Identifying people with metabolic syndrome in primary care by screening with a mailed tape measure: a survey of 14,000 people in the Netherlands.

OBJECTIVES: To determine the feasibility of population-based screening for metabolic syndrome (MetS) in primary care with self-measurement of waist circumference (WC) as first step, and the prevalence of MetS in a Dutch city. METHODS: A survey of 14,000 people on the list of primary care physicians in the city of IJsselstein. All adults between 20 and 70 years on July 1st, 2006 were asked to measure their WC using a mailed tape measure. Participants with a high WC (>88/102 cm for women/men) were invited for assessment of other factors defining MetS. For patients already known with cardiovascular risk factors, these data were collected from medical records. RESULTS: 11,862 subjects were invited, of whom 6843 (58%) measured their WC. 2004 had a WC>88/102 cm and 1721 participated in all examinations. In 473 MetS was detected. The sensitivity of the screening was 77%, the negative predictive value 96%. The prevalence of MetS, including patients known with cardiovascular risk factors, was 15.5%. CONCLUSIONS: A primary care physician-driven population screening with self-measurement of WC can identify adults with MetS. The estimated prevalence of MetS is 15.5%. This procedure creates possibilities for targeted screening, prevention and treatment of people who are at increased cardiovascular risk.

A dose-finding study of fondaparinux in patients with non-ST-segment elevation acute coronary syndromes: the Pentasaccharide in Unstable Angina (PENTUA) Study.

OBJECTIVES: In this dose-finding study, we sought to compare fondaparinux with enoxaparin in patients with acute coronary syndromes (ACS). BACKGROUND: Fondaparinux is a synthetic pentasaccharide that selectively inhibits activated clotting factor X. It has been demonstrated as effective in preventing thromboembolic complications in orthopedic surgery. METHODS: Four doses fondaparinux (2.5, 4, 8, or 12 mg once daily) and enoxaparin (1 mg/kg twice daily) were compared, both given for three to seven days, in patients with ACS without persistent ST-segment elevation. RESULTS: The rates of the combined primary end point of death, myocardial infarction, or recurrent ischemia after nine days were 27.9%, 35.9%, 34.7%, 30.3%, and 35.7% in patients allocated to fondaparinux doses of 2.5, 4, 8, and 12 mg and enoxaparin, respectively (p = NS). In the per-protocol analysis (929 patients who received adequate study drug and had adequate ST-segment monitoring), these figures were 30.0%, 43.5%, 41.0%, 34.8%, and 40.2%. Again, no dose response was observed. The lowest event rates were observed in the 2.5-mg fondaparinux group, which had significantly lower rates than the enoxaparin group as well as for 4 and 8 mg fondaparinux in the per-protocol analysis (p < 0.05). Bleeding rates were low and not different among the patient groups. No differences were observed in fondaparinux concentrations in patients with or without death, myocardial infarction, recurrent ischemia, or bleeding events. CONCLUSIONS: This dose-finding study revealed no dose response for different fondaparinux doses ranging from 2.5 to 12 mg subcutaneously and suggests that the efficacy and safety of fondaparinux may be similar to that of enoxaparin. Further studies with fondaparinux in ACS might include the lowest dose (2.5 mg) investigated in this study.

[Detection of metabolic syndrome by self-measurement of waist circumference]. / Opsporing van het metabool syndroom door mensen zelf hun middelomtrek te laten meten.

OBJECTIVE: Determination of both the feasibility and the result in terms of cardiovascular risk factors of self-measurement of waist circumference by apparently healthy people. We also investigated the prevalence of metabolic syndrome in a population of patients aged 20-69 years in IJsselstein, the Netherlands. DESIGN: Cross-sectional survey. METHODS: All patients aged 20-69 years in the care of a group of General Practitioners (GPs) in IJsselstein, the Netherlands, who were not known to have diabetes, hypertension or dyslipidaemia (n = 11,862), received a tape measure and instructions by mail with the request to measure their waist circumference. Those with an increased waist circumference (> 88 and > 102 cm for women and men, respectively) were invited to undergo investigations to determine whether they conformed to the NCEP ATP III criteria for metabolic syndrome. The prevalence of metabolic syndrome was determined by a combination of these results with file studies of those with already known risk factors for cardiac and vascular disease. RESULTS: The total response rate was 62%. The intraclass correlation between the waist circumference measured by the respondents and by the investigators was 0.80 (p < 0.05). 473 new cases of metabolic syndrome were detected among 1721 persons with an increased waist circumference on self-measurement, 40 % in people younger than 45 years. The total prevalence among those aged 20-69 years in IJsselstein was 15.5%. Only 39% of the people with the metabolic syndrome were already known to have risk factors. CONCLUSIONS: A GP initiated screening system for metabolic syndrome, in which self-measurement of waist circumference was the first step, proved to be feasible and reliable. A substantial group of people aged less than 45 years and at increased cardiovascular risk were also detected using this method of population screening.

The EUCCLID study: proposed European study on care and complications in people with type 2 diabetes in primary care.

AIM: The EUCCLID study aims to compare the quality of type 2 diabetes (DM2) care and the prevalence of complications in primary care DM2 patients in Europe. DESIGN: A cross-sectional survey consisting of three parallel studies: (1) study on actual clinical practice; (2) study on patient's perspective of diabetes care; (3) study on general practitioner's perspective of diabetes care. METHODS: Patients will be randomly selected from a list of all patients known to the participating GPs with DM2 for whom the GP is the main diabetes care provider. Exclusion criteria will include people with type 1 diabetes mellitus, diabetes of pregnancy, serious mental illness, unable to complete a questionnaire in national language or unable to give written informed consent. Approximately 12,000 patients will be included. Participants will have a detailed medical history and anthropometric measurements, blood and urine will be collected and questionnaires will be taken. Endpoints will include quality indicators of clinical DM2 care, prevalence of diabetic complications, knowledge, attitudes, barriers and behaviour affecting good control in DM2 patients, quality of life and patients' satisfaction with diabetes care. We will also determine primary care physician's attitudes, behaviour and perception of barriers to deliver effective diabetes care.