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Cardiometabolic Risk, Type 2 Diabetes, & Heart Disease

Cardiometabolic Risk, Type 2 Diabetes, & Heart Disease

The term cardiometabolic risk refers to having a high 10-year and/or lifetime risk for cardiovascular disease (CVD). Specific causes that can increase cardiometabolic risk include hyperglycemia, hypertension, dyslipidemia, obesity, and insulin resistance. When patients have one or more of these risk factors and are physically inactive or smoke, cardiometabolic risk is further increased. “Patients with type 2 diabetes often have many risk factors associated with cardiometabolic risk,” explains Cecilia C. Low Wang, MD, FACP (Figure). “It’s important to consider cardiometabolic risk as part of a comprehensive approach to patient care.” This allows clinicians to consider multiple disease pathways and risk factors to facilitate earlier intervention. The State of Risk According to current estimates, two of every three Americans are overweight or obese, and about 86 million have prediabetes. Nearly half of all adults in the United States have high cholesterol, and about one-third have high blood pressure (BP). “While it’s important to track A1C among patients with type 2 diabetes, it’s also critical to manage BP and cholesterol because these are two of the most important cardio-metabolic risk factors,” Dr. Low Wang says. Research has shown that good BP control can reduce diabetes-related deaths by 32% and lower the risk of stroke by 44% and micro-vascular complications by 37%. Addressing Risk Factors There are non-modifiable and modifiable cardio-metabolic risk factors to consider when managing patients with type 2 diabetes. Non-modifiable risk factors include age, race and ethnicity, gender, and family history. Modifiable factors include obesity, dyslipidemia, inflammation, hypertension, smoking, physical inactivity, unhealthy diet, and insulin resistance. “Patients should understand that having diabetes means being at higher risk for CVD,”...

Social Media Tips for Doctors

Recently, I was asked for personal advice on using Twitter. There are many articles out there that say we (physicians) don’t know how to properly use social media. Social media can be a very powerful tool in medicine. It can not only help us get medical information out there to our patients, but it can also help us connect with people, colleagues, and organizations to give us more visibility—whether for career advancement, media contacts, or just to get our voices heard. Social Media Basics: These are some of the tips I have come up with for doctors who want to take advantage of the many opportunities social media can offer: 1. Never communicate to patients through social media outlets. It is a set up for disaster and HIPAA violations. 2. Social media can be used for educating patients. Patients can follow you on these pages to get information about your practice and whatever medical information you wish to share. Twitter… 3.  Twitter is useful for growing your professional connections. It can be leveraged so you get known and also connect with other doctors, healthcare information technology people, media, etc. Patients can follow you on Twitter, but it generally is not a useful method of providing patient information because tweets are limited to 140 characters. 4. Choose your followers carefully. Block those who spam or troll you (“trolls” are people who negatively post with the deliberate intent of provoking a reaction). Many people will try to sell you things. Monitor your account because it is not uncommon for it to be hacked. 5. Grow your network. Have a group that...
Decision-Making Preferences After AMI

Decision-Making Preferences After AMI

In recent years, experts have called for greater partici­pation by patients in medical decision-making processes, but research suggests that shared decision making is not yet routinely incorporated into medical care. “In some cases, there may be a perception among patients that they need to defer decision making to their physicians,” says Harlan M. Krumholz, MD, SM. “This is certainly the sense by many cardiologists about patients hospitalized with an acute myocardial infarction (AMI).” Surveying the Scene To further investigate decision-making preferences among patients, Dr. Krumholz and colleagues conducted a study using combined data from two similar AMI registries. Published in JAMA Internal Medicine, the study group asked patients to indicate who they felt should make decisions on treatment options in AMI after they are given information about the risks and benefits of the possible treatments.   More than two-thirds of patients reported that they preferred to actively participate in decision making about their care, but about one-quarter stated that they wanted to make the decision alone. Most patients indicated that physicians and patients should have equal participation. About 15% suggested that patients should dominate the decision. “The key take-home message is that decision-making preferences vary among patients after an AMI, but many prefer an active style,” says Dr. Krumholz. Difficult to Predict Seven variables were associated with a greater likelihood of patients preferring active decision making, including female sex, Caucasian race, higher education, smoking, heart failure, lower Global Registry of Acute Coronary Events risk score, and not undergoing PCI during the hospitalization. Those who preferred an active role tended to be younger, but the majority of all age groups...
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