Risk-Factor Based-Medicine and Its Discontents

By MICHEL ACCAD, MD If concepts could get awards, then “risk factor” would surely be a Nobel prize winner.  Barely over 50 years of age, it enjoys such an important place in medicine that I suspect most of us doctors could hardly imagine practicing without it.  Yet, clearly, the concept is not native to our profession nor is its success entirely justified. A few years ago, on the occasion of the risk factor’s fiftieth anniversary, my colleague Herb Fred and I published an editorial highlighting some of the problem with the use of this concept.  I will summarize here some of those points. The risk factor concept was developed in the first decades of the twentieth century from within the life insurance industry as it began to systematically apply statistical methods in order to optimize actuarial predictions.  The idea was to identify which baseline characteristics held by individuals would correlate with future risk of death. The Framingham investigators imported this idea into the public health sphere and introduced the term risk factor in the medical literature in 1961.  From then on, the concept and term have enjoyed an unmitigated success. Originally confined to the cardiovascular arena, the concept is now thriving in every single medical discipline.  The diagram below is from a 2005 paper by Brotman et al.   The authors found that close to 1,200 papers per year claim new knowledge about &l...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs

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Abstract Objectives: To investigate the influence of statins on major adverse cardiovascular events (MACE) in patients with coronary microvascular dysfunction (CMVD). Participants: 23,494 patients who received coronary angiography (CAG) were included. Thrombolysis in Myocardial Infarction, Myocardial Perfusion Grading (TMPG), a useful angiographic method, was used to evaluate CMVD. Results: Using multivariate analysis, NYHA III/IV (HR, 1.44; 95% CI, 1.03-2.01; P=0.031), PCI history (HR, 3.69; 95% CI, 2.57-5.31; P
Source: Biomed Res - Category: Research Authors: Tags: Biomed Res Int Source Type: research
Conclusion: Inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment may substantially contribute to the visual recovery, reducing the incidence of secondary epiretinal membrane formation.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
Conclusion: Swept-source OCTA is a reproducible technique in the assessment of macular perfusion in diabetic patients with special regards to foveal avascular zone analysis. The agreement with FFA is limited especially for diabetic macular ischemia grading. Fundus fluorescein angiography is more sensitive in identifying microaneurysms.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
Conclusion: In Japanese patients with DME, IAI treatment was superior to laser for visual and anatomical outcomes and resulted in efficacy and safety outcomes similar to those in a non-Japanese patient population.
Source: RETINA - Category: Opthalmology Tags: Original Study Source Type: research
No abstract available
Source: RETINA - Category: Opthalmology Tags: Photo Essay Source Type: research
CONCLUSIONS The results indicated that longevity-associated FOXO3 variants were correlated with lower blood glucose levels in elderly women with type 2 diabetes in east China. PMID: 31009445 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
This study aims to assess the determinant of postprandial TG in healthy young adults.MethodsThis is a quasy-experimental study that involved 200 healthy young adults. This study compared fasting with postprandial TG and analyzed the relationship between postprandial TG with various demographic and metabolic parameters after ingestion of standardized high fat liquid meal.ResultThere was an upward trend from fasting TG to 2 h postprandial TG and 4 h postprandial TG. There was strong correlation between fasting TG and 2 h postprandial TG with 4 h postprandial TG (r = 0.731; p 
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research
Abstract Motor capability recovery after ischemic stroke involves dynamic remodeling processes of neural connectomes in the nervous system. Various neuromodulatory strategies combining direct stimulating interventions with behavioral trainings for motor recovery after ischemic stroke have been developed. However, the effectiveness of these interventions varies widely due to unspecific activation or inhibition of undefined neuronal subtypes. Optogenetics is a functional and structural connection-based approach that can selectively activate or inhibit specific subtype neurons with a higher precision, and it has been...
Source: Neural Plasticity - Category: Neurology Authors: Tags: Neural Plast Source Type: research
ConclusionUAE is a green and efficient technique for the preparation of flavonoids from sour Jujube seed. The flavonoids extract can reduce Aβ-induced toxicity in Caenorhabditis elegans.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 22 April 2019Source: Journal of EthnopharmacologyAuthor(s): Qiuyan Wang, Jiewen Zhou, Zhinan Xiang, Qilin Tong, Jun Pan, Luosheng Wan, Jiachun ChenAbstractEthnopharmacological relevanceCassiae Semen, the dried seed of Cassia obtusifolia L. (Leguminosae), is a traditional Chinese medicine. It has long been used as the treatment of diabetic hyperlipidemia and diabetic constipation in Traditional Chinese Medicine formulae.Aim of the studyThe present study was designed to investigate the anti-diabetic and renoprotective effects of Cassiae Semen extract (CSE) in streptozotocin (STZ)-induced di...
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
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