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PubMed1993

Psychological predictors of hypertension in the Framingham Study. Is there tension in hypertension?

OBJECTIVE: To test the hypothesis that heightened anxiety, heightened anger intensity, and suppressed expression of anger increase the risk of hypertension, using the Framingham Heart Study. DESIGN: A cohort of men and women without evidence of hypertension at baseline were followed up for 18 to 20 years. Baseline measures of anxiety (tension), anger symptoms, and expression of anger (anger-in and anger-out) were taken, along with biological and behavioral predictors of hypertension (initial systolic blood pressure, heart rate, relative weight, age, hematocrit, alcohol intake, smoking, education, and glucose intolerance). PARTICIPANTS: A total of 1123 initially normotensive persons (497 men, 626 women) were included. Analyses were stratified by age (45 to 59 or > or = 60 years) and gender. MAIN OUTCOME MEASURES: Hypertension was defined as either taking medication for hypertension or blood pressures higher than 160/95 mm Hg at a biennial examination. RESULTS: In univariate analyses, middle-aged men who went on to develop hypertension had greater baseline anxiety levels than men who remained normotensive (P = .04). Older hypertensive men had fewer anger symptoms at baseline (P = .04) and were less likely to hold their anger in (P = .01) than normotensives. In multivariate Cox regression analysis including biological predictors, anxiety remained an independent predictor of hypertension in middle-aged men (P = .02). Among older men, anger symptoms and anger-in did not remain significant predictors in the multivariate analysis. Further analysis showed that only middle-aged men with very high levels of anxiety were at increased risk (relative risk, 2.19; 95% confidence interval, 1.22 to 3.94). No psychological variable predicted hypertension in middle-aged or older women in either univariate or multivariate analyses. CONCLUSIONS: The results indicate that among middle-aged men, but not women, anxiety levels are predictive of later incidence of hypertension.

Aged↗

PubMed1993

Ruptured abdominal aortic aneurysms: predictors for early complications and death.

BACKGROUND: Urgent operation for ruptured aneurysm is still associated with a high operative mortality rate. The purpose of the study was to determine the risk factors that truly influence early complications and death. METHODS: Between 1979 and 1991, 314 consecutive patients with a mean age of 69 years were treated surgically for a ruptured infrarenal abdominal aortic aneurysm. Twenty-two preoperative, perioperative, and intraoperative variables were subjected to a multivariate analysis to identify the independent predictors. RESULTS: Early death occurred in 92 (29%) of 340 patients. Significant primary predictors for early death were duration of cross-clamp (p < 0.0001), preoperative shock (p = 0.0005), suprarenal cross clamp (p = 0.002), and a history of coronary artery disease (CAD) (p = 0.004). The following postoperative complications were risk factors for death: myocardial failure (p < 0.0001), renal failure (p < 0.0001), sepsis (p = 0.01), and colon ischemia (p = 0.03). Predictors for postoperative myocardial insufficiency were a history of CAD (p < 0.0001), amount of intraoperative volume substitution (p < 0.0001), suprarenal cross clamp (p = 0.0007), and preoperative shock (p = 0.05). CONCLUSIONS: Preoperative and perioperative risk factors that result in fatal postoperative complications can be partially influenced by the surgeon. Short clamping time and infrarenal position of aortic clamp may lower overall early mortality rates. A history of CAD is a highly significant predictor for postoperative complications and early death.

Aged↗

PubMed1996

Predictors of persistent palpitations and continued medical utilization.

