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Europace : European Pacing,... Jun 2018Women traditionally have been and are still underrepresented in research in many important areas of cardiology, and guideline recommendations which also encompass women...
Women traditionally have been and are still underrepresented in research in many important areas of cardiology, and guideline recommendations which also encompass women are mostly based on research conducted predominantly in men. However, there is plausible cause to believe that sex may have a potential influence on the benefit derived from the implantable cardioverter-defibrillators (ICD), alone or in association with cardiac resynchronization therapy. We assessed the possible relationship between sex and outcome with ICD implantation in the setting of primary prevention, by pooling the results of MUSTT, MADIT-II, DEFINITE, COMPANION, SCD-HeFT and DANISH trials in a meta-analysis. We pooled results for female and male patients separately. The results suggest that women as a group do not seem to obtain a significant survival benefit from the primary prevention ICD, contrary to men. This in turn may also have contributed to a relative underestimation of the ICD benefit among males when looking at the results in total. It is time for the medical and research communities to actively question the presumed overarching benefit of ICDs irrespective of sex and engage in systematic scientific efforts to definitively evaluate the value of this intervention in women.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Female; Humans; Male; Primary Prevention; Risk Assessment; Sex Factors
PubMed: 29016772
DOI: 10.1093/europace/eux203 -
American Journal of Respiratory and... Apr 2014
Topics: Biomedical Research; Chronic Disease; Humans; Lung Diseases; National Heart, Lung, and Blood Institute (U.S.); Primary Prevention; United States
PubMed: 24684354
DOI: 10.1164/rccm.201402-0380ED -
Mutation Research Apr 2000Primary prevention is based on the incontrovertible logic that a most efficient way to decrease the risk for a disease is to avoid, or reduce to minimal attainable... (Review)
Review
Primary prevention is based on the incontrovertible logic that a most efficient way to decrease the risk for a disease is to avoid, or reduce to minimal attainable levels, exposures to agents that can cause the disease or contribute to an increase in risk for the disease. This notwithstanding, the adoption of primary prevention measures has often encountered serious obstacles and unjustifiable delays. The success of primary prevention has also been limited by the combined effect of: (a) the inefficient and/or incomplete use of the cumulated etiological knowledge: (b) the spectrum of target organs for human carcinogens which does not include some of the most common cancer sites, a limitation that may be related to a disregard of epidemiological results and case reports that provide evidence that is less than sufficient of a causal relationship between an exposure and human cancer: (c) the pressure that powerful economic interests may have exerted in a variegated way to interfere or delay implementation of preventive measures that could have decreased their profit, and (d) the decreased acceptance of the ability of experimental results to predict similar effects in humans, in spite of the evidence that positive carcinogenicity results in experimental animals have often preceded and could indeed have predicted similar results in humans.
Topics: Carcinogens; Humans; Neoplasms; Occupational Diseases; Primary Prevention
PubMed: 11523541
DOI: 10.1016/s1383-5742(00)00029-6 -
The Cochrane Database of Systematic... Jul 2007Primary care physicians hold a strategic position in delivering preventive services. However discrepancies exist between evidence based guidelines and practice. (Review)
Review
BACKGROUND
Primary care physicians hold a strategic position in delivering preventive services. However discrepancies exist between evidence based guidelines and practice.
OBJECTIVES
To assess the effects of interventions to improve the delivery of preventive services in primary care.
SEARCH STRATEGY
We searched the Cochrane Effective Practice and Organisation of Care Group specialised register (November 1995; August 1999), MEDLINE (1980 to 1995) and hand searched relevant journals.
SELECTION CRITERIA
Randomised trials, controlled before and after studies, and interrupted time series analyses of interventions to improve preventive services by primary care professionals responsible for patient care.
DATA COLLECTION AND ANALYSIS
Two researchers independently extracted data and assessed study quality.
MAIN RESULTS
Fifty-five studies were included, involving more than 2000 health professionals and 99,000 people, with 83 comparisons between intervention and control groups. Post intervention differences between intervention and control groups varied widely within and across categories of interventions. Most interventions were found to be effective in some studies, but not in others. Five comparisons of group education versus no intervention showed absolute change of preventive services varying between -4% and +31%. Nine comparisons of physician reminders versus no intervention showed absolute change of preventive services varying between 5% and 24%. Fourteen comparisons of multifaceted interventions versus no intervention showed absolute change of preventive services varying between -3% and +64%. Six comparisons of multifaceted interventions versus group education reported absolute changes varying between -31% and +28%. All these comparisons used randomised groups. Ten comparisons of multifaceted interventions versus no intervention used non-randomised groups and showed absolute change of preventive services varying between -5% and +21%. The remaining planned comparisons within categories of interventions contained less than five comparisons.
