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Biomedical subjects

E H Wittels

Publications and source records attributed to E H Wittels.

6 recordsLinked to original sources
PubMed1991

An economic evaluation of lovastatin for cholesterol lowering and coronary artery disease reduction.

The costs and benefits of cholesterol lowering in the primary prevention of coronary artery disease (CAD) were considered using lifetime lovastatin therapy as the intervention model for adults between 35 and 55 years of age. The analysis projected the benefits of CAD risk reduction using estimates from the Framingham Heart Study. The chosen analytic perspective was that of the patient. For average-risk men with total serum cholesterol levels between 5.69 and 9.83 mmol/liter (220 and 380 mg/dl), the cost per life-year saved ranged from $9,000 to $106,000, whereas for average-risk women, the cost ranged from $35,000 to $297,000 (1989 U.S. dollars). In high-risk men (with smoking habit and hypertension), the cost per life-year saved values ranged from 6,000 to $53,000, whereas in high-risk women the cost per life-year saved values ranged from $19,000 to $160,000. The results were more favorable than those found in previous studies of alternate medication therapies for hypercholesterolemia. Even using conservative parameter assumptions, at least 800,000 Americans aged 35 to 55 years are at sufficiently high risk for CAD, so that the net cost of lovastatin therapy can be favorably compared with other widely used medical interventions.

Adult↗
PubMed1990

Medical costs of coronary artery disease in the United States.

A model has been developed to determine the cost of coronary artery disease (CAD) based on the 5 primary events identified in the Framingham Study: acute myocardial infarction, angina pectoris, unstable angina pectoris, sudden death and nonsudden death. The costs for diagnostic and therapeutic service for patients with CAD were linked to medical decision algorithms outlining the diagnosis and management of patients with CAD. Because CAD is a changing illness not represented by a single event, the algorithm tracked patients for 5 years after the time of diagnosis, or until death, to develop average cost estimates. The estimated 5-year costs (in 1986 United States dollars) of the 5 CAD events were: acute myocardial infarction $51,211, angina pectoris $24,980, unstable angina pectoris $40,581, sudden death $9,078 and nonsudden death $19,697. The costs of major CAD surgical procedures were also calculated because of their impact on health care costs for patients with CAD. These include: coronary artery bypass surgery per case over 5 years $32,465, and angioplasty per case over 5 years $26,916. The high cost of CAD reflects the improved technology and more effective and expensive therapies now available.

Algorithms↗
PubMed1990

Obstructive sleep apnea and obesity.

OSA affects approximately 1 per cent of the adult male population and is more common among obese patients. The mechanism for the relationship between obesity and OSA may be mechanical obstruction or hypoxemia. Patients with obesity often have other medical problems that can exacerbate or complicate OSA. The physician should look for other problems such as diabetes, hypertension, and coronary disease while evaluating an obese patient with OSA. Weight loss is important either as a primary therapy or in conjunction with surgical treatment of OSA. Weight loss methods include behavior modification with diet, very low calorie diets with behavior modification, and bariatric surgery. In morbidly obese patients, more dramatic means such as bariatric surgery or very low calorie diets seem to be preferable because of the significant reduction in the length of time it takes for patients to lose weight. Because of a tendency for obese patients to regain weight, it is important to follow the patients long term to prevent the regaining of weight.

Behavior Therapy↗
PubMed1985

Obesity and hormonal factors in sleep and sleep apnea.

The presence of obesity, defined as weight 20 per cent or more above ideal body weight or increased body fat content, significantly increases risk of pulmonary, cardiovascular, metabolic, and gastrointestinal problems. Obesity is a major cause of shortened life expectancy. While obesity is not essential for the development of the obstructive sleep apnea syndrome, a significant percentage of patients with obstructive sleep apnea are obese. When evaluating these patients who have obstructive sleep apnea, it is important to search diligently for medical problems that are commonly found among the obese. While there is an increased incidence of obese patients among those who have obstructive sleep apnea, the exact reason for this is uncertain. The study of endorphins and enkephalins may expand our understanding of obesity, ventilatory regulation, and obstructive sleep apnea. This may, in fact, enable us to understand better the interrelationship between obesity and obstructive sleep apnea. The role that thyroid hormone, testosterone, and progesterone play in obstructive sleep apnea has also been reviewed. Patients who have obstructive sleep apnea should not be treated with testosterone. All patients given testosterone should be observed quite closely for the possible signs and symptoms of obstructive sleep apnea. Progesterone seems to be of some help in patients who have obesity hypoventilation syndrome. Its effectiveness in patients with obstructive sleep apnea is less clear. The obesity hypoventilation syndrome as described by Burwell is relatively uncommon. Many of the manifestations of the obesity hypoventilation syndrome, however, are found in patients with obstructive sleep apnea. The recognition that the symptoms stem from underlying obstructive sleep apnea offers great potential for therapy. Weight reduction is valuable therapy for patients with obesity and pulmonary dysfunction, obesity and obstructive sleep apnea, and obesity hypoventilation syndrome. Weight reduction and weight maintenance, while difficult, are essential in patients with obesity, obesity and obstructive sleep apnea, and the hypoventilation syndrome. Obesity should be viewed as a medical problem deserving medical attention and long-term medical follow-up.

Adult↗