David Siegel

• MD, MPH
• Chief of Medicine at VA Northern California Health Care Systems

A portion of this article was previously published as part of an article titled “Human C-reactive protein and the metabolic syndrome” in the following journal: Curr Opin Lipidol. 2009 Jun;20(3):182–9. doi: 10.1097/MOL.0b013e32832ac03e. https://insights.ovid.com/crossref?an=00041433-200906000-00007

A portion of this article was previously published as part of an article titled “Human C-reactive protein and the metabolic syndrome” in the following journal: Curr Opin Lipidol. 2009 Jun;20(3):182-9.

Following publication of this article [1] it came to our attention that we neglected to reference an article by Ishwarlal Jialal published in Critical Pathways in Cardiology [2].

Background: Low-density lipoprotein cholesterol (LDL-C) concentrations are the primary therapeutic target in patients with atherosclerotic cardiovascular disease (ASCVD). However, at low LDL-C concentrations, there is a significant underestimation using the Friedewald equation compared with ultracentrifugation. Methods: In this pilot study, we c...

Thiazide diuretics (TD) are recommended as first-line therapy in uncomplicated hypertension by several professional organizations. However, they also may pose a risk of glucose metabolism abnormalities in certain individuals. Early studies showed TD cause a small increase in fasting glucose. These effects may be related to exacerbation of insulin r...

Background: Statin intolerance especially myalgias can be a serious problem. Whilst it is well know that drugs that compete for Cytochrome 450 system can result in myalgias there is sparse data on the role of glucuronidation of statins contributing to statin intolerance We report on a 60 year old male with Hypercholesterolemia (HC) who was referred...

Background: A relative cardiovascular risk reduction of 25% to 35% has been reported in patients starting a statin for elevated cholesterol; yet many patients fail to consistently take these medications as directed. Objective: To evaluate factors affecting adherence and persistence with statin therapy. Methods: This retrospective study analyze...

Background: Although hepatic insulin resistance has been documented in patients with metabolic syndrome using homeostasis model assessment of insulin resistance (HOMA-IR) as a measure, there is scanty data on adipose insulin resistance (Adipo-IR) and its relationship with the dysregulation of adipokines in metabolic syndrome. Thus, we examined whe...

abdominal obesity, an atherogenic dyslipidemia manifest as elevated levels of triglycerides (TGs) and low levels of high density lipoprotein-cholesterol (HDL-C), raised blood pressure, and impaired fasting glucose.1 The importance of metabolic syndrome is that it confers at least a twofold increased risk of cardiovascular disease and at least five-...

Anterior cruciate ligament (ACL) injuries are the most common ligament injury in the United States. These injuries can be career ending for athletes and severely disabling for all individuals. Our objectives are to review the epidemiology of these injuries, as well as ACL biomechanics, anatomy, and nonsurgical and surgical management so that genera...

The Metabolic Syndrome (MetS) confers a greater risk for both diabetes and cardiovascular diseases. Both insulin resistance and low grade inflammation appear to be pivotal in the pathogenesis of this disorder. The cornerstone of treatment presently is therapeutic lifestyle change with the emphasis on weight loss by diet and exercise. It appears tha...

Increasing evidence supports an important role for inflammation in all phases of atherosclerosis, from initiation of the fatty streak to final culmination in acute coronary syndromes. Numerous inflammatory biomarkers including cell adhesion molecules, cytokines, chemokines, and acute-phase reactants such as fibrinogen, serum amyloid A, and C-reacti...

Increase in obesity and metabolic syndrome are associated with increases in insulin resistance (IR) and type 2 diabetes mellitus. Results from animal intervention studies and human epidemiological studies suggest that n-3 polyunsaturated fatty acids can prevent and reverse IR, but results from human intervention studies have varied. Results from so...

The prevalence of obesity, hypertension and type 2 diabetes mellitus-all part of the metabolic syndrome--is increasing in the US and worldwide. In this setting, it is important to understand the effects of antihypertensives on several components of the metabolic syndrome. Overall, has treatment of hypertension in diabetes been beneficial? To answer...

A pharmacy database was used to identify patients with resistant hypertension who could then be tested for the presence of primary hyperaldosteronism. Inclusion criteria were: (1) resistant hypertension defined as uncontrolled hypertension and use of 3 antihypertensive medication classes or ≥ 4 antihypertensive classes regardless of blood pressure;...

