Attainment Of Therapeutic Goals Research Articles

Attainment of Best Practice Recommendations and Late Complications of Patients with Type 1 and Type 2 Diabetes Mellitus

Background: There is a need for information on the current practices of diabetes management to take some actions and improve the attainment of therapeutic goals. Objective. We aimed to describe the attainment of therapeutic targets and late complications of patients with type 1 (T1D) and type 2 (T2D) diabetes mellitus. Material and Methods. In the fourth wave of the International Diabetes Management Practices Study, 1,966 Mexican patients were analyzed (T1D: n=157, 8%; T2D: n=1809, 92%). The cross-sectional phase regarding metabolic profile, current complications, and management are analyzed. Results. Out of T1D patients, 77.6% received insulin alone, and 27.4% had insulin and oral glucose-lowering drugs (OGLD, mostly metformin). Out of T2D patients, 63% received OGLD exclusively (mostly metformin), 4.3% insulin alone, 30.4% OGLD, and insulin, and 2% were on a diet and exercise exclusively. Only 19.7% T1D and 35.9% T2D patients had HbA1c <7% (p=0.01), and only 5.0% of T1D and 3.9% of T2D met the combined therapeutic target of HbA1c <7% + BP <130/80 mmHg + LDL <100 mg/dl. Late diabetes-related complications occurred in 42.7% of T1D and 52.8% of T2D patients, mostly microvascular disease. Macrovascular complications were more frequent in patients with T2D, as compared with T1D (36.8% vs. 16.4%, p<0.001). The number of late complications increased steadily with disease duration, more pronounced in patients with T2D. Conclusions. This study evidences substantial lags in the attainment of clinical goals of patients with diabetes mellitus. There are noticeable differences in the achievement of current therapeutic targets between patients with T1D and T2D in a sample of the Mexican practice.

Effectiveness of Lifestyle Modification vs. Therapeutic, Preventative Strategies for Reducing Cardiovascular Risk in Primary Prevention-A Cohort Study.

Background: Cardiovascular diseases (CVD) are still the leading cause of death in developed countries. The aim of this study was to calculate the potential for CV risk reduction when using three different prevention strategies to evaluate the effect of primary prevention. Methods: A total of 931 individuals aged 20–79 years old from the Bialystok PLUS Study were analyzed. The study population was divided into CV risk classes. The Systematic Coronary Risk Estimation (SCORE), Framingham Risk Score (FRS), and LIFE-CVD were used to assess CV risk. The optimal prevention strategy assumed the attainment of therapeutic goals according to the European guidelines. The moderate strategy assumed therapeutic goals in participants with increased risk factors: a reduction in systolic blood pressure by 10 mmHg when it was above 140 mmHg, a reduction in total cholesterol by 25% when it was above 190 mg/dL, and a reduction in body mass index below 30. The minimal prevention strategy assumed that CV risk would be lowered by lifestyle modifications. The greatest CV risk reduction was achieved in the optimal model and then in the minimal model, and the lowest risk reduction was achieved in the moderate model, e.g., using the optimal model of prevention (Model 1). In the total population, we achieved a reduction of −1.74% in the 10-year risk of CVD death (SCORE) in relation to the baseline model, a −0.85% reduction when using the moderate prevention model (Model 2), and a −1.11% reduction when using the minimal prevention model (Model 3). However, in the low CV risk class, the best model was the minimal one (risk reduction of −0.72%), which showed even better results than the optimal one (reduction of −0.69%) using the FRS. Conclusion: A strategy based on lifestyle modifications in a population without established CVD could be more effective than the moderate strategy used in the present study. Moreover, applying a minimal strategy to the low CV risk class population may even be beneficial for an optimal model.

