Showing papers by "Anushka Patel published in 2007"
TL;DR: Routine administration of a fixed combination of perindopril and indapamide to patients with type 2 diabetes was well tolerated and reduced the risks of major vascular events, including death, which suggest that over 5 years, one death due to any cause would be averted.
1,913 citations
TL;DR: In this paper, a low-information Framingham risk prediction tool was used to predict future cardiovascular risk with similar accuracy in Asian populations as tools developed from data on local cohorts, and the performance of these equations, and a subsequently recalibrated Framingham equation, were evaluated among participants from independent Chinese cohorts.
Abstract: Background: Cardiovascular risk equations are traditionally derived from the Framingham Study. The accuracy of this approach in Asian populations, where resources for risk factor measurement may be limited, is unclear. Objective: To compare "low-information" equations (derived using only age, systolic blood pressure, total cholesterol and smoking status) derived from the Framingham Study with those derived from the Asian cohorts, on the accuracy of cardiovascular risk prediction. Design: Separate equations to predict the 8-year risk of a cardiovascular event were derived from Asian and Framingham cohorts. The performance of these equations, and a subsequently "recalibrated" Framingham equation, were evaluated among participants from independent Chinese cohorts. Setting: Six cohort studies from Japan, Korea and Singapore (Asian cohorts); six cohort studies from China; the Framingham Study from the US. Participants: 172 077 participants from the Asian cohorts; 25 682 participants from Chinese cohorts and 6053 participants from the Framingham Study. Main results: In the Chinese cohorts, 542 cardiovascular events occurred during 8 years of follow-up. Both the Asian cohorts and the Framingham equations discriminated cardiovascular risk well in the Chinese cohorts; the area under the receiver-operator characteristic curve was at least 0.75 for men and women. However, the Framingham risk equation systematically overestimated risk in the Chinese cohorts by an average of 276% among men and 102% among women. The corresponding average overestimation using the Asian cohorts equation was 11% and 10%, respectively. Recalibrating the Framingham risk equation using cardiovascular disease incidence from the non-Chinese Asian cohorts led to an overestimation of risk by an average of 4% in women and underestimation of risk by an average of 2% in men. Interpretation: A low-information Framingham cardiovascular risk prediction tool, which, when recalibrated with contemporary data, is likely to estimate future cardiovascular risk with similar accuracy in Asian populations as tools developed from data on local cohorts.
161 citations
TL;DR: Systolic blood pressure is an important marker of risk of CVD in people with and without diabetes, and a given reduction in systolicBlood pressure is likely to have a similar relative effect on reducing the risk of a cardiovascular event, regardless of diabetes status.
Abstract: Objective To assess the association between systolic blood pressure (SBP) and cardiovascular diseases (CVD) among participants with and without diabetes from cohorts in the Asia-Pacific region.Research design and methods Hazards ratios and 95% confidence intervals (CI) for CVD were calculated from Cox models, stratified by sex and region and adjusted for age using individual participant data from 36 cohort studies. Repeat measurements of SBP were used to adjust for regression dilution bias.Results During follow-up, 7387 fatal or non-fatal cardiovascular endpoints were recorded among 368307 participants (6.4% with diabetes). SBP was associated with coronary heart disease (CHD), ischaemic stroke and haemorrhagic stroke in a continuous log-linear fashion among individuals with diabetes, as well as those without diabetes. Overall, each 10 mmHg higher usual SBP was associated with 18% (95% Cl: 9-27%) and 23% (19-26%) greater risk for CHD among those with and without diabetes, respectively. The corresponding values for ischaernic stroke were 29% (14-45%) and 43% (37-50%), and for haernorrhagic stroke, 56% (32-83%) and 74% (66-82%). The testfor heterogeneity by diabetes status in each of these associations was not significant (P >= 0.10).Conclusions Systolic blood pressure is an important marker of risk of CVD in people with and without diabetes. A given reduction in systolic blood pressure is likely to have a similar relative effect on reducing the risk of a cardiovascular event, regardless of diabetes status.
87 citations
TL;DR: There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke.
