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Metformin associated with better cardiovascular outcomes than other glycaemic therapies
Context A question exists as to whether the outcome of glycaemic treatment of diabetes varies with the agent used; speculation surrounds whether metformin might be preferable to other treatments. Methods Ghotbi and colleagues performed an epidemiological analysis of 8192 obese patients with diabetes at increased cardiovascular risk participating in the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. Mortality and a combined cardiovascular outcome of non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest or cardiovascular death were compared among those receiving one of the following interv...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Bloomgarden, Z. T. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Heart failure, Stroke, Hypertension, Diet, Obesity (nutrition), Ischaemic heart disease, Diabetes, Health education, Smoking Therapeutics Source Type: research

Fruit and vegetable consumption is associated with reduced all-cause and cardiovascular mortality
Commentary on: Wang X, Ouyang Y, Liu J, et al.. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014;349:g4490 Context Dietary guidelines from around the world recommend the daily consumption of a variety of fruits and vegetables. For example, the ‘5 a day’ public health campaign in the UK encourages people to consume at least five 80 g portions of fruits and vegetables every day. These guidelines are largely based on recommendations from the WHO to consume at least 400&nb...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Crowe, F. L. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Diet, Ischaemic heart disease, Health education, Smoking Therapeutics/Prevention Source Type: research

ACE inhibitors in African Americans with hypertension associated with worse outcomes as compared to other antihypertensives
Commentary on: Bangalore S, Ogedegbe G, Gyamfi J, et al.. Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks. Am J Med 2015;128:1195–203. Context Hypertension affects one-third of the world's population and remains a leading cause of myocardial infarction, stroke, heart failure, renal failure and death. Although hypertension control has improved,1 the prevalence is increasing due to an ageing population, rising obesity and a shift towards western lifestyles and disease patterns in low-income and middle-income countries. Hypertension is now also a major contr...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Lund, L. H. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Obesity (nutrition), Ischaemic heart disease, Renal medicine, Drugs: musculoskeletal and joint diseases, Health education Source Type: research

Electronic physician notifications to improve guideline-based anticoagulation in atrial fibrillation: a randomized controlled trial
ConclusionsElectronic physician notification did not increase anticoagulation in patients with atrial fibrillation at elevated stroke risk. Primary care physicians did not prescribe anticoagulants because they perceived the bleeding risk was too high or stroke risk was too low.Trial RegistrationClinicalTrials.gov identifier NCT02950285
Source: Journal of General Internal Medicine - August 3, 2018 Category: Internal Medicine Source Type: research

Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults
ConclusionsDepressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.
Source: Journal of General Internal Medicine - February 27, 2019 Category: Internal Medicine Source Type: research

Factors that influence awareness and treatment of atrial fibrillation in older adults
Conclusions: With projected doubling of numbers of persons over 80 in the next 30 years in the British Isles, detection and management of AF is pressing. Two-thirds of adults at high risk of stroke were inadequately treated. More regular screening for AF, application of criteria for stroke and bleeding risk and awareness of factors influencing diagnosis and treatment is recommended.
Source: QJM - April 21, 2013 Category: Internal Medicine Authors: Frewen, J., Finucane, C., Cronin, H., Rice, C., Kearney, P. M., Harbison, J., Kenny, R. A. Tags: Original papers Source Type: research

Underuse of Anticoagulation in Patients with Atrial Fibrillation.
Authors: Vallakati A, Lewis WR Abstract Atrial fibrillation (AF) is a major risk factor for ischemic stroke. Guidelines recommend anticoagulation for patients with intermediate and high stroke risk (CHA2DS2-VASc score ≥2). Underuse of anticoagulants among eligible patients remains a persistent problem. Evidence demonstrate that the psychology of the fear of causing harm (omission bias) results in physicians' hesitancy to initiate anticoagulation and results in an inaccurate estimation of stroke risk. The American Heart Association (AHA) initiated the Get With The Guidelines-AFIB (GWTG-AFIB) module in June 2013 to...
Source: Postgraduate Medicine - December 20, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Association between comorbid conditions and BADL/IADL disability in hypertension patients over age 45: Based on the China health and retirement longitudinal study (CHARLS)
We examined the association between the number and categories of comorbid conditions and disability affecting activities of daily living in hypertension patients. The data were collected from the 2013 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS), which contains information about chronic conditions and disability. Additionally, socio-demographic characteristics of 3754 hypertension patients aged 45 and older were included in this study. Comorbid conditions included dyslipidemia, stroke, and 12 other chronic conditions. Disability in relation to activities of daily living was assessed usin...
Source: Medicine - August 1, 2016 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial
ConclusionsThe large variation in eclampsia and maternal and neonatal fatality from hypertensive disorders of pregnancy between countries emphasises that inequality and inequity persist in healthcare for women with hypertensive disorders of pregnancy. Alongside the growing interest in improving community detection and health education for these disorders, efforts to improve quality of care within healthcare facilities are key. Strategies to prevent eclampsia should be informed by local data. Trial registrationISRCTN: 41244132.
Source: PLoS Medicine - March 28, 2019 Category: Internal Medicine Authors: Nicola Vousden Source Type: research

