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Updated Stroke Prevention Guidelines

Updated Stroke Prevention Guidelines

The American Heart Association and American Stroke Association (AHA/ASA) have updated guidelines on primary stroke prevention based on comprehensive and timely evidence from clinical investigations and research trials. Recommendations are included for controlling risk factors, using interventional approaches to atherosclerotic disease, and antithrombotic treatments for preventing stroke. The guidelines were published in Stroke and are available for free online at http://stroke.ahajournals.org. “One of the most important changes in the AHA/ASA guidelines is that newer anticoagulants can be used as alternatives to warfarin to prevent stroke in patients with atrial fibrillation (AF),” says James F. Meschia, MD, FAHA, who chaired the AHA/ASA committee that developed the recommendations. The guidelines note that although some of the new AF drugs are more expensive, they require less ongoing monitoring and therefore represent reasonable options for patients. Another key recommendation from the guidelines is that clinicians are urged to use of statins, along with diet and exercise, to help lower the stroke risk in patients at high risk for experiencing a stroke within the next 10 years. “In addition, the CHA2DS2-VASc is recommended for stratifying the risk for stroke,” says Dr. Meschia. “Patients with a score of 0 on the CHA2DS2-VASc do not require anticoagulants, but those with a score of 2 or higher should receive these therapies.” He adds that patients with a score of 1 on CHA2DS2-VASc can be considered for anticoagulants.   Women & Stroke According to the AHA/ASA, women have higher stroke risks if they are pregnant, use oral contraceptives, use hormone replacement therapy, have migraines, and/or have depression. The guidelines recognize the different risk factors women face throughout their...

Analyzing Costs Associated With Cushing’s Disease

Reddit   Patients with Cushing’s syndrome—hypercortisolemia from any etiology—manifest a multitude of debilitating physical, metabolic, and psychiatric symptoms. Cush­ing’s disease (CD)—hypercortisolemia resulting from an adrenocorticotropic hormone-secreting pituitary adenoma— is the cause of about 70% of spontaneous Cushing’s syndrome cases. CD occurs more frequently in women, with most cases found in patients aged 25 to 45. Although relatively uncommon, CD has been associated with significant mortality and morbidity. Central obesity, wasting of the extremities, hair loss, facial hirsutism, acne, and easy bruising or fragile skin are among the most common patient complaints. Among the more serious comorbidities associ­ated with CD are: Osteoporosis with pathologic fractures. Immunosuppression with frequent infections. Hypertension, diabetes, and cardiac disease. Psychiatric illness, especially depression. While surgery to remove the adenoma is successful in 65% to 90% of cases and many associated comorbidities improve with resolution of the hypercortisolemia, the medical and psychological effects of CD may persist after the hypercorti­solemia has resolved. A Closer Look at the Economic Burden of Cushing’s Disease In the September 2011 issue of Endocrine Practice, my col­leagues and I had a study published for which we explored the healthcare costs of CD, including its comorbidities, and whether successful treatment improved the economic impact of the disease. Using administrative health insurance data, we compared healthcare resource use and costs among patients with CD with those of patients with non-functioning pitu­itary adenomas (NFPA) and population controls (PC) without pituitary disease. The prevalence of comorbidities and changes in medical costs were analyzed in patients with CD before and after surgical treatment and compared with controls. We found that coding for insurance claims demonstrated comor­bidities...
Early Observations From Look AHEAD

Early Observations From Look AHEAD

Type 2 diabetes continues to adversely impact life expectancy, quality of life, and medical costs. Compounding the problem is that obesity among patients with diabetes is also increasing, further impacting the potential for future improvements in life expectancy and quality of life for these patients. It has been well established that the excess morbidity and mortality experienced by people with diabetes is primarily due to increased cardiovascular disease (CVD) risk, specifically the triad of hyperglycemia, hypertension, and hyperlipidemia. People with type 2 diabetes die about 8 years earlier than those without the disease, primarily due to their increased risk of CVD. Interventions to reduce the adverse health outcomes of diabetes are primarily directed at cardiovascular risk factors, but despite these efforts most patients do not appear to be achieving optimal care goals for CVD risk reduction. Clinical studies have demonstrated that effective programs for people with diabetes that achieve long-term weight loss and increase physical activity are promising for improving cardiovascular risk while minimizing use of pharmacologic agents. More research continues to explore the role of lifestyle interventions in these patients. The Look AHEAD (Action for Health in Diabetes) study is an ongoing NIH trial, which is examining the effect of an intensive lifestyle intervention (ILI) on CVD morbidity and mortality in people with diabetes. The ILI includes group and individual meetings to achieve and maintain weight loss by decreasing caloric intake and increasing physical activity; the comparator is a traditional diabetes support and education intervention (DSE). In the June 2010 issue of Diabetes Care, my colleagues and I examined the effect of the Look AHEAD intervention on medication...
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