Prevention and control : the official journal of the World Heart Federation最新文献

Background

Information on lipid-lowering treatment (LLT) patterns (statin titration, statin switching, combination therapy and no change) in clinical practice is limited. The objectives of this study were to (i) characterize LLT patterns, (ii) explore variables that influence choice of aggressive initial and subsequent statin regimens and (iii) evaluate the impact of LLT patterns on LDL-C reduction and goal attainment.

Design

Randomly drawn patients who were newly initiated on statin (n = 603) from 62 randomly selected practices were retrospectively evaluated for a median of 3.9 years between 1998 and 2002.

Methods

Logistic regression, Cox model, t-test and GLM were used in the analyses. All tests of statistical significance were two-sided with α = 0.05.

Results

Both patient- and physician-related variables were important in the choice of initial and subsequent statin regimens. Patients initiated on LLT after revascularization were more likely to receive a high potency statin both initially and during subsequent changes. LDL-C levels influenced the choice of aggressive regimen. Switches to an aggressive regimen (68%) occurred in the first two years of therapy. Patients with more cardiac-related prescriptions at baseline had greater prescription persistence. Despite aggressive regimen changes, relatively few patients attained the target LDL-C of 100 mg/dL; nor was the reduction significantly different from that of the non-switched group.

Conclusion

Current statinmonotherapy-dominated LLT in Germany failed to get the majority of patients to recommended LDL-C goal of <100 mg/dL. Improved lipid management strategies are required so that patients on LLT get the necessary reductions in LDL-C and the benefits of projected reductions in CVD morbidity and mortality.

Introduction

Prevalence rates for tobacco use in Russia are among the highest in the world. At the same time tobacco control is a low priority in the country. In particular, the effect of addiction on users is underestimated and very little assistance is provided in the country, particularly from the state public health service, for smokers to stop smoking. Our aim was to create, implement and evaluate an effective smoking cessation service.

Design and measurements

We developed a smoking cessation group session (SCS), which consisted of a lecture by a specialist, examination with a carbon-monoxide detector, exchange of personal experiences and discussions about issues related to smoking cessation including pharmacotherapy. All smokers completed a questionnaire prior to beginning SCS to measure social, psychological and behavioral factors in order to assess possible determinants of SCS efficacy. Attempts were made to follow up all participants.

Results

Over 1400 smokers ages 18–74 years participated in SCS over a period of 2 years. The majority of smokers, 73% of men and 56% of women were highly tobacco dependent (⩾5 points on the Fagerstrom test). Follow up was unavailable for 29% of the participants. Of those with follow up, 41% stopped smoking for some period of time and 18% reduced their daily consumption of cigarettes by at least 25% of their pre-treatment level. No attempt at smoking cessation was made by 31% of all smokers after their participation in SCS. A large proportion of smokers, even after participation in SCS, were not sufficiently motivated and ready to stop smoking. Past quit attempts, number of cigarettes smoked per day, level of tobacco dependence, and the degree of motivation were associated with abstinence.

Conclusions

SCS is an effective model of smoking cessation assistance particularly for those motivated to quit. It should be used in most public health settings and thus integrated into the national health care system in Russia. Further research should address cost-effective ways of enhancing the impact of this program.

Argentina has an annual production of 150,000 tons of tobacco and 70% of this is exported. Since 1972, the state subsidy of the national tobacco industry is through a special fund supported by a 7% tax on each pack of cigarettes. Phillip Morris and British American Tobacco control over 90% of the tobacco market in Argentina through subsidiaries. Overall, 37% of adults over the age 16 years currently smoke cigarettes and second hand smoke exposure affects 70% of homes. Tobacco use accounts for 15% of all deaths in persons under age 65 years and this represents an economic cost equivalent to 0.17% of the gross national product. Health care for diseases caused by tobacco use accounts for some 16% of the total health care expenditures in the country. The transnational tobacco industry views Argentina as an expansion market and has developed an intense advertising campaign including targeting all persons 16 years of age and older. Psychographic profiles similar to those used in the US market have been developed in Argentina to target adolescents and young adults. There is no comprehensive tobacco control law in Argentina. Even though the President has signed the WHO Framework Convention on Tobacco Control, ratification is being delayed by the active lobbying of regional legislators from the tobacco growing provinces who in turn are influenced by industry positions.

Background

Large, randomized, controlled trials have shown that lowering low-density lipoprotein cholesterol (LDL-C) reduces risk of cardiovascular (CV) morbidity and mortality. It is unclear whether similar risk reduction is attained in clinical practice. The effect of early LDL-C goal achievement on future CV events also remains to be investigated. The objectives were to (i) investigate risk of recurrent CV events and influence of factors such as lipid levels on the risk of such events and (ii) explore effect of early LDL-C goal attainment on future CV events and hospitalization.

Methods and results

Randomly drawn patients (n = 603) from randomly drawn practices (n = 62) were retrospectively evaluated for a median of 3.6 years (1998–2002) on lipid-lowering therapy. Results of time to event analysis show that the hazard rate of recurrent CV events was highest in the first six months following an index event. Revascularization at baseline, high baseline co-morbidity and high LDL-C level increased the hazard rate of recurrent CV events. Probit analysis of panel data indicates that goal attainment during the first six months and treatment by a cardiologist reduced the risk of future recurrent CV events and all-cause hospitalization.

Conclusion

High LDL-C level significantly contributes to risk of CV morbidity. The potential for preventing CV morbidity is highest in the first six months because goal attainment within the first six months after the index event significantly reduces the risk of a future recurrent CV event. Our results support early goal attainment and aggressive LDL-C reduction to achieve a lower incidence of CV events and hospitalization.

Study objective

To determine the current prevalence of smoking among medical students and to ascertain their readiness for counseling on smoking cessation.

Methods

Cross-sectional randomized study, in which 297 medical students (146 males and 151 females) completed a questionnaire and exhaled carbon monoxide (CO).

Setting

Kyrgyz State Medical Academy in Bishkek, Kyrgyzstan.

Results

The overall prevalence of smoking among medical students was 35% (47.9% among men and 22.5% among women), with the highest rate among year 6 students (85.7% for men and 58% for women). The CO-adjusted prevalence for the entire sample was 44.8%. Overall 69% of students believed that smoking is related to cancer and chronic diseases however, the longer students were in school, the less confidence they demonstrated in this relationship. While 85.2% reported that advice should be given to smokers to stop, only 63% considered it potentially effective. Only 17.2% were aware of the Framework Convention on Tobacco Control, 90% of these supported its ratification, women significantly more so than men OR = 2.24, p < 0.05. Non-smokers expressed a greater demand for more information on smoking-related diseases and treatment of tobacco dependence (OR = 2.94, p < 0.05). Smokers were more likely to consume alcohol (OR = 4.0, p < 0.001) with no-alcohol students being more committed to tobacco control.

Conclusions

Across the years of study, the prevalence of smoking among medical students increased, and reached its peak at year 6. The lack of knowledge about tobacco control along with a decreased potential for anti-smoking advocacy likely reflect deficiencies in the educational curricula. There is an urgent need to address relevant changes in the educational curricula for medical students.