BACKGROUND: The aim of this study was to determine the predictors of persistent palpitations and continued medical utilization in a sample of medical patients referred for ambulatory electrocardiographic monitoring. METHODS: A prospective telephone follow-up was conducted with patients who had undergone ambulatory electrocardiographic monitoring 3 months earlier. At inception, patients completed in-person interviews and self-report questionnaires, assessing somatization, hypochondriacal attitudes, bodily amplification (high degree of sensitivity to bodily sensations), and two types of life stress (minor daily irritants and major life changes). At follow-up, patients completed a structured interview about their clinical course, palpitations, and utilization of medical care during the interval. RESULTS: At 3-month follow-up, 55 of the inception cohort of 67 patients were interviewed again. The mean severity of palpitations for the entire sample declined significantly, but 46 (83.6%) patients continued to experience their presenting symptoms. Stepwise multiple linear regression revealed that the interaction of bodily amplification and daily life stress at inception uniquely explained 10.0% of the variance in palpitation severity at follow-up. A four-step model composed of these two interaction terms and age and education level accounted for 21.4% of the variance in palpitations. The medical utilization findings are complementary in that the interaction of amplification and daily irritants at baseline predicted the number of unscheduled medical visits over the subsequent 3 months. The total number of ventricular premature contractions occurring during ambulatory monitoring was not a significant predictor of palpitations. CONCLUSIONS: Palpitations are more persistent in persons who are both highly sensitive to bodily sensations and who experience a greater number of minor daily irritants. The existence of either predictor alone is not sufficient to perpetrate this functional somatic symptom; it requires the combination of these predictors.

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PubMed1996

Geometric variables and bone mineral density as potential predictors for mechanical properties of the radius of Greyhounds.

OBJECTIVE: To determine cross-sectional geometry and bone mineral density of the Greyhound radius and correlate these values with torsional failure load and torsional stiffness in an ex vivo model. DESIGN: 3 regions, proximal, middle, and distal portions of the diaphysis, were studied. 5 levels of cross section were evaluated geometrically within each region. SPECIMENS: 10 paired radiuses from skeletally mature Greyhounds. PROCEDURE: Cortical area and area moment of inertia were measured from plain radiographic views and from digitized computed tomographic images. Bone mineral density was measured, using dual-energy x-ray absorptiometry. Torsional stiffness and torsional failure load were then determined mechanically. RESULTS: Minimum area moment of inertia and area moment of inertia estimated from plain radiographic views were significantly different in different regions of interest (P < 0.05). Significant bivariate correlations (P < 0.05) between torsional mechanical parameters and bone properties of the radius were identified for the distal portion of the diaphysis in particular. When independent variables for the distal portion were analyzed, estimate of area moment of inertia was entered into the model for torsional failure load as a predictor and minimum area moment of inertia was entered into the model for torsional stiffness as a predictor. Bone mineral density of the distal portion of the diaphysis was not a significant predictor. CONCLUSION: If accurate noninvasive predictors of bone failure load can be identified, further study of fracture risk should be possible.

Animals↗

PubMed1996

Predictors of side effects to spinal manipulative therapy.

OBJECTIVE: To study whether side effects of spinal manipulative therapy can be predicted and, if so, whether they are patient- or treatment-related. Also, to determine if there are different predictors for common reactions (i.e., local discomfort, headache, tiredness or radiating discomfort) and for uncommon reactions (i.e., dizziness, nausea, hot skin or "other" complaints). STUDY DESIGN: Data were collected in patient interviews using standard questionnaires in a prospective clinic-based survey. Several outcome variables (reactions during the course of treatment, reactions after each treatment, specific types of treatment reactions, severe or long-lasting reactions) were then cross-tabulated against sex, age, treatment session number, type of area treated, number of areas treated and type of treatment. SETTING: Chiropractic clinics in Norway. PARTICIPANTS: One hundred and two chiropractors (response rate: 70%) and 12 consecutive patients per chiropractor (resulting in 1058 chiropractic patients) attending for up to six treatments (totaling 4712 treatments). RESULTS: Some patient- and treatment-related predictors were identified. Women were more likely to report reactions to treatment than men. There were also differences between gender in the types of reactions reported. More reactions occurred during the first treatment sessions, when more than one spinal region was treated, or when the thoracic spine only was treated. However, there were no specific predictors for uncommon side effects. CONCLUSION: Some predictors to the side effects of spinal manipulative therapy were identified but more information is needed regarding their clinical significance.

