Although the frequency of cardiovascular disease is declining, it remains a major present and future threat to health in the United States. The deleterious effects of abnormal blood lipid concentrations have long been recognized, but the benefit of corrective intervention in this process has only recently been demonstrated. We review the major lipid abnormalities and the available clinical therapeutic interventions. In addition, we discuss data that address the premise that reducing low-density lipoprotein cholesterol or raising high-density lipoprotein cholesterol should decrease the progression of coronary atherosclerosis, and we summarize drug trials in which clofibrate, niacin, cholestyramine, and gemfibrozil decreased coronary heart disease events. Studies that used cholestyramine and the combination of colestipol and niacin resulted in decreased progression of coronary artery disease. On the basis of early experience with lovastatin, inhibitors of hydroxymethylglutaryl-coenzyme A reductase are likely to be effective in the treatment of hypercholesterolemia. The available information on the association of low cholesterol levels and cancer suggests that low total cholesterol is a consequence rather than a cause of carcinoma. Current data strongly support the concept of vigorous intervention directed at management of lipids, both with non-pharmacologic treatment and with drug therapy, for the primary and secondary prevention of coronary atherosclerosis.
"Although there has been considerable controversy over the recommendations for broad-based cholesterol screening and treatment made by a recent national advisory body, screening and attempts to lower cholesterol in individuals with very high cholesterol is much less controversial (Olson 1989). Men in the top cholesterol quintile have a 3.4-fold relative risk of coronary death (i.e., RR = 3.4 andf = .2) compared to the lowest quintile (Martin, Hulley, Browner, et al. 1986), and reducing cholesterol by 10 percent is achievable and proportionally reduces the incidence of coronary heart disease by 20 percent (i.e., RR' = 0.80) (Lipid Research Clinics Program 1984; Lavie et al. 1988). If these results generalize to women as well, reducing cholesterol by 10 percent in half of high-risk individuals (i.e., P = .5) "
[Show abstract][Hide abstract] ABSTRACT: Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health.
Health Services Research 01/1993; 27(5):619-50. · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A sample of 323 physicians from Edmonton, Alberta, was surveyed to evaluate their attitudes and knowledge level concerning heart disease and lipids. Of the sample, 117 physicians returned the questionnaire. When asked to choose significant risk factors of cardiovascular disease, 69% of the physicians indicated hypertension; 85% indicated smoking; and 87% indicated elevated serum cholesterol. Concerning the minimal low-density lipoprotein level that warrants treatment, 82% of the general practitioners and 50% of the specialists indicated that 4.2 mmol/L was the minimal level. This is in contrast to the level of 3.4 mmol/L for low-density lipoprotein recommended by the Canadian Consensus Conference on Cholesterol as the level at which treatment should be initiated.
Canadian family physician Médecin de famille canadien 04/1990; 36:673-7. · 1.34 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.