The metabolic syndrome, is a cluster of risk factors for cardiovascular disease (CVD), characterized by insulin resistance, visceral adiposity, low HDL cholesterol that confers an increased propensity to diabetes and cardiovascular disease. It is well-documented that inflammatory processes play an important role in the causation of CVD. Recent evid...

Hypertension Research, official publication of the Japanese Society of Hypertension, publishes papers reporting original clinical and experimental research in the field of hypertension and related cardiovascular diseases.

J Clin Hypertens (Greenwich). 2011;13:487–491.©2011 Wiley Periodicals, Inc. A pharmacy database was used to identify patients with resistant hypertension who could then be tested for the presence of primary hyperaldosteronism. Inclusion criteria were: (1) resistant hypertension defined as uncontrolled hypertension and use of 3 antihypertensive medi...

Metabolic syndrome (MetS), is a constellation of cardiometabolic disease risk factors, that affects 1 in 3 US adults and predisposes to increased risks for both diabetes and cardiovascular disease. While epidemiological studies show low vitamin D [(25(OH)D] levels in MetS, there is sparse data on vitamin D status in MetS patients in North America....

Abstract The Action to Control Cardiovascular Risks in Diabetes Study (ACCORD) was a well-designed trial of 10,251 patients with type 2 diabetes mellitus that studied the effects of tight control of blood sugar, hypertension, and lipids. Disappointingly, as compared with standard treatment, the use of intensive therapy to target normal glycosylated...

Much evidence supports a pivotal role for inflammation in atherosclerosis. C-reactive protein (CRP), the prototypic marker of inflammation in humans, is a cardiovascular risk marker and may also promote atherogenesis. CRP levels are increased in metabolic syndrome and hypertension and confer increased risk of cardiovascular events in patients in th...

Metabolic syndrome is associated with increased propensity for diabetes and cardiovascular disease. Low-grade inflammation is characteristic of metabolic syndrome. C-reactive protein, the best characterized biomarker of inflammation, is also an independent predictor of future cardiovascular events. This review outlines the role of high-sensitivity...

The prevalence of obesity, hypertension, and type 2 diabetes mellitus-in other words, the metabolic syndrome-is increasing in the United States. In this setting, it is important to understand the effects of antihypertensives on parameters of the metabolic syndrome in addition to glucose metabolism. Here the authors review pertinent clinical studies...

Niacin increases blood glucose, but whether the degree of increase is associated with increasing body mass index (BMI) is unknown. We evaluated the effect of extended-release niacin initiation on fasting plasma glucose (FPG) and the development of new-onset diabetes mellitus (DM) in relation to body mass index (kg/m(2)) in nondiabetic patients. Thi...

In order to evaluate efforts to improve blood pressure (BP) control in veterans with diabetes, the authors performed a retrospective review of computerized health records in the Veterans Affairs Northern California Health Care System (VANCHCS). A total of 6624 diabetic patients with BP data were identified and a comparison was made to earlier surve...

Dietary (n-3) PUFA reduce inflammation, an independent risk factor for cardiovascular disease. The antiinflammatory effects of docosahexaenoic acid (DHA) in hypertriglyceridemic men have not been previously reported, to our knowledge, and were the focus of this study. Hypertriglyceridemic men (n = 17 per group) aged 39-66 y, participated in a doubl...

Metabolic syndrome (MS), characterized by low-grade inflammation, confers an increased risk for cardiovascular disease. Statins, in addition to having lipid-lowering effects, have pleiotropic effects and decrease biomarkers of inflammation and oxidative stress. The Treating to New Target Study showed a greater decrease in low-density lipoprotein (L...

The prevalence of obesity, hypertension, and type 2 diabetes mellitus is increasing in the United States. In this setting, it is important to understand the effects of antihypertensives on glucose metabolism. We therefore examined the association between body mass index (BMI) (kg/m(2)) and fasting blood glucose (FBG) in subjects in whom thiazide an...

Plasma remnant-like particle-cholesterol (RLP-C) and the RBC (n-3) index are novel risk factors for cardiovascular disease. Effects of docosahexaenoic acid (DHA) supplementation on these risk factors in hypertriglyceridemic men have not been studied. We determined effects of DHA supplementation on concentrations of plasma RLP-C, the RBC (n-3) index...

Plasma remnant-like particle-cholesterol (RLP-C) and the RBC (n-3) index are novel risk factors for cardiovascular disease. Effects of docosahexaenoic acid (DHA) supplementation on these risk factors in hypertriglyceridemic men have not been studied. We determined effects of DHA supplementation on concentrations of plasma RLP-C, the RBC (n-3) index...