Adolescent↗

PubMed1996

Predictors of success on the Canadian Nurses Association testing service (CNATS) examination.

This retrospective study examined the relationship of selected admissions variables and in-course performance to success in the Canadian Nurses Association Testing Service (CNATS) examinations of 114 students admitted directly from secondary school to a four-year integrated, problem-based learning (PBL) baccalaureate nursing program in Canada. Data were analyzed using two separate hierarchical stepwise regression equations. The first equation examined a set of secondary school grades (Ontario Academic Credits, or OACs) used to calculate university admission averages and their ability to predict CNATS performance. OAC English was found to be the best predictor, followed by OAC chemistry and the admission average obtained on other OAC subjects. The second regression equation looked at in-course grades as potential predictors of CNATS scores. The basic sciences variable proved to be the best predictor, followed by research methodology, first-year Nursing Concepts I, a problem-based nursing average, and a clinical practice average. Findings support the continued use of English and chemistry as admission criteria. The basic sciences courses and first-year nursing courses also emerged as statistically significant predictors of licensure examination success.

Canada↗

PubMed1997

[Embolism in left-atrial thrombi (ELAT Study): are spontaneous echo contrast, thrombi in the left atrium/appendage and size of the left atrial appendage predictors of possible embolisms?].

Transesophageal echocardiography visualizes the left atrium, the left atrial appendage, thrombi and spontaneous echo contrast within them. The role of these findings as predictors for embolism in atrial fibrillation is unknown. We performed transesophageal echocardiography in 409 non-rheumatic atrial fibrillation outpatients (62 +/- 12 years, 36% female) with no recent (< 1 year) history of embolism. Patients with left atrial/appendage thrombi received oral anticoagulation, those without thrombi Aspirin. The patients were followed up over 2 years. Primary events were stroke, embolism and non stroke/embolism related deaths. Secondary events were initiation of anticoagulation in patients primarily assigned to Aspirin. Left atrial/appendage thrombi were diagnosed in 2.5%. They were associated with diabetes, heart failure and decreased left ventricular fractional shortening (p < 0.05 for each variable). Spontaneous echo contrast was diagnosed in 12%. It was associated with increased age, constant atrial fibrillation, hypertension, heart failure, valvular abnormalities and increased left atrial diameter (p < 0.05 for each variable). Increased left atrial appendage size was associated with constant atrial fibrillation, etiology of atrial fibrillation and valvular abnormalities (p < 0.05 for each variable). Follow-up was 25 +/- 7 months. 29 patients suffered a stroke, 33 further patients died of non stroke/embolism related causes. Secondary events occurred in 19 patients. Neither left atrial/appendage thrombi nor left atrial appendage size were predictors for embolism. Predictors for embolism were increased age (p = 0.003), hypertension (p = 0.01) and increased diastolic blood pressure (p = 0.04). In non-rheumatic atrial fibrillation outpatients with no recent history of embolism, transesophageal echocardiography is of limited value to assess embolic risk. Hypertension and increased diastolic blood pressure have been confirmed in their significance as clinical predictors for embolism.

Aged↗

PubMedDate not supplied

Predictors of the early development of advanced metachronous colon adenomas.

BACKGROUND/AIMS: In order to reduce the number of colonoscopies performed for the surveillance of patients after polypectomy, suitable predictors of adenomas recurrence are needed. The aim of this study was to find predictors of the early development of metachronous adenomas and specifically of advanced ones. MATERIALS AND METHODS: Forty-four patients underwent total colonoscopy 24-26 months after initial endoscopic polypectomy. All polyps were endoscopically removed and an adenoma was considered as advanced if the diameter was > 1 cm and/or villous component and/or severe dysplasia were present. RESULTS: Metachronous adenomas were detected in 16 (36.4% patients. Five (11.4%) of them had advanced metachronous adenomas. Early recurrence of adenomas was significantly correlated with the total number of indices adenomas (p = 0.027). On the contrary, the presence of metachronous adenomas was not related to any of the patients' characteristics nor to the site and the histology of the indices adenomas. The development of advanced metachronous adenomas during the same period was significantly correlated with patients' age, as it was observed only in patients aged > or = 60 years (5/21 or 23.8%) and in none of the patients aged < 60 years (Odds ratio: 15.7, p = 0.02). Logistic regression analysis revealed that patient's age was the only significant predictor of the early development of advanced metachronous adenomas (beta = 0.40, p = 0.02) and that the number of the indices adenomas was the only significant predictor for the recurrence of all adenomas (beta = 1.59, p = 0.02). CONCLUSIONS: 1. Only patients aged > or = 60 years seem to develop advanced metachronous adenomas two years after polypectomy and 2. The likelihood for developing metachronous adenomas during the same period is related to the number of indices adenomas.