Abstract: Background The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL cholesterol and stroke, particularly for stroke subtypes. Methods and results Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After adjustment for age and regression dilution, hazard ratios (95% confidence intervals) for a 1 standard deviation (SD) lower level of HDL cholesterol (0.4 mmol/L) were: for CHD events, 1.39 (1.22–1.57); for ischaemic stroke, 0.90 (0.75–1.07), and for haemorrhagic stroke, 0.89 (0.74–1.07). As total cholesterol (TC) increased relative to HDL cholesterol, the risk of CHD increased, the risk of ischaemic stroke was unchanged but the risk of haemorrhagic stroke decreased. A 1 SD increase in TC/HDL cholesterol (1.63 units) was associated with a 27% decrease in the risk of haemorrhagic stroke (95% confidence interval, 7–44%). Conclusion There is clear evidence of potential benefit for CHD of increases in HDL cholesterol and decreases in TC relative to HDL cholesterol, but no evidence of an association between either HDL cholesterol or TC/HDL cholesterol and ischaemic stroke. Increasing HDL cholesterol relative to TC may increase the risk of haemorrhagic stroke.
63 citations
TL;DR: While abnormal levels of other lipid fractions are frequently observed in people with diabetes, these data support aggressive lowering of total cholesterol and LDL-cholesterol levels for prevention of cardiovascular events.
Abstract: The aim of this study was to assess the association between total cholesterol and major cardiovascular diseases among persons with and without diabetes in the Asia-Pacific region. We used data on individual participants in 30 cohort studies from the Asia-Pacific region to compute the hazards ratios and 95% CIs for participants with and without diabetes at baseline, using Cox proportional models. Analyses were stratified by sex and region (Asia vs Australia or New Zealand) and adjusted for age. Repeat measurements of total cholesterol were used to adjust for regression dilution bias. The analysis included 333,533 individuals (6.3% with diabetes at baseline) who experienced 6,074 fatal and non-fatal cardiovascular events over a median follow-up period of 4.0 years. Total cholesterol was positively associated with coronary heart disease (CHD) and ischaemic stroke, and negatively with haemorrhagic stroke in a continuous, log-linear fashion, similarly among participants with and without diabetes. Each 1 mmol/l increase above the ‘usual’ level for total cholesterol was associated with a 41% (95% CI 23–63%) and 42% (95% CI 35–50%) greater risk of CHD among participants with and without diabetes. The corresponding values for ischaemic stroke were 23% (95% CI 0–52%) and 31% (95% CI 20–44%), respectively. These results were broadly consistent for sex, age and region. Total cholesterol is associated with similarly increased risks of cardiovascular events in people with and without diabetes. While abnormal levels of other lipid fractions are frequently observed in people with diabetes, these data support aggressive lowering of total cholesterol and LDL-cholesterol levels for prevention of cardiovascular events.
50 citations
TL;DR: In this paper, the authors evaluated the effects of communication between the central trial coordinators and the clinical sites in the setting of a large international multi-centre clinical trial and found that the additional communication strategy may be of some incremental benefit in helping sites achieve recruitment targets sooner.
27 citations
TL;DR: The AdRem study is designed to provide reliable evidence on the effects of intensive glucose control and blood pressure lowering on both diabetic retinopathy and abnormalities of retinal vasculature in patients with type 2 diabetes mellitus.
23 citations
TL;DR: One of the oldest and most commonly used forms of alternative medicine, acupuncture, has existed for >2500 years and was viewed by practitioners of Western medicine as “the Chinese equivalent of voodoo,” but certain events encouraged wider acceptance of this form of treatment beginning in the 1970s.
Abstract: Blood pressure–related disease remains a major public health problem in developed and developing countries alike. The Global Burden of Disease study estimates 62% of stroke, 49% of ischemic heart disease, and 14% of other cardiovascular disease can be attributable to mean systolic blood pressure levels >115 mm Hg worldwide.1 The mainstay of medical management of hypertension is a number of commonly used drugs,2 the mechanisms of action of which are well understood and grounded in conventional science. However, despite the strength of evidence supporting the efficacy of these agents and their wide endorsement in national and international guidelines, only about one half of those patients in whom treatment is indicated are compliant with drug therapy. Treatment cost, adverse effects, and complexity are commonly cited barriers to patient adherence,3,4 and such factors undoubtedly play an important role in the growing interest in alternative therapies for blood pressure control.