Medication nonadherence in Nigerian heart failure patients: A cross sectional study

Background: Anti-failure therapy is vital to the reduction of morbidity and mortality associated with heart failure (HF). Medication nonadherence (MNA) has been identified as a major limiting factor for the attainment of therapeutic goals. This study aimed to determine the prevalence and characteristics of MNA in HF patients attending Lagos University Teaching Hospital (LUTH), Lagos. Methods: This was a descriptive cross-sectional study involving 202 previously diagnosed HF patients attending an outpatient clinic in LUTH. Data were obtained from patient's medical records and the use of an interviewer-administered questionnaire. Medication Adherence Report Scale 5-items was used to determine MNA. Results: Of the 202 HF subjects, 68% (n = 128) were aged 31–60 years, 65% (n = 132) were females, 58%, (n = 116) were taking ≤4 pills/day, 54.5% were taking pills twice daily, and 72.3% (n = 146) had comorbid conditions. The overall prevalence of MNA was 69.3% with ACE inhibitors having the highest MNA of 73.2% and angiotensin receptor blocker/neprilysin inhibitor having the least MNA of 0%. MNA was independent of age, gender, educational status, pill burden, duration of HF, history of HF admission, functional status, and specific comorbidities (P

The Correlation between Waist-Hip Ratio and Achieving Therapeutic Lipid Goals in Taiwan.

Body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) are all simple anthropometric tools used to categorize obesity status. This study aimed to determine associations between different anthropometric indices and the attainment of therapeutic lipid goals in patients with atherosclerotic cardiovascular disease (CVD) undergoing secondary prevention. Between 2010 and 2014, this multi-center study enrolled 5718 patients undergoing secondary prevention for CVD. At study enrollment, total cholesterol, high-density lipoprotein protein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) were recorded. This cross-sectional study analyzed these three anthropometric obesity indices and correlations with achieving therapeutic lipid goals. Among the 5718 patients, multivariate analysis revealed that those with higher BMI or WC tended not to meet their HDL-C and TG therapeutic goals. However, neither BMI nor WC showed a relationship with achieving the LDL-C target. The patients with an elevated WHR (≥ 0.98 for males and ≥ 0.97 for females) were less likely to achieve all three lipid target values, including LDL-C (p = 0.05), HDL-C (p < 0.001) and TG (p < 0.001). Among Taiwanese patients undergoing secondary prevention for CVD, the higher the WHR the lower the likelihood of achieving the lipid therapeutic goals.

Adherence to Guidelines at a Stroke Prevention Clinic: A Follow-up Study.

In 2010, we published our stroke prevention clinic's performance as compared to Canadian stroke prevention guidelines. We now compare our clinic's adherence with guidelines to our previous results, following the implementation of an electronic documentation form. All new patients referred to our clinic (McGill University Health Center) for recent transient ischemic attack (TIA) or ischemic stroke between 2014 and 2017 were included. We compared adherence to guidelines to our previous report (N=408 patients for period 2008-2010) regarding vascular risk management and treatment. Three hundred and ninety-two patients were included, of which 36% had a TIA and 64% had an ischemic stroke, with a mean age of 70 years and 43% female. Although the more recent cohort has shown a higher proportion of cardioembolic stroke compared to previous (19.1% vs. 14.7%) following new guidelines regarding prolonged cardiac monitoring, increased popularity in CT angiography has not translated into greater proportion of large-artery stroke subtype (26.3% vs. 26.2%). Blood pressure (BP) targets were achieved in 83% compared with 70% in our previous report (p&lt;0.01). Attainment of low-density lipoprotein cholesterol target was also improved in our recent study (66% vs. 46%, p&lt;0.01). No significant difference was found in the consistency of antithrombotic use (97.7% vs. 99.8%, p=0.08). However, there was a decline in smoking cessation (35% vs. 73%, p=0.02). Overall, optimal therapy status was better attained in the present cohort compared to the previous one (52% vs. 22%, p&lt;0.01). The male sex was associated with better attainment of optimal therapy status (odds ratio, 1.61; 95% confidence interval, 1.04-2.51). The number of follow-up visits and the length of follow-up were not associated with attainment of stroke prevention targets. Our study shows improvement in attainment of therapeutic goals as recommended by Canadian stroke prevention guidelines, possibly attributed in part to the implementation of electronic medical recording in our clinic. Areas for improvement include smoking cessation counseling and diabetes screening.

