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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_189"
                     title="Tailoring Trumps Targeting for Cholesterol Control (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Cardiology/Dyslipidemia/tb/18023?impressionId=1265777179226"
                     
      &lt;p&gt;Lipid control is more than a simple matter of &quot;knowing your numbers,&quot; according to a computer model that found tailoring statin therapy to fit an individual&apos;s five-year risk of heart attack or stroke is a better prevention strategy than treating to preset goals.&lt;/p&gt;
&lt;p&gt;In the model, patients who whose five-year coronary artery disease risk was 5% to 15% received 40 mg of simvastatin (Zocor), while those whose risk was greater were given 40 mg of atorvastatin (Lipitor).&lt;/p&gt;
&lt;p&gt;In every scenario, the tailored approach was preferable, Rodney A. Hayward, MD, of the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System, and colleagues wrote in the Jan. 19 &lt;em&gt;Annals of Internal Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;While treating-to-target is appealingly simple, that simplicity may be its main limitation, the researchers argued.&lt;/p&gt;
&lt;p&gt;Treating to a single target means that one risk factor receives &quot;dramatically more weight than all other predictors of treatment benefit, resulting in other highly relevant information being either ignored or underweighted,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;That approach, tailoring treatment to reflect multiple risk factors rather than treating-to-target, is an &quot;interesting&quot; one, according to Christopher Cannon, MD, of Brigham and Women&apos;s Hospital in Boston, who was not involved in the study.&lt;/p&gt;
&lt;p&gt;But Cannon, principal investigator of a number of statin trials, said the idea may be a little too late to impact clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;The guidelines won&apos;t shift to this approach any time soon, and in two years, atorvastatin will be generic, so all patients can inexpensively be treated with more intensive therapy (which is better for everyone at all risk levels),&quot; Cannon wrote in an e-mail.&lt;/p&gt;
&lt;p&gt;Although intensive therapy may be better as a rule, he conceded, it&apos;s less cost-effective when an expensive drug is used. When atorvastatin becomes available as a generic, he wrote, for &quot;$4 a month at Walmart it is simply cheaper  --  and of course better  --  to treat everyone with atorvastatin 80 mg.&quot;&lt;/p&gt;
&lt;p&gt;Assuming a population of Americans ages 30 to 75 with no history of myocardial infarction, the authors developed three treatment models: &lt;ul&gt; &lt;li&gt;Standard National Cholesterol Education Program III (NCEP) treat-to-target recommendation, which requires treatment to an LDL target of less than 190 mg/dL for low-risk individuals, less than 160 mg/dL for moderate-risk, and less than 130 mg/dL for high-risk individuals&lt;/li&gt; &lt;li&gt;Intensive NCEP III treat-to-target approach, with targets of less than 100 mg/dL for high-risk individuals&lt;/li&gt; &lt;li&gt;The tailored model, with 40 mg of simvastatin for patients who whose five-year coronary artery disease risk was 5% to 15% and 40 mg of atorvastatin (Lipitor) for higher-risk patients&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;(In both NCEP III strategies statins would be used in a stepwise fashion  --  20 mg simvastatin, 40 mg simvastatin, 40 mg atorvastatin, and, finally, 80 mg atorvastatin  --  to achieve targets).&lt;/p&gt;
&lt;p&gt;Using standard NCEP III treat-to-target recommendations, &quot;37.9 million U.S. persons should receive statins, of which 7.9 million should receive high dose-potency therapy (atorvastatin 40 to 80 mg),&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Compared with no treatment, the standard strategy would save an estimated 48 quality adjusted life years (QALYs) per 1,000 Americans treated for five years, or a total of 1.83 million total QALYs.&lt;/p&gt;
&lt;p&gt;The intensive NCEP III treat-to-target recommendations would &quot;recommend that 53.4 million U.S. persons receive statins&quot; and would save about 570,000 more QALYs than the standard treatment.&lt;/p&gt;
&lt;p&gt;Using the computer model, this strategy prevented &quot;about 720,000 more nonfatal CAD events and 30,000 more deaths&quot; than the standard treatment.&lt;/p&gt;
&lt;p&gt;Tailored treatment, by contrast, would require that about the same number of people receive a statin  --  53 million. But only 13.3 million would require high-dose statin therapy, versus roughly 18 million who would be given high-dose statin therapy using the intensive NCEP III strategy.&lt;/p&gt;
&lt;p&gt;Even so, the tailored approach would save 520,000 more QALYs than the intensive treatment approach, the authors found.&lt;/p&gt;
&lt;p&gt;&quot;The tailored treatment approach was superior to both NCEP III approaches, resulting in both more CAD morbidity and mortality prevented in the overall population and higher treatment efficiency (greater benefit per person treated),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors noted a number of limitations, including the paucity of clinical trial data on statin therapy in persons ages 75 or older.&lt;/p&gt;
&lt;p&gt;Moreover, although the model suggested a robust benefit for tailored treatment, &quot;the absolute population-level benefit of the tailored treatment over the treat-to-target approaches are much less certain and can vary substantially on the basis of several factors, such as statin&apos;s effect on total mortality (estimates of which are less precise in the literature than estimates for nonfatal CAD events) and the level of treatment adherence that is achievable in real-world clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;Whether a tailored treatment approach is superior for other conditions in which treat-to-target strategies are currently recommended, such as blood pressure and glycemic control, warrants examination,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded in part by the Department of Veteran Affairs Health Services Research &amp;amp; Development Service&apos;s Quality Enhancement Research Initiative.&lt;/p&gt;&lt;p&gt;Hayward did not report any financial disclosures.&lt;/p&gt;&lt;p&gt;Cannon reported receiving research/grants/suport from Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, GlaxoSmithKline, Intekrin Therapeutics, Merck, Merck/Schering-Plough Partnership, Novartis, and Takeda. He is a clinical adviser with equity in Automedics Medical Systems.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_757"
                     title="AAD: Psoriasis Raises Risk of Heart Disease and Stroke"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13240?impressionId=1265777179226"
                     
      SAN FRANCISCO, March 12 -- Patients with psoriasis have a significantly greater risk of coronary heart disease and stroke than the general population, data from three large clinical trials suggests.