AUTHORS' CONCLUSIONS
There is currently no solid basis for assuming that a particular intervention or package of interventions will work. Effective interventions to increase preventive activities in primary care exist, but there is considerable variation in the level of change achieved, with effect sizes usually small or moderate. Tailoring interventions to address specific barriers to change in a particular setting is probably important. Multifaceted interventions may be more effective than single interventions, because more barriers to change can be addressed. Future research should analyse barriers to change and interventions to implement preventive services in more detail, to clarify how interventions relate to specific barriers. Since more complex interventions are likely to be more effective but also more costly, economic evaluations should also be included.
Topics: Humans; Practice Patterns, Physicians'; Primary Health Care; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 17636633
DOI: 10.1002/14651858.CD000362.pub2 -
Journal of General Internal Medicine Dec 2014Statins are the cornerstone of lipid-lowering therapy for cardiovascular disease prevention. The 2013 American College of Cardiology (ACC) and American Heart Association...
Statins are the cornerstone of lipid-lowering therapy for cardiovascular disease prevention. The 2013 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines represent a fundamental shift in how statins will be prescribed. The new guidelines recommend statins for nearly all older patients up to age 75 years, including healthy adults with low normal lipid levels and no atherosclerotic cardiovascular disease (ASCVD) risk factors other than age. Under the 2013 guidelines, age becomes a main determinant for initiating statin therapy for primary prevention among older adults. Specifically, according to the new guidelines, white males aged 63-75, white females aged 71-75, African American males aged 66-75, and African American females aged 70-75 with optimal risk factors would be recommended for statin treatment for primary prevention. Based on the new guidelines, one could term these older adults as having "statin deficiency," a condition warranting statin treatment. We call this putative condition of age-related statin deficiency "statinopause." After careful examination of the trial evidence, we find very little support for the new recommendations for primary prevention. The lack of evidence underscores the need for clinical trials to determine the risks and benefits of statin therapy for primary prevention among older adults.
Topics: Age Factors; Aged; Cardiovascular Diseases; Drug Prescriptions; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Practice Guidelines as Topic; Primary Prevention; Risk Assessment
PubMed: 25092007
DOI: 10.1007/s11606-014-2959-x -
Revista Espanola de Salud Publica 2007
Review
Topics: Humans; Primary Prevention; Vascular Diseases
PubMed: 18041536
DOI: 10.1590/s1135-57272007000400001 -
The Medical Journal of Australia Feb 2014
Topics: Cardiovascular Diseases; Humans; Primary Prevention
PubMed: 24528419
DOI: 10.5694/mja13.10924 -
Alzheimer Disease and Associated... 2006The prevention of Alzheimer disease (AD) remains an important goal because of its high prevalence in our society and its associated costs. Two types of primary... (Review)
Review
The prevention of Alzheimer disease (AD) remains an important goal because of its high prevalence in our society and its associated costs. Two types of primary prevention trials have been conducted in AD to date: trials in independent cohorts specifically recruited for an AD primary prevention trial and cohorts in other studies randomized to a drug of interest where appropriate cognitive measures can be added. There have been numerous difficulties in conducting primary prevention trials in AD because of the need for a large sample size, long length of poor follow up, and adverse event profile or toxicity of the agents being studied. Many primary prevention trials are ongoing. However, to date, no primary prevention trial has successfully delayed the development of AD. Future primary prevention trials for AD will need to carefully consider issues of safety, tolerability, ability to follow subjects over long periods of time, methods of collecting data, and strategies to enhance recruitment to carry out such trials.
Topics: Alzheimer Disease; Humans; Primary Prevention
PubMed: 16917204
DOI: 10.1097/00002093-200607001-00015 -
The Journal of the Arkansas Medical... Jul 1996
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Atencion Primaria 2013
Topics: Chronic Disease; Humans; Primary Prevention
PubMed: 23931963
DOI: 10.1016/j.aprim.2013.07.001