Last Updated: 2007-06-01 17:17:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - The "Statin Choice" decision aid, specifically tailored to patients with type 2 diabetes, improves their understanding of their cardiovascular risk profile, and assists them in making decisions regarding treatment with a statin drug, according to a report in the Archives of Internal Medicine for May 28.
Multiple studies have shown that some diabetics, despite their increased cardiovascular risk, do not adhere well to statin therapy. Dr. Victor M. Montori at the Mayo Clinic College of Medicine, Rochester, Minnesota, and colleagues attribute the poor compliance to lack of adequate patient involvement in the decision-making process.
To address that issue, the investigators designed "Statin Choice." It reveals a patient's probability of having a heart attack over the next decade, and includes specific risk factors that affect that probability. It depicts the benefits and lists downsides of using a statin, then asks what the patient has decided.
Dr. Montori's group compared Statin Choice with a standard educational pamphlet about cholesterol management (control) in a randomized trial that included 21 clinicians and 98 patients. Responses to the two interventions were documented in questionnaires.
Patients using the Statin Choice aid were more knowledgeable, "had better estimated cardiovascular risk (OR, 22.4) and potential absolute risk reduction with statin drugs (OR, 6.7) and had less decisional conflict than did patients in the control group," the researchers found.
The decision aid may have also improved compliance. At 3 months, 2 of 33 patients taking statins in the intervention group had missed a dose in the preceding week compared with 6 of 29 in the control group.
Despite limitations of the study, Dr. Montori and associates suggest that "the findings are well worth following up in future studies."
Nonalcoholic fatty liver disease linked to CVD in type 2 diabetes |
Last Updated: 2007-06-04 12:40:11 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Nonalcoholic fatty liver disease (NAFLD) is common in type 2 diabetes patients and is associated with a high prevalence of cardiovascular disease (CVD), according to findings reported in the May issue of Diabetes Care.
Dr. Giovanni Targher, of "Sacro Cuore" Hospital, Negrar, Italy, and colleagues studied 2839 adult outpatients with type 2 diabetes. Main outcome measures were NAFLD, assessed by patient history and liver ultrasound, and manifest vascular disease determined by patient history, record review, electrocardiogram, and echo-Doppler scanning of carotid and lower limb arteries.
Overall, 2421 of the 2839 subjects had hepatic steatosis on ultrasound and the unadjusted prevalence of NAFLD was 69.5%. The authors note that NAFLD was the most common cause (81.5%) of hepatic steatosis on ultrasound.
The prevalence of NAFLD increased with age, from 65.4% among those between the ages of 40 to 59 years to 74.6% among those 60 years of age or older. The age-adjusted prevalence of NAFLD was 71.1% and 68% in men and women, respectively.
Patients with NAFLD compared to those without NAFLD also had "remarkably (p < 0.001) higher age and sex-adjusted prevalences of coronary (26.6% versus 18.3%), cerebrovascular (20.0% versus 13.3%), and peripheral (15.4% versus 10.0%) vascular disease."
Results of logistic regression analysis revealed an association between NAFLD and prevalent CVD, independent of classical risk factors, glycemic control, medications, and metabolic syndrome features.
"These results further confirm the hypothesis that the identification of NAFLD in type 2 diabetes may help in CVD risk prediction," Dr. Targher and colleagues conclude. "Future experimental and follow-up studies are needed to elucidate the possible molecular mechanisms linking NAFLD and CVD and to determine whether NAFLD predicts the development and progression of CVD."
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