“Doc, I Got My Whole Genome Scanned – Now What?” (19 Sep 2011)
Susan Cheng, MDWhat do you do if your patient shows you a commercially produced report of a personal whole genome scan?
What do you do if your patient shows you a commercially produced report of a personal whole genome scan?
Some of you may remember a 2005 paper in JAMA, in which relevant clinical practice guidelines were applied to a hypothetical 79-year-old woman. This woman had multiple co-morbid conditions, otherwise known as multimorbidity, including COPD, type 2 diabetes, osteoporosis, hypertension, and osteoarthritis. The authors surmised that, if guideline-directed care were followed, this hypothetical patient would be…
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The surplus of specialists and neglect of primary and preventive care in modern American medicine has led to a very sharp focus on individuals, with little regard for families. A perfect example of how this imbalance has detrimental effects at the population level is the childhood obesity epidemic. Many healthcare professionals perceive obesity as an…
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Rita Redberg’s recent post, Why I Don’t Recommend Statins for Primary Prevention in Women, has gotten some attention on CardioExchange. In comments on the post, CardioExchange members and contributors support various approaches to preventive interventions for women. Here’s your chance to weigh in: How would you handle a 65-year-old woman who has reasonably controlled hypertension…
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For many treatment strategies, the highest-risk groups derive the most benefit. Prevention of cardiovascular disease is no exception: Secondary prevention is where the greatest benefits lie. With regard specifically to primary prevention of CVD in women, my review of the evidence has led me to conclude that statin use is not warranted as a broad-based…
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We are now at a point where it is increasingly difficult to demonstrate the incremental value of any preventive therapy, as we are successful in reducing CV risk to lower and lower levels. What is my take on the ACCORD BP study? It’s that we should focus on ensuring that all patients achieve at least the…
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Millions of people who take statins to reduce their cholesterol levels do not adhere to their prescribed regimens. That’s troubling in light of estimates from a recent analysis of data from more than 40,000 participants in the Melbourne Collaborative Cohort Study. It showed that if the percentage of patients with at least 80% adherence to…
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Aspirin is the best known and most widely used preventive therapy. A century of clinical experience and randomized trials in over 250,000 patients have proved its benefit in preventing cardiovascular events, and it costs pennies a day. So how can it be that not everyone who needs it gets it? In a new report, we…
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Last week, I posted a Voices blog detailing my concerns about a recent randomized controlled trial of varenicline that, in my opinion, was just another weak safety study. Absent from that post was a discussion of varenicline’s effectiveness, which was significant. At 12 weeks, 47% of varenicline users had been continuously abstinent, versus 14% of…
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The American Heart Association has issued its Heart Disease and Stroke Statistics 2010 Update, which underlines the fact that most Americans are ignoring prevention. While more than half a trillion dollars is spent annually on heart disease, little is spent on prevention. What can we do to change this? If more money were available for prevention, how do you think…
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