Increasing Youth Engagement in Residential Group Care: A Mixed Methods Pilot Study of a Youth-Guided Incentive Program

Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement. In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n = 16). A semi-structured focus group with service providers (n = 7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two). Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program. This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.

The Effect of Clinical Pharmacist-Led Comprehensive Medication Management on Chronic Disease State Goal Attainment in a Patient-Centered Medical Home.

Clinical pharmacy services were initiated at 7 of 11 clinics within a primary care network (PCN), which was designated as a patient-centered medical home and was affiliated with a large academic medical center in October 2014. The goal of the service was to target patients with uncontrolled chronic conditions, specifically diabetes. Patients met with a clinical pharmacist through individual clinic and telephonic appointments, in addition to usual appointments with physicians as needed. While managing patients with diabetes, many clinicians assess a patient's hemoglobin A1c (A1c), along with blood pressure and cholesterol, as indicators of disease state control and cardiovascular risk. These 3 parameters were combined into a bundled response score (BRS) in order to assess whether the addition of the clinical pharmacy service had a positive effect on patient therapeutic goal attainment rates for these areas. To assess the effect of pharmacist-led comprehensive medication management (CMM) on therapeutic goal attainment rates for glycemic, blood pressure, and dyslipidemia outcomes in PCN patients, which was represented by a BRS based on how many therapeutic goals were met. This retrospective study was conducted using patients seen in clinics within the PCN between October 1, 2014, and October 31, 2015. Patients were included in the intervention group if they were actively managed by a PCN pharmacist and had a diagnosis of diabetes. A control group included patients without access to a PCN pharmacist and was matched to the intervention group by baseline A1c results. Based on current clinical practice guidelines, therapeutic goals for the BRS were set as A1c ≤ 8%, blood pressure ≤ 140/90 mmHg, and prescription of a moderate- to high-intensity statin for dyslipidemia. In addition to the primary outcome, the individual components of the BRS were assessed, as well as the average number of medications used between groups. There were 95 patients included in the intervention group, with 132 patients included in the usual care group. Patients in the intervention group had significantly higher rates of therapeutic goal attainment for the 3 endpoints (40% vs. 12%, P < 0.001). The intervention group had statistically significantly higher improvements in the individual areas of A1c, blood pressure, and statin goal attainment. There were no significant differences in the number of medications for diabetes or antihypertensive medications used between groups at the time of study termination. This study demonstrated that the addition of CMM services provided by clinical pharmacists in this PCN had a positive effect on therapeutic goal attainment rates for patients with diabetes. This finding suggests that the integration of clinical pharmacists into primary care clinics could have positive effects on the clinical outcomes of diabetic patients in glycemic control, blood pressure, and statin treatment, in accordance with current guidelines. Support for this study was provided to Wilson by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number ULI TR001860. The content of this article is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. The authors have nothing additional to disclose.

A Humanistic Framework Using Nonlinear Analysis to Evaluate the Working Alliance and Coping for Adolescents in Crisis

The exploration of nonlinear relationships in counseling offers the opportunity to explore associations among variables from a humanistic perspective. Data on 75 adolescents admitted to crisis residence demonstrate the nonlinear association between the working alliance and therapeutic goal attainment. Implications of this research are addressed.

Examining the Relationship Between Working Alliance and Therapeutic Goal Attainment With Adolescents in Crisis

Literature regarding the relationship between working alliance and therapeutic goal attainment is limited. The purpose of this correlational study was to explore working alliance and therapeutic goal attainment with 75 adolescents in an inpatient, acute care, behavioral hospital in south Texas. Two canonical correlation analyses were conducted utilizing sets of subscale scores from the Working Alliance Inventory—Short Form (WAI-S) and the Crisis Stabilization Scale (CriSS). A statistically significant relationship was found between the clinician version of WAI-S subscales and the CriSS subscales, while no statistically significant relationship was found between the client version of WAI-S subscales and the CriSS subscales. A strong working alliance, specifically collaboration on tasks in counseling, is important for adolescents’ achievement of goals related to stabilization. In addition, clients may over report progress in counseling.

