-
[show abstract]
[hide abstract]
ABSTRACT: The World Health Organization (WHO) criteria for metabolic syndrome were originally published in 1998 and subsequently revised in 1999. The National Cholesterol Education Program (NCEP) proposed somewhat different criteria for the metabolic syndrome in 2001. This study compares the NCEP and WHO criteria for metabolic syndrome with respect to prevalence of coronary heart disease (CHD) in those 50 years and older. The Third National Health and Nutrition Examination Survey (NHANES III) was used to classify adults (> 50 years) by metabolic syndrome using NCEP and 1999 WHO definitions. Risk factor information for components of the metabolic syndrome, traditional cardiovascular risk factors and the prevalence of CHD were determined for each group. Individuals 50 years and older meeting only NCEP criteria had more traditional cardiovascular risk factors than those only meeting WHO criteria and less insulin resistance, per se. Consequently, the NCEP‐only group had a greater prevalence of CHD (18.8%) compared to the WHO‐only group (12.6%, p < 0.001). As a whole (including all individuals who met either NCEP or WHO criteria), prevalence of CHD was significantly higher in those meeting the NCEP definition (15.5%) compared to those meeting the WHO definition of metabolic syndrome (14.1%, p < 0.001). In conclusion, many individuals 50 years and older meet both NCEP and WHO criteria for metabolic syndrome (i.e., there is substantial concordance between the two criteria) and both criteria identify individuals with insulin resistance. NCEP criteria identified individuals with significantly higher CHD prevalence compared to the WHO criteria. In spite of the fact that individuals who met only the WHO criteria were more insulin resistant than the NCEP‐only individuals, those who met only the NCEP clinical criteria for metabolic syndrome had a much worse cardiovascular risk profile and were more likely to have prevalent CHD than those who met only the WHO criteria.
10/2008; 21(3-4):179-190.
-
[show abstract]
[hide abstract]
ABSTRACT: To review recent trials and reassess cardiovascular risk in people with diabetes.
Recent clinical trials have tended to focus on lower-risk participants with diabetes who have had event rates considerably lower than participants in the early lipid trials. Statin studies have generally shown benefit in those without cardiovascular disease and at lower levels of low-density lipoprotein cholesterol. Results of fibrate and glitazone studies have been mixed; the question of benefit among statin-treated patients remains unanswered. Investigators failed to confirm the benefits of glucose control observed in the original Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study possibly due to study design issues. Epidemiologic follow-up of the Diabetes Control and Complications Trial showed sustained benefit of glucose control. A number of studies have shown the benefit of inpatient control of blood glucose. We await the results of ongoing blood pressure trials and other ongoing trials, which should provide much new information. A conceptual model of cardiovascular risk for people with diabetes mellitus based on the UK Prospective Diabetes Study outcomes model is discussed.
The majority of adults with diabetes have a substantially greater risk compared with those without diabetes and a small percentage has very high risk. A minority of individuals may have considerably lower 10-year risk.
Current Opinion in Lipidology 01/2007; 17(6):644-52. · 6.09 Impact Factor
-
The American Journal of Cardiology 11/2006; 98(7):982-5. · 3.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate responsiveness of prescription demand within 9 therapeutic classes to increased cost-sharing compared with constant cost-sharing.
Retrospective prescription claims analysis.
Between 1999 and 2001, 3 benefit plans changed from a 2-tier to a 3-tier design (cases); 1 plan kept a 2-tier design (controls). Study subjects needed 24 months of continuous coverage and a prescription filled < OR = 3 months before the benefit change for a nonsteroidal anti-inflammatory agent (NSAID), a cyclooxygenase (COX-2) inhibitor, a selective serotonin reuptake inhibitor (SSRI), a tricyclic antidepressant (TCA), an angiotensin-converting enzyme (ACE) inhibitor, a calcium-channel blocker (CCB), an angiotensin-receptor blocker (ARB), a statin, or a triptan. Changes in use were compared with the Wilcoxon signed rank test. Elasticity of demand among cases was calculated.
Generally, medication possession ratios decreased for cases and increased for controls between 1999 and 2000. Switch rates increased for cases and decreased for controls for all classes but CCBs. Switches to lower copayments for ACE inhibitors, statins, and triptans occurred more often for cases. Discontinuation-rate changes for cases were 2 to 8 times those for controls. Generic-substitution rates depended on availability and initial generic utilization. Elasticity of demand for drugs was generally low, -0.16 to -0.10, for asymptomatic conditions (ACE inhibitors, ARBs, CCBs, statins), and moderate, -0.60 to -0.24, for symptomatic conditions (COX-2 inhibitors, NSAIDs, triptans, SSRIs).
Use of retail prescription medications within 9 specific therapeutic classes decreased as copayment increased. Demand for pharmaceuticals was relatively inelastic with these copayment increases.