The metabolic syndrome (MS) is characterized by low-grade inflammation and confers an increased risk for diabetes mellitus and cardiovascular disease. Statins reduce cardiovascular events in patients with the MS and have pleiotropic effects in addition to lowering low-density lipoprotein cholesterol. Because there is a paucity of data on the effect...

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed. Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel...

Treatment with different antihypertensive drug classes has varied effects on glucose metabolism. Thiazide diuretic use in hypertensives has been associated with the development of glucose intolerance and diabetes. Some findings suggest that the probability of worsening glucose metabolism and the development of new diabetes after thiazide initiation...

The effects of docosahexaenoic acid (DHA) on the mean size and concentrations of VLDL, LDL, and HDL subclasses have not been previously studied. We determined the effects of DHA supplementation on the concentrations of apoproteins; large, medium, and small VLDL, LDL, and HDL particles; and the mean diameters of these particles in fasting and postpr...

Adherence measures the extent to which patients take medications as prescribed by their health care provider. The control of hypertension is dependent on medication adherence and may vary on the basis of antihypertensive medication class and other factors. The Department of Veterans Affairs' automated pharmacy database captures pharmacy medication...

Journal of Human Hypertension is exclusively concerned with all clinical aspects of human hypertension. The journal publishes fully refereed original research papers from around the world.

Hypertension is a major contributor to both macro- and microvascular disease in patients with diabetes. We have previously described (ASH 2001) a high prevalence of systolic hypertension among veterans with diabetes in the VANCHCS. A follow-up study (ASH 2003) confirmed this finding, but suggested that BP control improved, commensurate with more ag...

This study evaluates antihypertensive medication adherence using Department of Veterans Affairs pharmacy databases. Automated data extraction routines capture pharmacy, ICD-9, laboratory, and patient demographic data on a monthly basis. We included patients with a diagnosis of hypertension (ICD-9 codes 401.1 to 401.9) who had a history of medicatio...

There are major differences between the current knowledge of the treatment of cardiac conditions derived from evidence-based medicine and the widespread application of this knowledge. This is particularly true in the treatment of hypertension. Hypertension is the most common chronic cardiovascular condition, affecting more than 50 million Americans...

Studies describe differences between recommendations for hypertension treatment and actual drug use. Antihypertensive use data from the Department of Veterans Affairs (VA) for 1995 to 1999 showed a downward trend for calcium antagonist (CA) use and increased use of beta-blockers (BB) and thiazide diuretics (TD). This study evaluates national VA ant...

Background: Studies describe differences between recommendations for hypertension treatment and actual drug use. Antihypertensive use data from the Department of Veterans Affairs (VA) for 1995 to 1999 showed a downward trend for calcium antagonist (CA) use and increased use of beta-blockers (BB) and thiazide diuretics (TD). This study evaluates nat...

Several studies indicate that treatment of hypertension in the United States does not follow recommendations from expert bodies. We thus implemented a program using academic detailers to increase practitioner compliance with antihypertensive treatment guidelines. Five Veterans Affairs medical facilities including academic medical centers and commun...

Hypertension is a major contributor to both macro- and microvascular disease in patients with diabetes. As a result, many guidelines, including JNCVI, suggest aggressive blood pressure (BP) management in these patients, with a goal of < 130/85 mm Hg. We have previously described (ASH 2001) a high prevalence of systolic hypertension among veterans w...

Objective: Recent evidence suggests that less then one-third of hypertensive patients in the United States have adequate blood pressure control. In an attempt to improve hyper-tension management for Department of Veterans Affairs' (VA) patients, we implemented three electronic hypertension reminders using the VA's Computerised Patient Record Sys-te...

Several studies indicate that treatment of hypertension in the United States does not follow recommendations from expert bodies. We thus implemented a program using academic detailers to increase practitioner compliance with antihypertensive treatment guidelines. Five Veterans Affairs medical facilities including academic medical centers and commun...

Recent Veterans Affairs (VA) guidelines recommend that persons with stable type 2 diabetes controlled on oral agents or diet therapy perform self-monitoring of blood glucose (SMBG) twice weekly. We assessed the impact of a modification of these guidelines on hemoglobin A1c (HbA1c) and monitoring cost. Retrospective, noncrossover clinical trial. Pat...

Hypertension is a major contributor to both macro- and microvascular disease in diabetics. As a result, many guidelines, such as JNCVI, suggest aggressive blood pressure management in these patients, with a goal of <130/85 mm Hg. To assess our success in reaching this goal, we performed a review of all computerized health records in the VANCHCS: 52...

