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Biomedical subjects

J P Frolkis

Publications and source records attributed to J P Frolkis.

7 recordsLinked to original sources
PubMed2001

Using the new cholesterol guidelines in everyday practice.

The third Adult Treatment Panel guidelines from the National Cholesterol Education Program, released in May 2001, depart from previous guidelines in several ways. As in previous guidelines, treatment and treatment goals are based not only on lipid levels but also on the patient's risk status. The method for calculating risk, however, has been refined considerably. Patients are classified in the highest-risk group if they have any of these disorders: known coronary artery disease, diabetes mellitus, peripheral vascular disease, abdominal aortic aneurysm, carotid artery disease, or a 10-year risk of a coronary event of more than 20% (as determined by use of a scoring method).

Adult↗
PubMed1999

Screening for cardiovascular disease. Concepts, conflicts, and consensus.

CVD in the United States is prevalent, costly, and disabling. Wherever in the arterial tree atherosclerosis occurs, the process appears to begin in youth, to develop under the influence of the same risk factors, and to be amenable to the same interventions. The relationship between CVD and its associated risk factors is continuous, is graded, and extends below thresholds previously defined as normal. This observation, in turn, is based on an appreciation that in our society, the gap between normal and optimal can be considerable. CVD is a multifactorial process, often related to modifiable lifestyle choices; we focus on any single risk factor to the exclusion of others puts patients in danger. Because risk factors rarely occur in isolation, risk assessment must be as multifactorial as the underlying disease process. By understanding differences between risk factors in terms of the impact of their modification on the underlying disease, targeted interventions become possible that are tailored to the likelihood of an individual patient acquiring CVD. To change the overall prevalence of an epidemic disease such as CVD, however, such a high-risk approach must be applied in concert with a population strategy that seeks to effect smaller degrees of change in the large segment of society that may be at only moderate risk but--because of their great numbers--bears most of the morbidity and mortality of CVD. Finally, despite the remarkable progress that has been made in our understanding of the pathophysiology of CVD and the effectiveness of risk factor modification, significant gaps remain between knowledge and behavior. Fewer than 50% of diabetics are even aware that they have the disease. Only a third of those whose lipid levels qualify them for treatment receive intervention of any kind, including dietary advice. Only 27% of hypertensives have their blood pressure adequately controlled. The potential impact of more vigorous screening practices in the primary care setting on the health of individuals and communities cannot be overstated.

Cardiovascular Diseases↗
PubMed1998

Physician noncompliance with the 1993 National Cholesterol Education Program (NCEP-ATPII) guidelines.

BACKGROUND: We sought to determine the frequency with which physicians follow National Cholesterol Education Program (NCEP-ATPII) guidelines in screening for cardiovascular risk factors and treating hyperlipidemia. METHODS AND RESULTS: We conducted a retrospective chart review on randomly sampled charts of 225 patients admitted to the coronary care unit between January and June 1996. The main outcome measures were rates of physician screening for coronary heart disease risk factors; rates of counseling for cigarette cessation, diet, and exercise; and extent of use of NCEP algorithms for obtaining LDL cholesterol values and treating hypercholesterolemia. Screening rates for interns (who performed best) were: cigarette use (89%), known coronary heart disease (74%), hypertension (68%), hyperlipidemia (59%), family history (56%), diabetes (37%), postmenopausal hormone therapy (11%), and premature menopause (1%). Four percent of smokers were counseled to quit, 14% of patients were referred to dietitians, and 1% were encouraged to exercise. A full lipid panel was obtained in 50% of patients in whom it was indicated on the basis of NCEP criteria. Patients were more likely to receive lipid-lowering treatment if NCEP criteria indicated that they should, but 36% of hospitalized patients and 46% of patients who should have been treated on discharge were not. CONCLUSIONS: Physicians are poorly compliant with NCEP guidelines for risk factor assessment and counseling, even in patients at high risk for coronary heart disease. Physicians follow NCEP-ATPII algorithms for obtaining an LDL value, a key step in evaluating the need for treatment, only 50% of the time. NCEP criteria seem to influence the decision to initiate lipid-lowering therapy, but significant numbers of eligible patients remain untreated.

Aged↗