The Interpersonal Risk Awareness Survey: Understanding the Risk of Self‐Disclosure

The authors investigated perceptions of comfort related to self‐disclosure through an instrument development process. The Interpersonal Risk Awareness Survey was developed using classical and modern test theory. Results of the study support its use for facilitating the therapeutic relationship and helping beginning humanistic counselors pursue therapeutic goal attainment.

Postoperative physiotherapy for cardiac patients: two different organizational models

Physiotherapists are involved in the postoperative recovery of cardiac patients. Physiotherapy is a discipline that is characterized by a one-on-one relationship between patient and professional, as well as by many relationships between each physiotherapist and other professionals. Ideally, this relational synergy contributes to the pursuit and attainment of valuable therapeutic goals. However, this becomes complicated when dealing with complex and challenging physical conditions, which often happens in critical cardiac settings. Given such a frame, public health institutions must choose the organizational model that can best facilitate the provision of optimal care. Models can be divided into a care setting model, in which a physiotherapist’s intervention is provided within a ward, or a pathway-centered model, in which professionals follow a patient’s care along its clear progression from hospital admission to discharge. One of the main determinants of the decision to choose a care setting or a pathway-centered model involves the volume of therapeutic services to be provided. Responding to the demand for health care is a difficult task that requires more than just effort: it requires in-depth knowledge of the patient, a broad perspective on and understanding of professional standards. The best patient care should be pursued by means of the coordination of the managerial decisions with the therapeutic actions, together with a continuous monitoring of the system.

Outcome of Gaucher Disease in India: Lessons from Prevalent Diagnostic and Therapeutic Practices.

To study disease severity and response to enzyme replacement therapy in Gaucher disease. Updated data was captured from records of 37 patients (35 reported previously) with confirmed diagnosis of Gaucher disease from January 1995 through December 2011 (31, 83.8 %) and prospectively from January 2012 through June 2013 (6, 16.2 %). Severity of manifestations was determined by Gaucher disease Severity Score Index. Response to enzyme replacement therapy was assessed in terms of attainment of therapeutic goals. Moderate to severe manifestations (domain score of > 2) were observed in treated patients at baseline (83%, 58%, 66% and 25% for anemia, thrombocytopenia, hepatomegaly and leucopenia, respectively and 100% for splenomegaly and elevated plasma chitotriosidase). None of the 11 patients treated with synthetic enzyme (average annual dose 23 to 53 units/kg) attained all therapeutic goals in the recommended time frame, particularly the visceral, skeletal and growth domains. Early onset of moderate to severe disease in Indian patients mandates early therapy with optimum doses to ensure attainment of all recommended therapeutic goals.

Adherence to guidelines: experience of a canadian stroke prevention clinic.

Few studies have assessed the performance of stroke prevention clinics. In particular, limited information exists on patient compliance, achievement of therapeutic targets, and related occurrence of vascular events. We compared our clinical practice to recommendations from published guidelines in newly referred patients for transient ischemic attack (TIA) or ischemic stroke between 2008 and 2010. We monitored our cohort for at least 1 year and assessed for adequacy of vascular risk factor management, drug adherence, and occurrence of nonlethal vascular outcomes. Of 408 patients, 57.8% had a stroke and 42.2% a TIA. The mean age was 68±13 years, and 52% male. Average follow-up was 15.8 months. During follow-up, 253 patients (70.3%) completely achieved their blood pressure target, 151 (45.5%) achieved their low-density lipoprotein (LDL) cholesterol target, and 407 (99.8%) were on antithrombotics. Eighty-nine patients (21.8%) attained optimal therapy status, defined as reaching targets for LDL cholesterol, blood pressure, and antithrombotic use. Adherence to drug therapy was associated with attainment of optimal therapy status (p=0.01). Diabetes was associated with lower probability of attaining optimal therapy status (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.20-0.66) and blood pressure targets (OR, 0.09; 95% CI, 0.05-0.17). During follow-up, 52 (12.7%) patients had a nonlethal vascular event. Our study shows good attainment of therapeutic goals associated with adherence to drug therapy. However, optimal therapy status and blood pressure targets were more difficult to attain in patients with diabetes; therefore, more intensive preventive efforts may be required for these individuals.