Older studies of antihypertensive treatment have shown that prescribing patterns are not consistent with recommendations from expert national panels. We determined whether prescribing patterns for antihypertensive drugs changed recently in the largest integrated health care system in the United States. Specifically, we determine 1) patterns of anti...

In some patients with renal disease, use of angiotensin-converting enzyme (ACE) inhibitors is thought to improve renal function, whereas in others their use leads to worsening. Many questions remain about the categories of patients that benefit from ACE inhibitor use. To clarify the use of ACE inhibitors in patients with renal disease. A literature...

Am J Hypertens (2001) 14, 103A–104A; doi:10.1016/S0895-7061(01)01415-7 P-225: Impact of a regional VA academic detailing program to improve medication prescribing in hypertension Julio Lopez1,2,3,4,5, Joy Meier1,2,3,4,5, Bradley Brazill1,2,3,4,5, Samuel Lee1,2,3,4,5, Mazen Matalka1,2,3,4,5 and David Siegel1,2,3,4,51Pharmacy Service VA Northern Cal...

Older studies of antihypertensive treatment have shown that prescribing patterns are not consistent with recommendations from expert national panels. We determined whether prescribing patterns for antihypertensive drugs changed recently in the largest integrated health care system in the United States. Specifically, we determine 1) patterns of anti...

Efforts to influence medical practice include the formation of expert medical panels who make recommendations for the evaluation and treatment of clinical problems. Despite the considerable expense and effort that go into these activities, it is unclear whether they are successful. Recent studies have evaluated whether recommendations from the Fift...

There is a gap between the current knowledge of the treatment of cardiac conditions derived from evidence-based medicine and the widespread application of this knowledge. The use of ACE inhibitors for patients with congestive heart failure, beta blockers in postmyocardial infarction patients, anticoagulation in patients with chronic atrial fibrilla...

Although the presence of a comorbid condition should be an important factor in etermining the choice of an antihypertensive agent, the prevalence of conditions complicating hypertension is unknown in most patient populations. It is also unknown whether the presence of comorbid conditions influences antihypertensive therapy. To address these questio...

Patterns of antihypertensive drug use, the cost of this care and potential savings with changes of treatment patterns, were studied for all hypertensives treated at US Veterans Affairs (VA) medical facilities for fiscal years 1995 and 1996. Data was aggregated by individual medication as well as by antihypertensive drug class. Cost estimates were b...

The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications. To describe national antihypertensive medication prescribing patterns for 1992 and 1995; to explore the influence of the Fifth Joint National Committee on the Detection, Evaluat...

Patterns of antihypertensive drug use, the cost of this care and potential savings with changes of treatment patterns, were studied for all hypertensives treated at US Veterans Affairs (VA) medical facilities for fiscal years 1995 and 1996. Data was aggregated by individual medication as well as by antihypertensive drug class. Cost estimates were b...

Did the 1993 published recommendations from the Fifth Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure influence the antihypertensive prescribing patterns of clinicians? To answer this question, we studied prescribing patterns for both 1992 and 1995 for all medications dispensed by a national sample of 35,...

Context. —The choice of pharmacological treatment for the approximately 50 million people in the United States with hypertension has important therapeutic and financial implications.

Peer-led, school-based interventions show promise for preventing AIDS among adolescents, but little is known about the processes underlying effective peer education or the conditions that promote its efficacy. This study examined the implementation in one school of an effective, peer-led AIDS prevention program for inner-city 7th-grade participants...

To review (1) basic principles of follow-up in patients who are in complete remission following curative therapy for cancer; (2) evaluate the available data on follow-up strategies for testicular cancer, Hodgkin's disease, non-Hodgkin's lymphoma, breast cancer, colorectal cancer, small cell and non-small cell lung cancer, and prostate cancer; and (...

Peer‐led, school‐based interventions show promise for preventing AIDS among adolescents, but little is known about the processes underlying effective peer education or the conditions that promote its efficacy. This study examined the implementation in one school of an effective, peer‐led AIDS prevention program for inner‐city 7th‐grade participants...

OBJECTIVE: To review (1) basic principles of follow-up in patients who are in complete remission following curative therapy for cancer; (2) evaluate the available data on follow-up strategies for testicular cancer, Hodgkin’s disease, non-Hodgkin’s lymphoma, breast cancer, colorectal cancer, small cell and non–small cell lung cancer, and prostate ca...

