Social networks in cardiovascular disease management.

Cardiovascular disease remains the leading cause of death in the USA. Social networks have a positive association with obesity, smoking cessation and weight loss. This article summarizes studies evaluating the impact of social networks on the management of cardiovascular disease. The 35 studies included in the article describe the impact of social networks on a decreased incidence of cardiovascular disease, depression and mortality. In addition, having a large-sized social network is also associated with better outcomes and improved health. The role of pharmacists is beginning to play an important role in the patient-centered medical home, which needs to be incorporated into social networks. The patient-centered medical home can serve as an adaptive source for social network evolvement.

Gastroenterologists' prescribing of infliximab for Crohn's disease: a national survey.

BACKGROUND: Practice guidelines suggest that immunomodulators (IMs) be given prior to infliximab (IFX) in patients with Crohn's disease (CD). The package insert for IFX recommends that maintenance therapy be prescribed for patients who respond to induction therapy. Our aim was to determine the extent to which gastroenterologists (GIs) are utilizing IM prior to IFX and prescribing maintenance IFX when treating patients with CD. METHODS: An 18-item questionnaire was developed and validated. The survey was sent to 4515 GIs who are members of the American Gastroenterology Association. Bivariate and multivariate analyses were performed. RESULTS: In all, 305 GIs responded; 70% use an IM prior to IFX, 86% prescribe maintenance IFX, and 62% reported both use of IM prior to IFX and use of maintenance IFX. Academic GIs, Midwest GIs, and GIs prescribing IFX a few times per year were more likely to report both use of an IM prior to IFX and use of maintenance IFX (odds ratio [OR] = 4.56, 2.18, and 2.25, respectively). GIs demonstrated awareness of the risk of reactivation of tuberculosis when initiating IFX and appropriately manage infusion reactions. GIs were unable to rank serious adverse reactions associated with IFX. CONCLUSIONS: A total of 38% of GIs did not report the use of IM prior to IFX and/or did not use maintenance IFX. GIs practicing outside the Midwest and those in nonacademic settings may need additional training regarding prescribing IFX.

New National Cholesterol Education Program III guidelines for primary prevention lipid-lowering drug therapy: projected impact on the size, sex, and age distribution of the treatment-eligible population.

BACKGROUND: The guidelines in the Third Report of the National Cholesterol Education Program (NCEP III) include absolute risk and lower LDL cholesterol (LDL-C) levels to assess eligibility for lipid-lowering drug therapy. We studied the impact of these changes on the size, sex, and age distribution of the target US population using data from the Third Annual National Health and Nutrition Survey (NHANES III) (1988 to 1994). METHODS AND RESULTS: A subsample of NHANES III participants aged 20 to 79 years with known cardiovascular risk factors and LDL-C levels was identified (n=13 589). We assessed their eligibility for drug therapy first using NCEP II guidelines and then using the new NCEP III criteria. We also calculated the number eligible for LDL-C lowering to <100 mg/dL. An estimated 15 million individuals aged 20 to 79 years are eligible for drug therapy under NCEP II; 51% are males, 49% are females, 26% are <45 years old, and 28% are > or =65 years old. Under NCEP III, 36 million would be eligible for treatment; 55% are males, 45% are females, 32% are <45 years old, and 27% are > or =65 years old. This represents a 140% increase in eligibility overall, a 157% increase among males, a 122% increase among females, a 131% increase among those > or =65 years old, and a 201% increase among those < 45 years old. Of treatment-eligible individuals, 26% of males, 24% of females, 39% of elderly, and 14% of those <45 years old are targeted for LDL-C lowering to <100 mg/dL. CONCLUSIONS: The NCEP III guidelines will alter the age and sex distributions of the treatment-eligible population, targeting many more younger (<45 years old) and greater numbers of elderly (> or =65 years) individuals, particularly for aggressive intervention.