              &lt;br&gt; 
              &lt;br&gt;Considering the prevalence of cardiovascular risk factors, the risk of coronary disease was almost 30% greater in psoriasis patients, and stroke risk exceeded the rate of the general population by 12%, Alexa B. Kimball, M.D., of Harvard, and colleagues reported at the American Academy of Dermatology meeting.
              &lt;br&gt; 
              &lt;br&gt;The risk did not vary by severity of psoriasis, as patients with moderate and severe disease had a similar prevalence of heart disease and stroke.
              &lt;p&gt; 
              &lt;p&gt;If anything, investigators cautioned that their figures might underestimate the true risk of cardiovascular disease in psoriasis patients.
              &lt;p&gt; 
              &lt;p&gt;&quot;The results of this analysis are conservative estimates of the risk of coronary heart disease and stroke in psoriasis patients with moderate and severe psoriasis because patients with severe cardiovascular disease were excluded from the analyzed trials, and psoriasis itself may confer additional risks not measured by these traditional risk factors,&quot; they concluded.
              &lt;p&gt; 
              &lt;p&gt;Several studies have provided evidence that psoriasis increases the risk of heart disease. Different studies have suggested an increased risk of heart failure, occlusive vascular events, and an unfavorable cardiovascular risk profile, as well as excess cardiovascular mortality associated with psoriasis severity, the investigators said.
              &lt;p&gt; 
              &lt;p&gt;In an attempt to gain an overall perspective on the risk, Dr. Kimball and colleagues examined data from three randomized clinical trials of adalimumab (Humira) for patients with moderate to severe psoriasis.
              &lt;p&gt; 
              &lt;p&gt;The study population was a 1,591-patient sample from the three trials, stratified by disease severity, as determined by the Psoriasis Area and Severity Index (PASI). The analysis included 1,082 patients with moderate psoriasis (PASI 10 to 20) and 509 with severe disease (PASI &gt;20).
              &lt;p&gt; 
              &lt;p&gt;Using the Framingham Risk Score algorithm, the investigators estimated each patient&apos;s 10-year risk of CHD and stroke.
              &lt;p&gt; 
              &lt;p&gt;The CHD algorithm was based on six baseline variables: age, presence of diabetes, smoking, blood pressure, total cholesterol, and HDL.
              &lt;p&gt; 
              &lt;p&gt;The stroke algorithm comprised eight variables: age, presence of diabetes, blood pressure, antihypertensive therapy, history of cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy.
              &lt;p&gt; 
              &lt;p&gt;Risk estimates for patients with psoriasis were compared with the imputed risk of CHD and stroke for the general population, using data from Framingham and other sources.
              &lt;p&gt; 
              &lt;p&gt;In the general population, the average 10-year probability of CHD ranged from 3% in men ages 30 to 34 to 30% in men ages 70 to 74. Estimates for women ranged from &lt;1% to 14%.
              &lt;p&gt; 
              &lt;p&gt;The 10-year estimated stroke risk stratified by age and sex ranged from 6% for men and 3% for women ages 55 to 59 to 22% for men and 24% for women ages 80 to 84.
              &lt;p&gt; 
              &lt;p&gt;The investigators used Framingham criteria to define risk categories for CHD and stroke: low, &lt;10%; intermediate, 10% to 20%; high, &gt;20%.
              &lt;p&gt; 
              &lt;p&gt;A comparison of predicted risk for psoriasis patients and the age-sex adjusted imputed risk for the general population yielded statistically significant differences.
              &lt;p&gt; 
              &lt;p&gt;Psoriasis patients had a 12.25% mean estimated 10-year risk for CHD compared with 9.56% for the general population (&lt;em&gt;P&lt;/em&gt;&lt;0.001). Stroke risk averaged 8.4% for patients with psoriasis and 7.51% for the general population (&lt;em&gt;P&lt;/em&gt;=0.020).
