Association of diabetes with coronary artery calcium in South Asian adults and other race/ethnic groups: The multi-ethnic study of atherosclerosis and the mediators of atherosclerosis in South Asians living in America study.

PURPOSE: South Asian (SA) persons have increased risks for diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). We examined whether the association of DM with subclinical atherosclerosis assessed by coronary artery calcium (CAC) differs in SA versus other ethnic groups. METHODS: We studied adults from the Multi-Ethnic Study of Atherosclerosis and the Mediators of Atherosclerosis in South Asians Living in America studies without ASCVD. CAC was examined among those normoglycemic, pre-DM and DM. Logistic regression examined pre-DM and DM with the odds of any CAC > 0 and CAC ≥ 100. RESULTS: Among 7562 participants, CAC > 0 and CAC ≥ 100 in those with DM was highest in non-Hispanic White (NHW) (80% and 48%) and SA (72% and 41%) persons. Adjusted Ln (CAC + 1) was highest in NHW (3.68 ± 0.21) and SA (3.60 ± 0.23) (p < .01) DM patients. SA and NHW adults with DM (vs normoglycemic) had highest odds of CAC > 0 (2.13 and 2.27, respectively, p < .01). For CAC ≥ 100, SA and Chinese adults had the highest odds (2.28 and 2.27, respectively, p < .01). Fasting glucose and glycated hemoglobin were most strongly associated with CAC among SA. CONCLUSIONS: Diabetes mellitus most strongly relates to any CAC in SA and NHW adults and CAC ≥ 100 in SA and Chinese adults, helping to explain the relation of DM with ASCVD in these populations.

Who should be referred for a CT coronary calcium score? Introducing a simple patient risk questionnaire combining traditional and novel risk factors.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death. Coronary artery calcium (CAC) strongly predicts the risk of ASCVD. There is a need to know who would benefit most from CAC scanning. OBJECTIVES: We examined the utility of a new, simple, easy-to-use, and interactive patient risk questionnaire (PRQ), incorporating both traditional and non-traditional risk factors to identify those most likely to benefit from CAC scanning. METHODS: Data from the EISNER Study was used to study the PRQ in relation to the extent of CAC and whether it added incremental value over the Pooled Cohort Risk Score (PCRS) for identifying CAC. RESULTS: Among 1332 participants a mean PRQ score of 5.6 ± 1.7 was obtained. Negative scans ranged from 95.5% for PRQ scores of 0-1 to only 32.5% for those with a PRQ score of 8. A PRQ score of 3 or more was shown to be associated with a 54% prevalence of CAC. The frequency of a CAC score >=100 was 0 with PRQ = 0-1 and 36% in patients with PRQ = 8. The cNRI of the PRQ score over the PCRS in predicting the presence of CAC was 0.20 (95% CI, 0.09- 0.30; P = 0.0004), mainly due to down-stratifying risk. CONCLUSIONS: A unique and simple PRQ identifies those most likely to have a positive CAC scan and may be useful to predict who will benefit most from CAC scanning, allowing for its use in those patients who are most appropriate.

PRE-VIEW: Development and Pilot Testing of An Interactive Video Doctor Plus Provider Alert to Increase Cancer Screening.

BACKGROUND: Interventions to increase recommended cancer screening tests and discussions are needed. METHODS: We developed PRE-VIEW (The PREventive VIdeo Education in Waiting Rooms Program), a multimedia cancer prevention intervention for primary care clinics based on the Transtheoretical Model of Behavior Change We pilot tested PRE-VIEW An Interactive Video Doctor plus Provider Alert for feasibility and acceptability in primary care clinic settings in the San Francisco Bay Area, California in 2009-2010. RESULTS: Eighty participants (33 men and 47 women; more than half non-white) at 5 primary care clinics were included. After PRE-VIEW, 87% of women were definitely interested in mammography when due and 77% were definitely interested in a Pap test. 73% of participants were definitely interested in colorectal cancer screening when due, and 79% of men were definitely interested in a discussion about the PSA test. The majority indicated that they received an appropriate amount of information from PRE-VIEW and that the information presented helped them decide whether or not to be screened. CONCLUSIONS: PRE-VIEW was well received and accepted and potentially provides an innovative and practical way to support physicians' efforts to increase cancer screening.

Preferences for genetic testing to identify hereditary colorectal cancer: perspectives of high-risk patients, community members, and clinicians.

The aim of this study was to establish key characteristics that patients, consumers, and health professionals value regarding genetic testing (GT) and personalized medicine using the example of GT for hereditary Lynch syndrome. We conducted a series of focus groups with individuals recruited from a clinic that follows those at high risk for hereditary cancer, individuals recruited from the community, physicians, and genetic counselors. Participants were presented with clinical scenarios about Lynch syndrome testing and asked to identify characteristics that they perceived as important in making decisions about GT. Forty-two participants (19 community members, 8 high-risk and cancer patients, 3 genetic counselors, and 8 physicians) participated. Among community members and patients, the most frequently discussed considerations were the personal impact of GT and family impact, respectively. Among physicians, the most frequently discussed topic was the characteristics of genomic services (e.g., test invasiveness); among genetic counselors, the most frequently discussed topic was evidence and recommendations. A variety of test characteristics were important in decision making about GT. High-risk patients, community members, and health care providers had different priorities. Health care professionals should be aware of differences between their own considerations about GT and those that are important to patients.