 44.2% of all office-based visits; 46.5% for Whites, 35.4% for Blacks, and 30.3% for Hispanics (χ2, p< 0.05). Diet/nutrition counseling was ordered/provided in 39.7% of office-based visits; 40.4% for Whites, 32.6% for Blacks, and 39.0% for Hispanics (χ2, p<0.05). Exercise counseling was ordered/provided in 32.1% of office-based visits; 32.7% for Whites, 27.2% for Blacks, and 30.6% for Hispanics (χ2, p<0.05). These findings reveal a disparity in use of pharmacotherapy for hyperlipidemia, physicianordered/provided Cholesterol Screening, diet/nutrition counseling, and exercise counseling by ethnicity/race. Further research is required to discern, in greater detail, reasons for the observed differences reported, and to ensure equitable access to established standards of care.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Background Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia.
David A Sclar - One of the best experts on this subject based on the ideXlab platform.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia. The aim of this study was to examine the extent of racial/ethnic disparities in the provision of pharmacotherapy, Cholesterol Screening and diet/nutrition or exercise counseling during US office-based physician-patient encounters (visits) by patients with hyperlipidemia. We examined data from the 2005 US National Ambulatory Medical Care Survey for office-based visits for hyperlipidemia for patients aged ≥20 years in terms of prescribing for hyperlipidemia, and the ordering/provision of Cholesterol testing, diet/nutrition counseling, and exercise counseling. Use of pharmacotherapy for hyperlipidemia varied by ethnicity/race (χ2, p<0.05). Physician-ordered/provided Cholesterol Screening occurred in 44.2% of all office-based visits; 46.5% for Whites, 35.4% for Blacks, and 30.3% for Hispanics (χ2, p< 0.05). Diet/nutrition counseling was ordered/provided in 39.7% of office-based visits; 40.4% for Whites, 32.6% for Blacks, and 39.0% for Hispanics (χ2, p<0.05). Exercise counseling was ordered/provided in 32.1% of office-based visits; 32.7% for Whites, 27.2% for Blacks, and 30.6% for Hispanics (χ2, p<0.05). These findings reveal a disparity in use of pharmacotherapy for hyperlipidemia, physicianordered/provided Cholesterol Screening, diet/nutrition counseling, and exercise counseling by ethnicity/race. Further research is required to discern, in greater detail, reasons for the observed differences reported, and to ensure equitable access to established standards of care.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Background Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia.
Joshua J Neumiller - One of the best experts on this subject based on the ideXlab platform.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia. The aim of this study was to examine the extent of racial/ethnic disparities in the provision of pharmacotherapy, Cholesterol Screening and diet/nutrition or exercise counseling during US office-based physician-patient encounters (visits) by patients with hyperlipidemia. We examined data from the 2005 US National Ambulatory Medical Care Survey for office-based visits for hyperlipidemia for patients aged ≥20 years in terms of prescribing for hyperlipidemia, and the ordering/provision of Cholesterol testing, diet/nutrition counseling, and exercise counseling. Use of pharmacotherapy for hyperlipidemia varied by ethnicity/race (χ2, p<0.05). Physician-ordered/provided Cholesterol Screening occurred in 44.2% of all office-based visits; 46.5% for Whites, 35.4% for Blacks, and 30.3% for Hispanics (χ2, p< 0.05). Diet/nutrition counseling was ordered/provided in 39.7% of office-based visits; 40.4% for Whites, 32.6% for Blacks, and 39.0% for Hispanics (χ2, p<0.05). Exercise counseling was ordered/provided in 32.1% of office-based visits; 32.7% for Whites, 27.2% for Blacks, and 30.6% for Hispanics (χ2, p<0.05). These findings reveal a disparity in use of pharmacotherapy for hyperlipidemia, physicianordered/provided Cholesterol Screening, diet/nutrition counseling, and exercise counseling by ethnicity/race. Further research is required to discern, in greater detail, reasons for the observed differences reported, and to ensure equitable access to established standards of care.
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ethnicity race use of pharmacotherapy scope of physician ordered Cholesterol Screening and provision of diet nutrition or exercise counseling during us office based visits by patients with hyperlipidemia
American Journal of Cardiovascular Drugs, 2010Co-Authors: Megan N Willson, Joshua J Neumiller, David A Sclar, Linda M Robison, Tracy L SkaerAbstract:Background Elevation of serum Cholesterol, or hyperlipidemia, is recognized as one of the major modifiable risk factors in the development of atherosclerosis and cardiovascular disease. On a US population basis, there has been a downward trend in total- and LDL-Cholesterol levels, and an increase in Cholesterol Screening. Nevertheless, previous research suggests that there remain racial/ethnic disparities in the access to and quality of care for hyperlipidemia.