Showing papers by "Bruce Neal published in 2004"

Association of Mean Platelet Volume With Risk of Stroke Among 3134 Individuals With History of Cerebrovascular Disease

Abstract: Background and Purpose— Mean platelet volume (MPV) is positively associated with measures of platelet activity and may be a useful indicator of the risk of vascular events in a variety of patient groups. Methods— The association of MPV with the risk of stroke was assessed in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). All participants had a history of cerebrovascular disease at baseline, and analyses were adjusted for the effects of potential confounders. Results— The study followed 3134 individuals for an average of 3.9 years (mean age, 65 years; 71% male; average MPV, 10.0 fL). Three hundred eighty-three individuals had 402 stroke events, and 160 had major coronary events. MPV was positively associated with the risk of stroke, with an 11% increased relative risk (95% CI, 3% to 19%) of stroke per femtoliter greater MPV. There was no clear association of MPV with the risk of major coronary events (9% decreased relative risk; 95% CI, −23% to 7%). Perindopril did not alter MPV. Con...

Priority medicines for Europe and the world

Abstract: World Health Organization — For the first time, EU countries have more people over 65 years of age than under 15 years of age. Echoing the trend seen in Europe, much of the rest of the world is moving in a similar direction. Priority medicines for Europe and the world 2013 update calls for pharmaceutical researchers to adjust their research and development efforts to account for this shifting demography.

Effects of an Angiotensin-converting Enzyme Inhibitor–based Regimen on Pneumonia Risk

Abstract: Observational studies conducted among Asian populations suggest that the risk of pneumonia is substantially reduced among users of angiotensin-converting enzyme (ACE) inhibitors but not other blood pressure-lowering agents. We conducted analyses of the effects of ACE inhibitor therapy on pneumonia in 6,105 patients with a history of stroke or transient ischemic attack enrolled in a randomized trial conducted in Australasia, Europe, and Asia. Patients were randomly assigned perindopril-based active treatment or placebo. The effects of ACE inhibitors on pneumonia (fatal or nonfatal) were determined from Cox models fitted according to the principle of intention to treat. During a median follow-up of 3.9 years, 261 patients developed pneumonia. Overall, active treatment was associated with a nonsignificant 19% lower risk of pneumonia (95% confidence interval, -3 to 37; p = 0.09) compared with placebo. Active treatment significantly reduced the risk of pneumonia among participants of Asian ethnicity (47%, 14-67%; p = 0.01), with no significant effect among non-Asian participants (5%, -27 to 29%; p = 0.7) (p for homogeneity = 0.04). These findings substantially add to the body of evidence about the effects of these drugs on pneumonia but do not provide the definitive information required to inform clinical decisions about the prevention of pneumonia with ACE inhibitors.

Prevalence and determinants of overweight and obesity in Thai adults: results of the Second National Health Examination Survey.

Abstract: To describe the prevalence of overweight and obesity and examine their relationship with socio-demographic factors in Thai adults. Using data from a cross-sectional survey, the National Health Examination Survey II (NHESII), the authors examined the prevalence of overweight (BMI > or = 25 kg/m2) and obesity (BMI > or = 30 kg/m2) in 3,220 Thai adults aged 20-59 yr. Univariate analyses and Logistic regression models were used to examine the association of overweight and obesity with socio-demographic and behavioral risk factors. The overall age-adjusted prevalence of overweight and obesity were 28.3% and 6.8% respectively, with a higher prevalence for women than for men (overweight: 33.9% vs 19.2% and obesity: 8.8% vs 3.5%). The prevalence of overweight and obesity was greater among older compared to younger people and among residents of urban (34.8% and 9.9%) compared to rural areas (26.4% and 5.9%). The prevalence of overweight and obesity varied by region in line with the level of economic development--Bangkok, Central, North, South and North-East. By using logistic regression analysis, overweight was associated with a number of characteristics as follows: age (per ten years increase) with adjusted Odds Ratio (OR) of 1.3; women 1.4; married 2.2; being a current smoker 0.4, and living in Bangkok and the central region 1.6 (compare to North-East). There was no clear difference in prevalence of overweight and obesity among education levels and type of occupation after controlling for other covariates. In conclusion, women of middle age, married, and living in Bangkok and the Central region, are at greater risk of overweight and obesity. Without effective lifestyle modification programs to curb these physiologic risk factors at population level, it is likely that related disease burden will ensue. Public health surveillance and intervention to modify the risk factors of excessive weight should be implemented.