Article p 3121
Acupuncture, one of the oldest and most commonly used forms of alternative medicine, has existed for >2500 years. In traditional acupuncture, fine needles are inserted into precisely defined, specific points on the body, each of which has distinct therapeutic actions.5 For a long time, acupuncture was viewed by practitioners of Western medicine as “the Chinese equivalent of voodoo,”6 but certain events encouraged wider acceptance of this form of treatment beginning in the 1970s. One such event is said to have been President Richard Nixon’s goodwill visit to China in 1972 during which he saw acupuncture in practice. His personal physician subsequently wrote, “I have seen acupuncture work.” This statement not only increased public interest but also encouraged key figures in the medical community to travel to China to develop a …
11 citations
Journal Article•
TL;DR: In traditional acupuncture, fine needles are inserted into precisely defined, specific points on the body, each of which has distinct therapeutic actions as mentioned in this paper, each having distinct therapeutic action has been viewed by practitioners of Western medicine as “the Chinese equivalent of voodoo,” but certain events encouraged wider acceptance of this form of treatment beginning in the 1970s.
Abstract: Blood pressure–related disease remains a major public health problem in developed and developing countries alike. The Global Burden of Disease study estimates 62% of stroke, 49% of ischemic heart disease, and 14% of other cardiovascular disease can be attributable to mean systolic blood pressure levels >115 mm Hg worldwide.1 The mainstay of medical management of hypertension is a number of commonly used drugs,2 the mechanisms of action of which are well understood and grounded in conventional science. However, despite the strength of evidence supporting the efficacy of these agents and their wide endorsement in national and international guidelines, only about one half of those patients in whom treatment is indicated are compliant with drug therapy. Treatment cost, adverse effects, and complexity are commonly cited barriers to patient adherence,3,4 and such factors undoubtedly play an important role in the growing interest in alternative therapies for blood pressure control.
Article p 3121
Acupuncture, one of the oldest and most commonly used forms of alternative medicine, has existed for >2500 years. In traditional acupuncture, fine needles are inserted into precisely defined, specific points on the body, each of which has distinct therapeutic actions.5 For a long time, acupuncture was viewed by practitioners of Western medicine as “the Chinese equivalent of voodoo,”6 but certain events encouraged wider acceptance of this form of treatment beginning in the 1970s. One such event is said to have been President Richard Nixon’s goodwill visit to China in 1972 during which he saw acupuncture in practice. His personal physician subsequently wrote, “I have seen acupuncture work.” This statement not only increased public interest but also encouraged key figures in the medical community to travel to China to develop a …
10 citations
TL;DR: SBP predicted ICHrisk in subjects with cerebrovascular disease, whereas CRP, sVCAM-1, homocysteine, NT-proBNP, and renin did not predict ICH risk, and trends for prediction of ICH Risk by mean LDL particle diameter and large LDL particle concentration are hypothesis generating and require confirmation in larger studies.
Abstract: BackgroundOnly limited data are available for risk factors for intracerebral haemorrhage (ICH) in subjects with established cerebrovascular disease.DesignWe performed a nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). This was a randomized, placebo-controlled trial that established the beneficial effects of blood pressure lowering in 6105 patients with cerebrovascular disease.MethodsEach of 41 subjects who experienced ICH during a mean follow-up of 3.9 years was matched to 1-3 control subjects. Lipoprotein particles and other plasma markers were measured in baseline blood samples from PROGRESS participants.ResultsIn comparison with control subjects, ICH cases had increased mean low-density lipoprotein (LDL) diameter (P=0.04) and increased large LDL particle concentration (P=0.03). The odds ratio (adjusted for regression dilution bias) for ICH risk with 10 mmHg increase in systolic blood pressure (SBP) was 1.45 (95% confidence interval: 1.01...
9 citations
TL;DR: It is concluded that plasma NT-proBNP level, in addition to predicting cardiovascular risk, may provide a measure of risk reduction by blood pressure-lowering therapy.
Abstract: ObjectiveThe plasma amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) level predicted congestive heart failure, myocardial infarction, and ischaemic stroke in participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a placebo-controlled study of the effects of bl
Journal Article•
TL;DR: The safety and efficacy of perindopril–indapamide in lowering blood pressure and of a gliclazide-MR-based regimen in loweringBlood glucose have been established with the completion of a 6-week run-in phase and of more than 4 years of post-randomization follow-up.
Abstract: ObjectivesADVANCE (Action in Diabetes and Vascular Disease – PreterAx and DiamicroN MR Controlled Evaluation) is a large-scale clinical trial designed to investigate the benefits of blood pressure lowering and intensive glucose control in patients with type 2 diabetes mellitus.Methods and participan
Journal Article•