Pre-existing Depression among Newly Diagnosed Dyslipidemia Patients and Cardiovascular Disease Risk.

BACKGROUND: Whether depression before diagnosis of dyslipidemia is associated with higher cardiovascular disease (CVD) risk among newly diagnosed dyslipidemia patients is yet unclear. METHODS: The study population consisted of 72,235 newly diagnosed dyslipidemia patients during 2003 to 2012 from the National Health Insurance Service-Health Screening Cohort of South Korea. Newly diagnosed dyslipidemia patients were then detected for pre-existing depression within 3 years before dyslipidemia diagnosis. Starting from 2 years after the diagnosis date, patients were followed up for CVD until 2015. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD were calculated by Cox proportional hazards regression. RESULTS: Compared to dyslipidemia patients without depression, those with depression had higher risk for CVD (aHR, 1.24; 95% CI, 1.09 to 1.41). Similarly, pre-existing depression was associated with increased risk for stroke (aHR, 1.27; 95% CI, 1.06 to 1.53). The risk for CVD among depressed dyslipidemia patients for high (aHR, 1.42; 95% CI, 1.06 to 1.90), medium (aHR, 1.17; 95% CI, 0.91 to 1.52), and low (aHR, 1.25; 95% CI, 1.05 to 1.50) statin compliance patients tended to be increased compared to patients without pre-existing dyslipidemia. The risk-elevating effect of depression on CVD tended to be preserved regardless of subgroups of smoking, alcohol consumption, physical activity, and body mass index. CONCLUSION: Dyslipidemia patients with pre-existing depression had increased risk for CVD. Future studies that determine CVD risk after management of depression among dyslipidemia patients are needed.

Comorbidity burden in systemic sclerosis: beyond disease-specific complications.

Systemic sclerosis (SSc) is a chronic, systemic disease characterized by fibrosis of the skin and internal organs, vasculopathy, and auto-immune activation. On the top of severe organ involvement such as interstitial lung and myocardial fibrosis, pulmonary hypertension, and renal crisis, individuals diagnosed with SSc may suffer from a number of comorbidities. This is a narrative review according to published recommendations and we searched the online databases MEDLINE and EMBASE using as key words the following terms: systemic sclerosis, scleroderma, myocardial fibrosis in combination with micro- and macro-vascular disease, cardiac involvement, atherosclerosis, cardiovascular disease and coronary arteries, infections, cancer, depression, osteoporosis, and dyslipidemia. Although data are usually inconclusive it appears that comorbidities with significant impact on life expectancy, namely cardiovascular disease, infections, and cancer as well as phycological disorders affecting emotional and mental health are highly prevalent in SSc population. Thereafter, the aim of this review is to summarize the occurrence and the clinical significance of such comorbidities in SSc population and to discuss how rheumatologists can incorporate the management of these conditions in daily clinical practice.

An Observational Study of the Association of Video- Versus Text-Based Informed Consent With Multicenter Trial Enrollment: Lessons From the PALM Study (Patient and Provider Assessment of Lipid Management).

BACKGROUND: Patient participation in clinical research is low, in part because of the length and complexity of the informed consent process. Video informed consent may enhance the appeal of research and help break down barriers to participation. METHODS AND RESULTS: The PALM study (Patient and Provider Assessment of Lipid Management) enrolled 7904 patients at cardiology, endocrinology, and primary care clinics across the United States to evaluate cholesterol management practices. Of 153 participating clinics, 67 (43.8%) secured institutional review board approval to use a tablet-based video informed consent tool that patients could select to navigate through the informed consent process instead of traditional text-based informed consent. At sites without institutional review board approval of video consent, all patients read a text-based informed consent document. Site activation times and enrollment volumes, as well as characteristics of enrolled patients, were compared between sites with and without video consent capability. Sites with video consent capability more often used a central institutional review board (89.6% versus 73.3%), were more often rural (16.7% versus 3.8%), and tended to have fewer providers. Compared with sites without video consent capability, sites with video consent capability had shorter times from site approach to first patient enrollment (median 178 versus 207 days; P=0.02). Sites with video consent capability enrolled similar numbers of patients as sites without video consent capability (P=0.48) but enrolled a greater proportion of patients who were ≥75 years old (27.5% versus 23.6%; P<0.001) and nonwhite (17.7% versus 14.2%; P<0.001). CONCLUSIONS: In this observational study of recruitment in a multicenter registry, sites approved for video consent use enrolled the same number of patients as sites with only traditional text-based informed consent but had faster speed to first patient enrolled and more often enrolled older and nonwhite patients. Future randomized trials are needed to assess the impact of video consent on enrollment mechanics and demographics. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02341664.