Adenoma↗

PubMed1997

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

OBJECTIVE: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI). DESIGN: Prospective cohort study. SETTING: Urban tertiary care teaching hospital. METHODS: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework. RESULTS: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality). CONCLUSION: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

Age Distribution↗

PubMed1995

Sources of social support as predictors of exercise adherence in women and men ages 50 to 65 years.

Examines types of social support that best predicts adherence at different time points during a 1-year endurance exercise program in 269 women and men ages 50 to 65 years. Results indicate that social support had similar effects on exercise participation for women and men, and support specific to exercise was a better predictor of exercise adherence than general social support. A preference for receiving a lesser amount of initial support from exercise staff was the strongest social support-related predictor of exercise adherence during the initial 6 months of the program. Support currently received from family and friends and exercise staff at Month 6 was found to be the strongest predictor of adherence during Months 7 to 12. Format of exercise was also a strong predictor of exercise adherence with home-based programs related to greater adherence. Additionally, divorced nonsmokers appear to be at increased risk for poor early exercise adherence and should be targeted in interventions to promote exercise participation.

Aged↗

PubMed1998

Predictors of students' success in the Air Force School of Health Care Sciences.

This study assessed the predictors for students' success in the 882d Training Group's (Air Force School of Health Care Sciences) allied health courses at Sheppard Air Force Base, Texas. Correlation and regression analyses provided many predictors of students' success. From these predictors, the researchers ascertained demarcation points to provide direction for instructors and students. Using these parameters, proactive intervention by instructors, students, and the Student Learning Center will improve the success of allied health students. Further research conducted by the 882d Training Group in evaluating predictors of success will yield a seamless evaluation process. This process will establish an improved proactive educational system enhancing the career field selection process and the quality of students' education, as well as decrease costs.

Aerospace Medicine↗

PubMed1998

Predictors of AIDS-preventive behavioral intentions among adult heterosexuals at risk for HIV-infection: extending current models and measures.

This study examined the predictors of the intention to use condoms with new sexual partners. A sample of heterosexual adult females and males (n = 711) was recruited through various channels. A substantial part of the sample had engaged in risky sexual behavior. Predictors were based on various theoretical models. Compared with men, women were in general more aware of the risks of AIDS and perceived fewer barriers to using condoms, but they also perceived less support for condom use among potential new partners. Among those with a risk factor for HIV infection (n = 514), various types of barriers, absolute and comparative self-efficacy, and three types of social norms were independently related to the intention to use condoms. When including all relevant predictors, self-efficacy, anticipated regret, and descriptive norms in the reference group, were independent predictors of condom use intention among men as well as among women. The implications for prevention are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates, and predictors of transition to secondary diseases.