Metabolic syndrome in patients with peripheral arterial disease

Background and objectiveThe prevalence of metabolic syndrome (MS) in patients with peripheral arterial disease (PAD) and coronary or cerebrovascular disease is increasing, but it is not known whether this association also exists in patients with isolated PAD. The aim of the current study was to assess the prevalence of MS in patients with PAD who had no coronary or cerebrovascular disease, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals in patients with PAD and with and without MS. Patients and methodsMulticenter, cross-sectional study of 3934 patients aged ≥45 years with isolated PAD who were treated in primary care and specialized outpatient clinics during 2009. A diagnosis of PAD was reached for ankle brachial indices <0.9, a previous history of amputation or revascularization. ResultsIn the overall population, the mean age was 67.6 years, 73.8% were males and 63% had MS (95% CI, 61.5–64.3%). Patients with MS had a higher prevalence of cardiovascular risk factors and comorbidities, more severe PAD and higher prescription rate of evidence-based cardiovascular therapies. After adjusting for risk factors and comorbidity, there was a more frequent use of renin–angiotensin system blockers, beta-blockers, diuretics and statins among the patients with MS. A lower percentage of patients with MS achieved the therapeutic goals for blood pressure (22% vs. 41.5%, p<0.001). Similarly, a lower percentage of patients with diabetes achieved the glycated hemoglobin goals (44% vs. 53.1%, p<0.001), with no differences in LDL-cholesterol levels (29.8% vs. 39.1%, p=0.265). ConclusionPatients with PAD have a high prevalence of MS. Patients with MS do not attain therapeutic goals as frequently as those without, despite taking more cardiovascular drugs.

Síndrome metabólico en pacientes con enfermedad arterial periférica

Background and objectiveThe prevalence of metabolic syndrome (MS) in patients with peripheral arterial disease (PAD) and coronary or cerebrovascular disease is increasing, but it is not known whether this association also exists in patients with isolated PAD. The aim of the current study was to assess the prevalence of MS in patients with PAD who had no coronary or cerebrovascular disease, the prescription rate of evidence-based cardiovascular therapies and the attainment of therapeutic goals in patients with PAD and with and without MS. Patients and methodsMulticenter, cross-sectional study of 3.934 patients aged ≥ 45 years with isolated PAD who were treated in primary care and specialized outpatient clinics during 2009. A diagnosis of PAD was reached for ankle brachial indices <0.9, a previous history of amputation or revascularization. ResultsIn the overall population, the mean age was 67.6 years, 73.8% were males and 63% had MS (95% CI 61.5-64.3%). Patients with MS had a higher prevalence of cardiovascular risk factors and comorbidities, more severe PAD and higher prescription rate of evidence-based cardiovascular therapies. After adjusting for risk factors and comorbidity, there was a more frequent use of renin-angiotensin system blockers, beta-blockers, diuretics and statins among the patients with MS. A lower percentage of patients with MS achieved the therapeutic goals for blood pressure (22% vs. 41.5%, p<0.001). Similarly, a lower percentage of patients with diabetes achieved the glycated hemoglobin goals (44% vs. 53.1%, p<0.001), with no differences in LDL-cholesterol levels (29.8% vs. 39.1%, p=0.265). ConclusionPatients with PAD have a high prevalence of MS. Patients with MS do not attain therapeutic goals as frequently as those without, despite taking more cardiovascular drugs.