Impact of Hospitalization for Acute Myocardial Infarction on Adherence to Statins Among Older Adults.

BACKGROUND: Little is known about the impact of hospitalization for an acute myocardial infarction (AMI) on subsequent adherence to statins. METHODS AND RESULTS: Using administrative claims from a 5% random sample of Medicare beneficiaries, we identified a cohort of Medicare patients aged ≥65 years, hospitalized from 2007 to 2011, taking statins in the year before AMI hospitalization (n=6618). We then determined the proportion of patients nonadherent to statins (proportion of days covered <80%) in the year before AMI hospitalization who became statin adherent (proportion of days covered ≥80%) in the year after AMI hospitalization. The proportion of statin-adherent patients who became nonadherent was also studied. These proportions were compared with patients hospitalized for pneumonia (n=11 471) and patients not hospitalized (n=158 099) in 2010 and 2011. Among patients nonadherent to statins before AMI hospitalization, 37.7% became adherent after discharge. Patients hospitalized for AMI were more likely to become adherent than patients hospitalized for pneumonia (adjusted relative risk: 1.70; 95% confidence interval, 1.57-1.84) or patients not hospitalized (adjusted relative risk: 1.79; 95% confidence interval, 1.68-1.90). Among patients adherent to statins before AMI hospitalization, 32.6% became nonadherent after discharge. Those hospitalized for AMI were less likely to become nonadherent than those hospitalized for pneumonia (adjusted relative risk: 0.93; 95% confidence interval 0.88-0.98) but more likely to become nonadherent than patients without hospitalizations (adjusted relative risk: 1.41; 95% confidence interval, 1.35-1.48). CONCLUSIONS: Among nonadherent patients, hospitalization for AMI was associated with increased likelihood of becoming adherent to statins compared with hospitalization for pneumonia or no hospitalizations. Among adherent patients, hospitalization for AMI was associated with increased likelihood of becoming nonadherent to statins compared with no hospitalizations.

Apolipoprotein E genotyping and questionnaire-based assessment of lifestyle risk factors in dyslipidemic patients with a family history of Alzheimer's disease: test development for clinical application.

The cholesterol-raising properties of the apolipoprotein E (APOE) epsilon-4 (ε-4) allele has been validated in the South African population. Mounting evidence supports the added value of APOE genotyping for the evaluation of cardiovascular risk in dyslipidemic patients beyond its established role in the diagnosis of late-onset Alzheimer's disease (AD). The aim of this study was to determine the potential benefits of combining AD family history with questionnaire-based lifestyle assessment to facilitate the clinical interpretation of APOE genotyping results. A total of 580 unrelated South African individuals prospectively enrolled in a chronic disease screening program incorporating a genetic component (2010-2015) was selected for inclusion in this study based on the presence (75) or absence (505) of AD family history. Biochemical assessment of their lipid profiles was performed according to standard laboratory protocols. All study participants were genotyped for the APOE ε-2/ε-3/ε-4 alleles using allele-specific TaqMan real-time polymerase chain reaction technology. In patients without a family history of AD, APOE genotype modified the relationship between alcohol intake and body mass index (p = 0.026), with a significant positive correlation noted between these parameters being limited to ε-4 allele carriers. APOE genotype also modified the association between alcohol intake and total serum cholesterol in patients with a positive family history of AD (p = 0.026). We demonstrated the benefits of a questionnaire-based approach for assessment of lifestyle risk factors to facilitate clinical interpretation of APOE genotyping results for targeted intervention in a genetic subgroup of dyslipidemic patients at increased risk for AD.

[The assessment of the effects of cytoflavin and cardioxipin on the emotional status of rats with dyslipidemia].

OBJECTIVE: To compare the effects of cytoflavin and cardioxipin on the emotional status of rats with experimental disturbance of lipid metabolism using the uplifted cruciform labyrinth method. MATERIAL AND METHODS: The disturbance of lipid metabolism was induced by the introduction of exogenic cholesterol-in -oil emulsion in dosage 40 mg /kg of body mass during 20 days. Pharmacological treatment was performed in the 11th day. The drugs were injected intraperitoneally during 10 days: cytoflavin in dose 1,75 ml/ kg (175 mg/kg with succinic acid), cardioxipin in dose 52,5 mg/kg. RESULTS AND CONCLUSION: Cytoflavin and cardioxipin caused the positive changes in the parameters of emotional status of rats in conditions of experimental dyslipidemia.

Treatment beliefs and attending follow-up visits in a lipid clinic.