OBJECTIVE: To summarize the current literature on the frequency, rates, types, and outcome predictors of secondary diseases that develop in patients with primary Raynaud phenomenon. METHODS: A structured MEDLINE literature search with the MeSH heading "Raynaud's disease," which was crossed with (1) systemic sclerosis, (2) prognosis, (3) prospective studies, (4) follow-up studies, and (5) retrospective studies, was used to identify 910 articles for possible inclusion. Articles that identified patients with primary Raynaud phenomenon who were followed up and re-evaluated at the end of the study, and which used published classification criteria to assess the presence or absence of secondary disease were included. Patient-years of Raynaud disease, patient-years of follow-up, and rates and predictors of transition to secondary disease were calculated from the articles selected. The summary odds ratio and positive predictive value for evaluation criteria at entry were calculated from 2 x 2 tables generated for each variable. RESULTS: Ten articles identified a total of 639 patients with primary Raynaud phenomenon who were followed up for 2531 patient-years. Eighty-one patients (12.6%) developed a secondary disorder, 80 of which were connective-tissue diseases. Transitions occurred at a mean rate of 3.2 per 100 patient-years of observation. The mean time to develop a secondary disorder was 2.8 years from study entry and 10.4 years from the onset of Raynaud phenomenon. At entry, the best predictor of transition was an abnormal nailfold capillary pattern (positive predictive value, 47%). Antinuclear antibodies in these patients had a positive predictive value of only 30%. CONCLUSION: Although a variety of clinical and serological abnormalities can be found in patients with primary Raynaud phenomenon, only a small percentage of them develop a connective-tissue disease.

Adult↗

PubMed2000

Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study.

BACKGROUND: The appropriate duration of oral anticoagulation after a first episode of venous thromboembolism (VTE) is uncertain and depends upon VTE recurrence rates. OBJECTIVE: To estimate VTE recurrence rates and determine predictors of recurrence. METHODS: Patients in Olmsted County, Minnesota, with a first lifetime deep vein thrombosis or pulmonary embolism diagnosed during the 25-year period from 1966 through 1990 (N = 1,719) were followed forward in time through their complete medical records in the community for first VTE recurrence. RESULTS: Four hundred four patients developed recurrent VTE during 10,198 person-years of follow-up. The overall (probable/definite) cumulative percentages of VTE recurrence at 7, 30, and 180 days and 1 and 10 years were 1.6% (0.2%), 5.2% (1.4%), 10.1% (4.1%), 12.9% (5.6%), and 30.4% (17.6%), respectively. The risk of recurrence was greatest in the first 6 to 12 months after the initial event but never fell to zero. Independent predictors of first overall VTE recurrence included increasing age and body mass index, neurologic disease with paresis, malignant neoplasm, and neurosurgery during the period from 1966 through 1980. Independent predictors of first probable/definite recurrence included diagnostic certainty of the incident event and neurologic disease in patients with hospital-acquired VTE. Recurrence risk was increased by malignant neoplasm but varied with concomitant chemotherapy, patient age and sex, and study year. CONCLUSIONS: Venous thromboembolism recurs frequently, especially within the first 6 to 12 months, and continues to recur for at least 10 years after the initial VTE. Patients with VTE with neurologic disease and paresis or with malignant neoplasm are at increased risk for recurrence, while VTE patients with transient or reversible risk factors are at less risk.

Adult↗

PubMed2000

Predictors of virological success and ensuing failure in HIV-positive patients starting highly active antiretroviral therapy in Europe: results from the EuroSIDA study.