Perceptions and knowledge gaps on CHA < sub > 2 < /sub > DS < sub > 2 < /sub > -VASc score components: a joint survey of Chinese clinicians and clinical pharmacists
CONCLUSIONS: Chinese medical professionals, especially EPs and GPs, revealed a lack of knowledge and insufficient skills for CHA2DS2-VASc scores and their components. Improvements in the awareness of the CHA2DS2-VASc score and its detailed scoring criteria are urgently needed for Chinese medical professionals. Therefore, education programs concerning the introduction of stroke risk evaluation for AF patients and the development of referencing scoring tools are necessary.PMID:34694951 | DOI:10.1080/00325481.2021.1996815
Source: Postgraduate Medicine - October 25, 2021 Category: Internal Medicine Authors: Chi Zhang Long Shen Mang-Mang Pan Ying-Li Zheng Zhi-Chun Gu Hou-Wen Lin Source Type: research

Defining Metabolic Syndrome and Factors Associated with Metabolic Syndrome in a Poly-pharmaceutical Population.
CONCLUSION: The IDF definition for METs that makes allowance for treatment for each specific condition can lead to an overestimation in the prevalence of METs in population studies. Not including those medicated with normal results conversely underestimates the prevalence of METs. We have therefore proposed adjustments to BP and lipid measurements based on pooled mean effects from published systematic reviews to mitigate bias in future research on prevalence of METs. PMID: 27558757 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - August 27, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Prevalence and Costs of Discharge Diagnoses in Inpatient General Internal Medicine: a Multi-center Cross-sectional Study
ConclusionsGIM services care for a markedly heterogeneous population but the most common conditions were similar across 7 hospitals. The diversity of conditions cared for in GIM may be challenging for healthcare delivery and quality improvement. Initiatives that cut across individual diseases to address processes of care, patient experience, and functional outcomes may be more relevant to a greater proportion of the GIM population than disease-specific efforts.
Source: Journal of General Internal Medicine - July 27, 2018 Category: Internal Medicine Source Type: research

Cardiovascular disease risk unmasked by pregnancy complications.
Abstract Pregnancy related complications indicate a propensity for atherosclerotic disease. Epidemiologic data demonstrate early onset cardiovascular disease in women with a history of pregnancy loss, preterm pregnancy or pregnancy complicated by intrauterine growth restriction. Early onset diabetes, increased rates of MI and increased rates of stroke are more prevalent after gestational diabetes. In addition, hypertensive disorders of pregnancy mark significant pathophysiologic changes, including vascular dysfunction and immunologic changes, which induce atherogenesis and result in a substantial increase in rates...
Source: European Journal of Internal Medicine - July 25, 2018 Category: Internal Medicine Authors: Jasper R, Skelding K Tags: Eur J Intern Med Source Type: research

Bone mineral loss and cognitive impairment: The PRESENT project
Low bone mineral density (BMD) is correlated with Alzheimer's disease and its severity, but the association remains unclear in adults (≥50 years) without a history of stroke or dementia. We assessed BMD and cognitive function using the Mini-Mental Status Examination (MMSE) in 650 stroke- and dementia-free subjects (≥50 years) who were recruited for an early health check-up program between January 2009 and December 2010. The mean age was 62.9 ± 8.0 years and mean MMSE score was 27.6 ± 3.6. A total of 361 subjects had reduced BMD: 197 (30.3%) had osteopenia and 154 (23.6%) had osteoporosis, based on criteria ...
Source: Medicine - October 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study
This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findingsWe harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54 –105 (mean = 72.7) years and without dementia at baseline. Studies had 2–15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mas...
Source: PLoS Medicine - July 22, 2019 Category: Internal Medicine Authors: Darren M. Lipnicki Source Type: research

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