Reductions in the risks of recurrent stroke in patients with and without diabetes: The PROGRESS Trial

Abstract: Background: Analyses of the risks of stroke were conducted for subjects with and without diabetes, participating in a randomized, double‐blind, placebo‐controlled trial of a perindopril‐based blood pressure lowering regimen in 6105 people with prior stroke or transient ischaemic attack (TIA), followed for a median of 3.9 years. Findings: Seven hundred and sixty‐one patients had diabetes at baseline. Diabetes increased the risk of recurrent stroke by 35% (95% CI 10–65%) principally through an effect on ischaemic stroke (1.53, 95% CI 1.23–1.90). Active treatment reduced blood pressure by 9.5/4.6 mmHg in patients with diabetes and by 8.9/3.9 mmHg in patients without diabetes. The proportional risk reductions achieved for stroke in patients with diabetes, 38% (95% CI 8–58%), and patients without diabetes, 28% (95% CI 16–39%), were not significantly different (p homogeneity = 0.5). The absolute reduction in the risk of recurrent stroke in the patients with diabetes was equivalent to one stroke avoided among ev...

International Collaborative Study of Cardiovascular Disease in Asia: Design, rationale, and preliminary results

Abstract: Objectives The overall objective of the International Collaborative Study of Cardiovascular Disease in Asia (InterASIA) was to estimate the prevalence and distribution of cardiovascular disease risk factors, including hypertension, hypercholesterolemia, diabetes, obesity, cigarette smoking, and physical inactivity, in the general population of both China and Thailand Methods and results A multistage cluster sampling method was used to select a nationally representative sample of 15,838 adults, aged 35-74 years, in China, and 5,350 similarly aged adults in Thailand Data on medical history, cigarette smoking, alcohol consumption, diet, physical activity, and awareness and control of risk factors for cardiovascular disease, were collected Blood pressure, body weight and height, and hip and waist circumferences, were measured using standard methods Fasting blood specimens were collected to measure levels of total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, and creatinine All data were carefully collected by specially trained, experienced observers using standardized methods and a stringent level of quality control The prevalence of self-reported cardiovascular disease in Chinese adults aged 35-74 years was 33% in men and 36% in women (representing 8,147,000 male and 8,270,000 female cases nationally) The prevalence of self-reported cardiovascular disease in Thai adults was 15% in men and 17% in women (representing 184,000 male and 226,000 female cases) Conclusions The InterASIA study provides important information on the current prevalence and control of both cardiovascular disease and its risk factors in the region These findings will be useful for developing national strategies to reduce the large, and increasing, burden of cardiovascular disease in China and Thailand

The PROGRESS trial three years later: time for more action, less distraction.

Abstract: Since the publication of the results of the PROGRESS trial, there has been much comment in the BMJ and elsewhere.1 2 Most of this acknowledges the importance of the findings for the care of patients with cerebrovascular disease. These patients are at high risk of stroke recurrence, and before the trial was completed few interventions had been proved to reduce this risk. Aspirin was known to modestly reduce the risk of recurrence of ischaemic stroke, but no treatment had been shown to reduce the frequently catastrophic recurrence of cerebral haemorrhage. This situation was changed profoundly by the results of PROGRESS, which showed that a simple blood pressure lowering regimen substantially reduced the risks of recurrent stroke,3 disability,4 and cardiac events5 across a broad range of blood pressure levels in patients with either ischaemic or haemorrhagic cerebrovascular disease. PROGRESS was conceived during an era in which many stroke specialists were concerned about possible risks of blood pressure lowering in patients with compromised cerebral circulation. While epidemiological evidence indicated that the lowest blood pressure levels were associated with the lowest risks of stroke recurrence,6 prevailing clinical opinion required us to allow individual doctors the discretion to determine the intensity of the blood pressure lowering regimen they provided to individual patients. …

Resolving the differences between ACE inhibitors and diuretics - ALLHAT and ANBP2

Abstract: The protective effects of blood pressure reduction are clear. However, the choice of antihypertensive drug is less clear. Two trials comparing the effects of ACE inhibitors and diuretics have produced apparently conflicting conclusions. The US Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial reported that diuretic therapy was probably better, while the second Australian National Blood Pressure study suggested that ACE inhibitor-based regimens were superior. On balance, it appears that differences in the design and conduct of these two trials probably explain the differing results. Neither trial provides really compelling evidence for the preferential selection of one drug over the other. Achieving good blood pressure control is probably far more important than the drug with which that control is achieved.