BACKGROUND: Predictors of virological response to highly active antiretroviral therapy (HAART) have never been systematically evaluated in a large continental multicenter cohort of unselected human immunodeficiency virus (HIV)-infected people. OBJECTIVE: To determine the factors related to achieving and maintaining undetectable plasma HIV-1 RNA levels among HIV-1-infected patients first starting protease inhibitor- or nonnucleoside retrotranscriptase inhibitor-containing HAART in Europe. DESIGN: Prospective multicenter cohort study. SETTING: Fifty-two clinical centers in 17 European countries included in the EuroSIDA Study Group, from August 1996 to April 1999. PATIENTS: A total of 1469 HIV-positive patients first starting HAART recruited from an unselected cohort of more than 7300 HIV-positive patients. MAIN OUTCOME MEASURE: Detection of factors related to virological success after first starting HAART (baseline) and ensuing failure by standard survival techniques, including Kaplan-Meier techniques and Cox proportional hazards models. All analyses were intention to treat. RESULTS: Most patients (80%) achieved plasma HIV-1 RNA levels of less than 500 copies/mL during follow-up (60.4% at 6 months from the onset of HAART). Patients with higher baseline HIV-1 RNA levels (relative hazard [RH], 0.76 per log higher; 95% confidence interval [CI], 0.69-0.84; P<.001) and those taking saquinavir mesylate hard gel as a single protease inhibitor (RH, 0.62; 95% CI, 0.47-0.82; P<.001) were less likely to reach undetectable HIV-1 RNA levels. Conversely, higher CD4+ lymphocyte counts (RH per 50% higher, 1.09; 95% CI, 1.02-1.16; P = .008) and the initiation of 3 or more new antiretroviral drugs (RH, 1.29; 95% CI, 1.03-1.61; P = .02) were independent predictors of higher success. Once success was achieved, HIV-1 RNA levels rebounded in more than one third of all patients during follow-up (24% at 6 months). Antiretroviral-naive patients (RH, 0.50; 95% CI, 0.29-0.87; P = .01), older patients (RH, 0.86 per year older; 95% CI, 0.75-0.99; P = .04), and those starting a protease inhibitor other than saquinavir hard gel (RH, 0.66; 95% CI, 0.44-0.98; P = .04) were at decreased hazard for virological failure. Higher baseline HIV-1 RNA level (RH, 1.18 per log higher; 95% CI, 0.99-1.40; P = .06) and a longer time to achieve virological success (RH per 12 months, 1.53; 95% CI, 0.99-2.38; P = .06) were marginally significant predictors of a decreased hazard of ensuing virological failure. CONCLUSIONS: HAART is associated with a favorable virological response if started when the baseline HIV-1 RNA level is low, if at least 2 new nucleoside retrotranscriptase inhibitors are added, and if standard doses of saquinavir hard gel capsule are avoided as a single protease inhibitor. Older patients are more likely to achieve virological success. Thereafter, the higher durability of virological response is predicted by an antiretroviral-naive status and by the use of specific regimens. Lower baseline HIV-1 RNA levels and rapid maximal viral suppression seem to be other important factors in the durability of virological response.

Anti-HIV Agents↗

PubMedDate not supplied

Hypoglycemia as a predictor of mortality in hospitalized elderly patients.

BACKGROUND: Hypoglycemia during hospitalization occurs in patients with and without diabetes. The aims of this study were to determine the incidence, associated risk factors, and short- and long-term outcome of hypoglycemia among hospitalized elderly patients. METHODS: This is a case-control study conducted at geriatric and medicine departments. All patients 70 years or older with documented hypoglycemia hospitalized within 1 year (n = 281) were compared with a nonhypoglycemic group of 281 elderly, randomly selected patients from the same hospitalized population. RESULTS: Among 5404 patients 70 years or older, 281 (5.2%) had documented hypoglycemia. Compared with the nonhypoglycemic group, we found the following characteristics to be true in the hypoglycemic group: there were more women than men (58% vs 44%, P =.001); sepsis was 10 times more common (P<.001); malignancy was 2.8 times more common (P =.04); the mean serum albumin level was lower (2.8 g/dL vs 3.4 g/dL, P<.001); and the mean serum creatinine and alkaline phosphatase levels were higher (P<.001 for both). Diabetes was known in 42% of the hypoglycemic group and in 31% of the nonhypoglycemic group (P =.03); 70 patients in the hypoglycemic group were taking sulfonylureas or insulin. Multivariate logistic analysis showed that sepsis, albumin level, malignancy, sulfonyurea and insulin treatment, alkaline phosphatase level, female sex, and creatinine level were all independent predictors of developing hypoglycemia. In-hospital mortality and 3-month mortality were about twice as high in the hypoglycemic group (P<.001). Multivariate analysis of mortality found that sepsis, low albumin level, and malignancy were independent predictors, while hypoglycmia was not. CONCLUSIONS: Hypoglycemia was common in elderly hospitalized patients and predicted increased in-hospital 3- and 6-month cumulative mortality. However, in a multivariate analysis, hypoglycemia was not an independent predictor for mortality, implying that it is only a marker.