The American journal of managed care 11/2005; 11(10):621-8. · 2.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This retrospective study examined lipid-lowering therapy treatment rates from 2000 to 2001 using the Ingenix LabRx Database. Patients with multiple risk factors without coronary heart disease were identified based on the presence of >/=2 of the following: men >/=45 years, women >/=55 years, hypertension, high-density lipoprotein cholesterol <40 mg/dl, total cholesterol >/=200 mg/dl, or obesity. Lipid treatment rates were estimated among those needing therapy (defined as low-density lipoprotein cholesterol >/=130 mg/dl or currently receiving lipid-lowering therapy). The overall lipid-lowering therapy treatment rate was 38% and the estimated lipid treatment gap (percent needing treatment who were not receiving it) was 62%.
The American Journal of Cardiology 04/2005; 95(7):862-4. · 3.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many health plans have instituted more cost sharing to discourage use of more expensive pharmaceuticals and to reduce drug spending.
To determine how changes in cost sharing affect use of the most commonly used drug classes among the privately insured and the chronically ill.
Retrospective US study conducted from 1997 to 2000, examining linked pharmacy claims data with health plan benefit designs from 30 employers and 52 health plans. Participants were 528,969 privately insured beneficiaries aged 18 to 64 years and enrolled from 1 to 4 years (960,791 person-years).
Relative change in drug days supplied (per member, per year) when co-payments doubled in a prototypical drug benefit plan.
Doubling co-payments was associated with reductions in use of 8 therapeutic classes. The largest decreases occurred for nonsteroidal anti-inflammatory drugs (NSAIDs) (45%) and antihistamines (44%). Reductions in overall days supplied of antihyperlipidemics (34%), antiulcerants (33%), antiasthmatics (32%), antihypertensives (26%), antidepressants (26%), and antidiabetics (25%) were also observed. Among patients diagnosed as having a chronic illness and receiving ongoing care, use was less responsive to co-payment changes. Use of antidepressants by depressed patients declined by 8%; use of antihypertensives by hypertensive patients decreased by 10%. Larger reductions were observed for arthritis patients taking NSAIDs (27%) and allergy patients taking antihistamines (31%). Patients with diabetes reduced their use of antidiabetes drugs by 23%.
The use of medications such as antihistamines and NSAIDs, which are taken intermittently to treat symptoms, was sensitive to co-payment changes. Other medications--antihypertensive, antiasthmatic, antidepressant, antihyperlipidemic, antiulcerant, and antidiabetic agents--also demonstrated significant price responsiveness. The reduction in use of medications for individuals in ongoing care was more modest. Still, significant increases in co-payments raise concern about adverse health consequences because of the large price effects, especially among diabetic patients.
JAMA The Journal of the American Medical Association 06/2004; 291(19):2344-50. · 30.03 Impact Factor
-
Diabetes Care 01/2004; 26(12):3329-30. · 8.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although the individual components of the metabolic syndrome are clearly associated with increased risk for coronary heart disease (CHD), we wanted to quantify the increased prevalence of CHD among people with metabolic syndrome. The Third National Health and Nutrition Examination Survey (NHANES III) was used to categorize adults over 50 years of age by presence of metabolic syndrome (National Cholesterol Education Program [NCEP] definition) with or without diabetes. Demographic and risk factor information was determined for each group, as well as the proportion of each group meeting specific criteria for metabolic syndrome. The prevalence of CHD for each group was then determined. Metabolic syndrome is very common, with approximately 44% of the U.S. population over 50 years of age meeting the NCEP criteria. In contrast, diabetes without metabolic syndrome is uncommon (13% of those with diabetes). Older Americans over 50 years of age without metabolic syndrome regardless of diabetes status had the lowest CHD prevalence (8.7% without diabetes, 7.5% with diabetes). Compared with those with metabolic syndrome, people with diabetes without metabolic syndrome did not have an increase in CHD prevalence. Those with metabolic syndrome without diabetes had higher CHD prevalence (13.9%), and those with both metabolic syndrome and diabetes had the highest prevalence of CHD (19.2%) compared with those with neither. Metabolic syndrome was a significant univariate predictor of prevalent CHD (OR 2.07, 95% CI 1.66-2.59). However, blood pressure, HDL cholesterol, and diabetes, but not presence of metabolic syndrome, were significant multivariate predictors of prevalent CHD. The prevalence of CHD markedly increased with the presence of metabolic syndrome. Among people with diabetes, the prevalence of metabolic syndrome was very high, and those with diabetes and metabolic syndrome had the highest prevalence of CHD. Among all individuals with diabetes, prevalence of CHD was increased compared with those with metabolic syndrome without diabetes. However, individuals with diabetes without metabolic syndrome had no greater prevalence of CHD compared with those with neither.
Diabetes 06/2003; 52(5):1210-4. · 8.29 Impact Factor