Factors Associated With Therapeutic Goal Attainment in Patients With Concomitant Hypertension and Dyslipidemia

Background: Hypertension and dyslipidemia are the most prevalent cardiovascular risk factors, with approximately 30 million patients in the United States having these concomitant conditions. Further, the presence of high body mass index (BMI) has a negative effect on the achievement of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) targets. Objective: This study evaluates the demographic, diagnostic, and medication-related factors associated with BP and LDL-C goal attainment in patients with concomitant hypertension and dyslipidemia stratified by BMI. Methods: This retrospective study utilized the GE Centricity Electronic Medical Records database (2004–2011) of a primary care physician group. Patients aged ≥ 18 years with concomitant hypertension and dyslipidemia were included. The attainment of BP and LDL-C targets were assessed based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Patients were classified into 3 cohorts based on their BMI: normal weight (≤ 24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30.0 kg/m2). Multivariate logistic regression analysis was conducted to identify the predictors of goal attainment. Results: A total of 9086 patients with concomitant hypertension and dyslipidemia were identified, of which 7723, 6724, and 5824 patients did not attain BP, LDL-C, and dual BP and LDL-C goals, respectively. Age was a significant predictor of BP and LDL-C goal attainment in those who were of normal weight or overweight, and obese women had a decreased likelihood of achieving these goals (P < 0.05). Failure to attain BP and LDL-C goals was more likely in patients with diabetes across all BMI groups (P < 0.001). Further, patients with stage 1 hypertension and higher baseline total cholesterol levels were less successful in attaining BP and LDL-C goals, respectively (P < 0.001). Conclusions: These variations in therapeutic goal attainment in patients with concomitant hypertension and dyslipidemia across different BMI groups suggest that future research is needed to determine the underlying reasons for these disparities.

Is there a practical way of predicting therapeutic success in type 2 diabetes on the basis of psychological features? Development and validation of the Psychological Predictors of Therapeutic success in Diabetes (PPTD) questionnaire

Many psychiatric disorders and symptoms have been associated with impaired metabolic control in type 2 diabetes; several studies focused on non-pathological psychological features. Aims of this observational, longitudinal study are: the assessment of the impact of a wide range of psychological factors on metabolic control in type 2 diabetes; and the development and validation of a simple questionnaire to assess the impact of psychological factors on therapeutic success. To identify psychological factors interfering with attainment of glycemic targets, a prospective 1-year study was performed on a sample of 250 patients with type 2 diabetes. The impact of identified factors on therapeutic outcome was then subsequently verified on a further, independent sample of 200 patients. The first phase of the study allowed the development of a 19-items questionnaire, the Psychological Predictors of Therapeutic success in Diabetes (PPTD) questionnaire. Validation analyses showed that the questionnaire was able to predict therapeutic success. Patients with HbA1c ≤7% (53 mmol/mol) at follow-up showed higher test scores than those with HbA1c >7% [31.0 (26.2; 35.0) vs 28.0 (23.0; 32.0); p = 0.016]. The attainment and maintenance of therapeutic goals in patients with type 2 diabetes depend on a wide range of factors. The PPTD is an attempt at condensing the complexity of psychological factors affecting glycemic control in a simple and easy-to-use self-reported questionnaire, which can be used in wide-scale research.

Association between Obesity and Therapeutic Goal Attainment in Patients with Concomitant Hypertension and Dyslipidemia