Aged↗

PubMed2005

Predictors of adherence with antihypertensive and lipid-lowering therapy.

BACKGROUND: Patients with comorbid hypertension and dyslipidemia are at high risk for cardiovascular disease, which can be considerably mitigated by treatment. Adherence with prescribed drug therapy is, therefore, especially important in these patients. This study was undertaken to describe the patterns and predictors of adherence with concomitant antihypertensive (AH) and lipid-lowering (LL) therapy. METHODS: This retrospective cohort study examined 8406 enrollees in a US managed care plan who initiated treatment with AH and LL therapy within a 90-day period. Adherence was measured as the proportion of days covered in each 3-month interval following initiation of concomitant therapy (mean follow-up, 12.9 months). Patients were considered adherent if they had filled prescriptions sufficient to cover at least 80% of days with both classes of medications. A multivariate regression model evaluated potential predictors of adherence. RESULTS: The percentage of patients adherent with both AH and LL therapy declined sharply following treatment initiation, with 44.7%, 35.9%, and 35.8% of patients adherent at 3, 6, and 12 months, respectively. After adjustment for age, sex, and other potential predictors, patients were more likely to be adherent if they initiated AH and LL therapy together, had a history of coronary heart disease or congestive heart failure, or took fewer other medications. CONCLUSIONS: Adherence with concomitant AH and LL therapy is poor, with only 1 in 3 patients adherent with both medications at 6 months. Physicians may be able to significantly improve adherence by initiating AH and LL therapy concomitantly and by reducing pill burden.

Adolescent↗

PubMed2005

Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: the Women's Health Initiative Observational Study.

BACKGROUND: Increasing evidence supports a role for inflammation in the atherosclerotic process. The role of the leukocyte count as an independent predictor of risk of a first cardiovascular disease (CVD) event remains uncertain. Our objective was to describe the relation between the baseline white blood cell (WBC) count and future CVD events and mortality in postmenopausal women. METHODS: In this prospective cohort study set in 40 US clinical centers, the study population comprised 72 242 postmenopausal women aged 50 to 79 years, free of CVD and cancer at baseline, enrolled in the Women's Health Initiative Observational Study. Main outcome measures included incident fatal coronary heart disease (CHD), nonfatal myocardial infarction, stroke, and total mortality. RESULTS: At baseline, the mean +/- SD age of the women was 63 +/- 7.3 years, 84% were white, 4% had diabetes, 35% had hypertension, and 6% were current smokers. The mean WBC count was 5.8 +/- 1.6 x 10(9) cells/L. During a mean of 6.1 years of follow-up, there were 187 CHD deaths, 701 nonfatal myocardial infarctions, 738 strokes, and 1919 deaths from all causes. Compared with women with WBC counts in the first quartile (2.5-4.7 x 10(9) cells/L), women in the fourth quartile (6.7-15.0 x 10(9) cells/L) had over a 2-fold elevated risk for CHD death (hazard ratio, 2.36; 95% confidence interval, 1.51-3.68), after multivariable adjustment for age, race, diabetes, hypertension, smoking, hypercholesterolemia, body mass index, alcohol intake, diet, physical activity, aspirin use, and hormone use. Women in the upper quartile of the WBC count also had a 40% higher risk for nonfatal myocardial infarction, a 46% higher risk for stroke, and a 50% higher risk for total mortality. In multivariable models adjusting for C-reactive protein, the WBC count was an independent predictor of CHD risk, comparable in magnitude to C-reactive protein. CONCLUSIONS: The WBC count, a stable, well-standardized, widely available and inexpensive measure of systemic inflammation, is an independent predictor of CVD events and all-cause mortality in postmenopausal women. A WBC count greater than 6.7 x 10(9) cells/L may identify high-risk individuals who are not currently identified by traditional CVD risk factors.

Aged↗