To examine patterns of cigarette smoking among individuals of different socioeconomic status (SES) and ethnicity. A cross-sectional and longitudinal community-based random household sample. Unmarried African-American, Latino and while men and women, aged 20-44 years, living in San Francisco in 1988-9 and in 1989-90, were surveyed regarding prior an...

A school-based AIDS-prevention program for junior high school students was developed and implemented in an inner-city area in northern California that serves predominantly African-American and Asian students. The curriculum, taught by science teachers, consisted of twelve classroom sessions using both didactic and interactive exercises covering sex...

To describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors. A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in...

To examine the extent of hepatitis B virus infection (HBV) in an inner-city community, we determined the prevalence, incidence, and correlates of HBV seroreactivity in a representative sample of unmarried whites, African-Americans, and Hispanics living in San Francisco during 1988 to 1989 and again 1 year later in 1989 to 1990. Unmarried men and wo...

To examine the extent of hepatitis B virus infection (HBV) in an inner-city community, we determined the prevalence, incidence, and correlates of HBV seroreactivity in a representative sample of unmarried whites, African-Americans, and Hispanics living in San Francisco during 1988 to 1989 and again 1 year later in 1989 to 1990. Unmarried men and wo...

To examine the extent of infection with syphilis in an inner-city community, we determined the prevalence, incidence, and correlates of syphilis seroreactivity in a representative sample of unmarried whites, African Americans, and Hispanics living in San Francisco during 1988 to 1989 and again 1 year later in 1989 to 1990. One thousand seven hundre...

Elementary school-age children's conceptual understanding and factual knowledge about the causes of acquired immunodeficiency syndrome (AIDS), colds, and obesity are poorly understood, particularly among black children living in low-income, urban neighborhoods. We examined minority children's conceptual understanding about the causes of these illne...

We investigated serum glucose and insulin levels resulting from thiazide or thiazide-like diuretic administration and determined whether they were associated with serum or intracellular potassium or magnesium values. We also explored the role of obesity both alone and with thiazides on serum insulin and glucose. Hypertensive men were withdrawn from...

We examined correlates of condom use among heterosexual whites, blacks, and Hispanics (ages 20-45 years) with an human immunodeficiency virus (HIV) risk factor in a community-based longitudinal sample (San Francisco; n = 716). Lag models were used to examine hypothesized antecedents of condom use at wave 2. High levels of condom use were associated...

Twenty-one percent of a sample of inner-city junior high school students were found to be sexually active (n = 403). Only 31% of them reported a single lifetime sexual partner, 25% reported two partners, and 43% reported three or more partners. Logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors...

We examined changes in condom use over a one‐year period (1988–89 to 1989–90) among heterosexual Whites, Blacks, and Hispanics (aged 20–45 years) with a Human Immunodeficiency Virus (HIV)‐related risk factor in a community‐based longitudinal sample (n = 716). This study is the first to examine changes in condom use based on a random household proba...

To examine the extent and correlates of infection with herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in an inner-city community, we studied the prevalence of antibodies to these viruses and their association with risk behaviors in a representative sample of unmarried white, black, and Hispanic adults living in San Francisco, Calif. Cross-s...

Objective. - To examine the extent and correlates of infection with herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in an inner-city community, we studied the prevalence of antibodies to these viruses and their association with risk behaviors in a representative sample of unmarried white, black, and Hispanic adults living in San Francisco, C...

Objective.—To examine the extent and correlates of infection with herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in an inner-city community, we studied the prevalence of antibodies to these viruses and their association with risk behaviors in a representative sample of unmarried white, black, and Hispanic adults living in San Francisco, Cal...

The prevalence, characteristics and circadian pattern of silent myocardial ischemia, and its association with ventricular arrhythmias was studied in hypertensive men aged 35 to 70 years (mean 61) without clinical cardiac disease. Participants were withdrawn from diuretic treatment and received 1 month of oral electrolyte repletion with 40 mmol of p...

To examine the actual and potential spread of human immunodeficiency virus (HIV) from an acquired immunodeficiency syndrome (AIDS) epicenter to surrounding neighborhoods, we studied the prevalence of the viral infection and AIDS risk behaviors from 1988 to 1989 in a representative sample of unmarried whites, African Americans, and Hispanics living...

In Reply. —We agree with Drs Clarfield, Friedman, and Bergman that hypertension is an important risk factor in the elderly; in fact, some of our previous work is on this topic.1 However, the present study focused on middle-aged men because the goal was to examine findings in the Multiple Risk Factor Intervention Trial (MRFIT), which found an assoc...