OBJECTIVE: To explore the value of demographics, clinical parameters, and treatment beliefs in predicting attendance at follow-up visits in a lipid clinic. DESIGN: Prospective cohort study. METHODS: A total of 104 consecutive patients, who attended the Meir Medical Center lipid clinic for the first time, were followed for an average of 14 months. During the first visit, demographic and clinical parameters were obtained and a treatment beliefs and a self-rated health questionnaire were completed. Those who kept all scheduled follow-up visits were categorized as attendees and those who were lost to follow up as non-attendees. The two groups were compared on demographic and clinical parameters, as well as on treatment and health beliefs. RESULTS: Lipid target level achievement was higher in attendees (p < .001). However, only 49 patients (47%) attended the scheduled clinic visits. None of the demographic or clinical parameters significantly predicted attendance. Both groups scored high on perceived risk-to-health of uncontrolled lipid levels and on perceived effectiveness and benefits of treatment. Non-attendees reported significantly more perceived barriers and treatment misconceptions/disbeliefs, and lower self-rated health. CONCLUSIONS: Beliefs concerning lipid-lowering treatment should be identified so that they may be effectively addressed in order to improve patient attendance at follow-up visits to a lipid clinic.

Compliance with a statin treatment in a usual-care setting: retrospective database analysis over 3 years after treatment initiation in health maintenance organization enrollees with dyslipidemia.

BACKGROUND: Patients treated in a usual-care setting often do not comply with prescribed treatment regimens as closely as those treated in a clinical trial, for a variety of reasons. OBJECTIVES: We sought to describe compliance over 3 years with a statin treatment in an observational study in a usual-care setting and to investigate potential risk factors for poor compliance. METHODS: Enrollees in a Massachusetts health maintenance organization (HMO) who presented with baseline low-density lipoprotein cholesterol (LDL-C) > or =130 mg/dL and who started statin treatment between January 1, 1994, and July 1, 1999, were followed until death, termination of membership in the HMO, or July 1, 1999, whichever came first, as documented by the HMO's drug-dispensing electronic records. The records included information about the demographics, service dates, laboratory data, and filled prescriptions. The outcome measures were time to treatment discontinuation, time to treatment resumption, and adherence to treatment. RESULTS: A total of 4776 enrollees were included in the analysis. Most patients were aged 50 to 69 years (57%), men (52%), had LDL-C > or =160 mg/dL (77%), and received their prescription for antihyperlipidemia therapy from an internist or family physician (87%). The hazard of discontinuation was high during the first 6 months of therapy, with 20% of the initial population discontinuing treatment during this time period, then decreased, so that the fraction of continuing users leveled off: 74%, 65%, and 61% of statin initiators were still on treatment 1, 2, and 3 years after entry, respectively. The probability of resuming statin treatment was 51% within 24 months after last prescription filled. The proportion of adherent users stayed stable, between 53% and 55%, after the first 6 months. Risk factors of treatment discontinuation, treatment resumption, and adherence were remarkably similar and were stable over time. The significant predictors of treatment discontinuation were age <50 years (hazard ratio [HR], 1.45 [95% Cl, 1.26-1.68]), female sex (HR, 1.18 [95% CI, 1.06-1.30], and previous antihyperlipidemia treatment (HR, 0.71 [95% CI, 0.63-0.79]). CONCLUSIONS: In this HMO setting, women and individuals 1026 aged <50 years were at risk for poor compliance with statin therapy. Our analysis suggests that the association between compliance and age or gender may be quite stable over the first 3 years of treatment.

Metabolism, lifestyle and bipolar affective disorder.

Lifestyle, illness and treatment factors in people with bipolar disorder (BD) may confer additional risk of morbidity and mortality to the increasing rates of obesity, metabolic syndrome, diabetes mellitus and cardiovascular mortality in the general population.The aim of this review is to examine whether the risk of obesity and related morbidity and mortality are raised in BD, and possible contributory effects of lifestyle, illness and treatment factors to this risk.Systematic search of Medline and Cochrane Collaboration for relevant studies followed by a critical review of literature was carried out.Mortality from cardiovascular causes and pulmonary embolism (standardized mortality ratio approximately 2.0), and morbidity from obesity and type 2 diabetes mellitus may be increased in BD compared to the general population. Reduced exercise and poor diet, frequent depressive episodes, comorbidity with substance misuse and poor quality general medical care contribute to the additional risk of these medical problems in people with BD. There is no evidence that patients with BD are more sensitive than other patients to weight gain and medical problems associated with long-term use of psychotropic medication; in fact long-term treatment with lithium, antipsychotics and tricyclic antidepressants may reduce overall mortality. Psychiatrists, general practitioners and other health professionals should work together to systematically assess and manage weight gain and related medical problems to reduce the morbidity and mortality associated with obesity in BD. There is insufficient evidence to associate any of these factors with specific drug treatments. More research is required to understand how BD changes the risk for physical health comorbidity.