Background: Obesity is associated with cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes mellitus, as well as cardiovascular diseases. Objectives: To evaluate demographic, diagnostic, and treatment characteristics of patients with concomitant hypertension and dyslipidemia, stratified by body mass index and the attainment of blood pressure (BP) and lipid targets in obese versus nonobese patients. Methods: This retrospective study used data from GE Centricity Electronic Medical Records database (2004–2011) of a primary care physician group. Patients aged ≥ 18 years and having concomitant hypertension and dyslipidemia were categorized based on their body mass index: normal weight (≤ 24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30.0 kg/m2). Blood pressure and lipid goal attainments were based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and National Cholesterol Education Program Adult Treatment Panel III guidelines, respectively. Results: A total of 9086 patients with concomitant hypertension and dyslipidemia were identified and categorized as normal weight (n = 1256), overweight (n = 3058) and obese (n = 4772). Patients who were obese were younger (< 65 years); were more likely to have diabetes mellitus (P < 0.001); had higher baseline BP and triglyceride levels and lower levels of high–density lipoprotein cholesterol (P < 0.05); and were more likely to be prescribed antihypertensives and antilipemic agents (P < 0.001). In multivariate analyses, obese patients were significantly more likely to fail to attain BP (odds ratio = 1.562, P < 0.001) and dual BP and low–density lipoprotein cholesterol (odds ratio = 1.193, P = 0.023) goals. Conclusions: Obesity appears to be an independent risk factor for the failure to attain BP and dual BP and low–density lipoprotein cholesterol goals in patients with concomitant hypertension and dyslipidemia. These findings suggest that future research is needed to determine the underlying link between obesity and failure to attain these goals.

Potential implications of the choice among three alternative treatment targets for apolipoprotein B100 in the management of patients with type 2 diabetes and chronic kidney disease

This study analyses discordance rates between attainment of therapeutic goals for apolipoprotein B100 (apoB) and both low-density lipoprotein-cholesterol (LDL-C) and non-high-density lipoprotein-cholesterol (non-HDL-C) in a sample of 152 patients with type 2 diabetes and chronic kidney disease from Gran Canaria (Spain), using treatment targets recommended by the American Diabetes Association/American College of Cardiology (ADA/ACC), the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and by a Spanish population-based study. Among subjects with LDL-C levels at therapeutic goal, apoB was above target in 16.3% (ADA/ACC), 6.5% (ESC/EAS) and 39.1% (population-based criteria), and among subjects with non-HDL-C levels at therapeutic goal, apoB was above target in 10.5% (ADA/ACC), 1.2% (ESC/EAS) and 29.6% (population-based criteria). These findings show that clinical management would be very differently altered depending on the criteria used to set treatment targets for apoB. Cut-off points derived from population data identify a greater number of subjects suitable for a more intensive lipid-lowering therapy.

PCV120 - Association between obesity and therapeutic goal attainment in patients with concomitant hypertension and dyslipidemia

To evaluate demographic, diagnostic, and treatment characteristics of patients with concomitant hypertension and dyslipidemia, stratified by body mass index (BMI) and the attainment of blood pressure (BP) and lipid targets in obese versus non-obese patients. This retrospective study utilized data from 2004 to 2011 from the GE Centricity Electronic Medical Records database of a primary care physician group in Southwestern Pennsylvania. Patients having ‘active’ status (with one or more visit(s) to the physician), ≥18 years of age, and having concomitant hypertension and dyslipidemia (identified based on diagnosis, medication, and BP/lipid measurements) were included. Patients were classified into three cohorts based on their BMI: normal-weight (≤24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Goal attainment for BP and lipid levels were assessed based on JNC 7 and NCEP ATP III guidelines, respectively. Univariate and multivariate analyses were conducted to compare BP and lipid goal attainment in obese versus non-obese. A total of 9,086 patients with concomitant hypertension and dyslipidemia were identified and categorized as normal weight (13.8%), overweight (33.7%) and obese (52.5%). Patients who were obese were younger (<65 years); more likely to have diabetes (P<0.001); had higher baseline BP, triglyceride levels and lower HDL-C (P<0.05); and more likely to be prescribed both antihypertensives and antilipemic agents (P<0.001). In multivariate analyses, obese patients were significantly more likely to fail to attain BP (OR=1.562, P<0.001) and dual BP and LDL-C (OR=1.193, P=0.023) goals as well as optimal levels of triglycerides (OR=1.864, P<0.001) and HDL-C (OR=1.933, P=0.009). Obesity appears to be an independent risk factor for the failure to attain BP and dual BP and LDL-C goals in patients with concomitant hypertension and dyslipidemia. These findings suggest that future research is needed to determine the underlying link between obesity and failure to attain these goals.