              &lt;p&gt; 
              &lt;p&gt;The differences translated into a 28% increase in the relative risk of CHD among psoriasis patients and an 11.8% increase in the relative risk of stroke.
              &lt;p&gt; 
              &lt;p&gt;The estimated 10-year risk of CHD did not differ between patients with moderate psoriasis (12.25%) or severe disease (12.24%). Estimated stroke risk averaged 8.26% for patients with moderate psoriasis and 8.74% for those with severe psoriasis.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The authors reported no financial relationships with commercial interests. The study was funded by Abbott Laboratories. Two of the co-authors were employees of Abbott Laboratories.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_19_756"
                     title="AAD: Poor Nutrition Linked to Psoriasis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13239?impressionId=1265777179226"
                     
      SAN FRANCISCO, March 12 -- Addressing individual factors associated with metabolic syndrome may have benefits for psoriasis, preliminary findings from an ongoing study suggest.
              &lt;p&gt;
              &lt;p&gt;Obesity, poor diet, and lack of exercise all correlated with psoriasis, and a higher body mass index was associated with more severe disease, Jennifer Ahdout, of UCLA, and colleagues reported at the American Academy of Dermatology meeting.
              &lt;p&gt; 
              &lt;p&gt;However, patients with psoriasis did not have a higher prevalence of diseases associated with metabolic syndrome compared with a nonpsoriatic control group.
              &lt;p&gt; 
              &lt;p&gt;&quot;Previous studies have shown an association between psoriasis and metabolic syndrome; however, the nature of this relationship is unclear,&quot; the investigators said.
              &lt;p&gt; 
              &lt;p&gt;&quot;Based on our sample, it appears that, on average, psoriasis patients may have poorer dietary habits and a trend toward poorer exercise habits compared with controls,&quot; they added.
              &lt;p&gt; 
              &lt;p&gt;Over the past 25 years, several reports in the medical literature have linked psoriasis to obesity and an increased risk of cardiovascular morbidity and mortality. However, the reports provided little insight into specific factors contributing to the associations, the investigators said.
              &lt;p&gt; 
              &lt;p&gt;Metabolic syndrome comprises several modifiable risk factors for cardiovascular disease. The extent to which the factors might play a role in psoriasis had not been examined, leading the UCLA group to study 118 adults, 66 of whom had psoriasis. The remaining 52 individuals constituted a control group.
              &lt;p&gt; 
              &lt;p&gt;The study had a twofold objective: evaluate the prevalence of modifiable metabolic syndrome-related risk factors and determine whether any of the modifiable risk factors correlate with psoriasis severity, as assessed by the Psoriasis Area and Severity Index (PASI).
              &lt;p&gt; 
              &lt;p&gt;Patients with psoriasis had a significantly higher mean BMI (27.73 versus 25.67 for controls, &lt;em&gt;P&lt;/em&gt;=0.04). However, the association became only a trend after controlling for age, sex, and smoking status (&lt;em&gt;P&lt;/em&gt;=0.08).
              &lt;p&gt; 
              &lt;p&gt;The patients and control group had a similar prevalence of diseases associated with metabolic syndrome, including diabetes, heart disease, hypercholesterolemia, hypertension, and stroke.
              &lt;p&gt; 
              &lt;p&gt;Self-reported stress also did not differ significantly between the groups.
              &lt;p&gt; 
              &lt;p&gt;Psoriasis patients did, however, exhibit a trend toward less exercise compared with controls (&lt;em&gt;P&lt;/em&gt;=0.06).
              &lt;p&gt; 
              &lt;p&gt;Additionally, they reported significantly poorer overall nutrition than the control group, as reflected by a lower mean score on the Rapid Eating Assessment for Patients questionnaire (2.23 versus 2.38, &lt;em&gt;P&lt;/em&gt;=0.004).
              &lt;p&gt; 
              &lt;p&gt;Increasing BMI predicted more severe psoriasis as assessed by PASI (&lt;em&gt;P&lt;/em&gt;=0.004). 
              &lt;p&gt; 
              &lt;p&gt;PASI scores also had significant correlations with stress (&lt;em&gt;P=&lt;/em&gt;0.02), smoking (&lt;em&gt;P&lt;/em&gt;=0.005), and current treatment with systemic therapy (&lt;em&gt;P&lt;/em&gt;=0.02).
              &lt;p&gt; 
              &lt;p&gt;The investigators called for larger studies to continue the evaluation of possible links between psoriasis and modifiable risk factors for metabolic syndrome, particularly dietary and exercise habits.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study received support from the Dermatologic Research Foundation of California.
              &lt;p&gt; 
              &lt;p&gt;The investigators reported no relationships with commercial interests.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_3_334"
                     title="AHA: Women Receive Less Cardiovascular Secondary Prevention"
                     score="-0.005"
                     href="