Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us

Size: px
Start display at page:

Download "Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us"

Transcription

1 Hormones and cardiovascular disease, what the Danish Nurse Cohort learned us Ellen Løkkegaard, Clinical Associate Professor, Ph.d. Dept. Obstetrics and Gynecology. Hillerød Hospital, University of Copenhagen

2 Design: Longitudinal observational study 1993 The Danish Nurse Cohort Study Questionnaire 23,178 female Danish Nurses >44 years Respons n=19,898 (86%) Postmenopausal women n=13,084

3 Design: Longitudinal observational study 1993 Questionnaire 23,178 female Danish Nurses >44 years Respons n=19,898 (86%) Never Users 58% Postmenopausal women n=13,084 HRT Exposure 10% Unopposed Estrogen Past Users 14% Current Users 28% 18% Combined Estrogen+progestin

4 Design: Longitudinal observational study 1993 Questionnaire 23,178 female Danish Nurses >44 years Respons n=19,898 (86%) Postmenopausal women n=13,084 Covariates Smoking Alcohol/week Body mass Index (BMI) Physical activity Hypertension Heart medication Diabetes Metabolic disease Familiar predisposition Self-rated health

5 Design: Longitudinal observational study 1993 Questionnaire National Registers of Hospital Discharges and Death End of 1998 Registers 23,178 female Danish Nurses >44 years Respons n=19,898 (86%) Ischemic Heart Disease - of those MI Stroke n=351 n=108 n=144 Death n=971 Postmenopausal women n=13,084

6 Cox proportional harzard p h(t,x) = h0(t) exp[ Σ βi xi ] i=1 Event Censur End of follow-up Age

7 Hazard ratios (95% confidence intervals) for risk of death, according to use of hormone replacement therapy at baseline BMJ VOLUME FEBRUARY 2003 bmj.com

8 Hazard ratios (95% confidence intervals) for risk of ischemic heart disease and myocardial infarction according to use of hormone replacement therapy at baseline. BMJ VOLUME FEBRUARY 2003 bmj.com

9 Differential effects Hormone exposition Cardiovascular disease Cardiovascular risk-factor, present Confounder Hormone exposition Cardiovascular disease Cardiovascular Confounder risk-factor, not present

10 Ischemic heart disease Kaplan - Meier estimater No diabetes 0.50 Never HT Ever HT 0.25 Diabetes Never HT Ever HT age Løkkegaard, E et al. BMJ 2003;326:426

11 Risk of ischemic heart disease with Hormone Therapy stratified on presence of diabetes Løkkegaard, E et al. BMJ 2003;326:426 Copyright 2003 BMJ Publishing Group Ltd.

12 The Danish Nurse Cohorte vs. literature Cardiovascular disease Stroke Review (Nelson, 2002) The Danish Nurse Cohort The Women s health initiative, JAMA 2002

13 Danish Nurse Cohorte vs. literature Total follow-up due to national registerbased end-point definitions No healthy user bias in the Danish Nurse Cohort study No protective effect from hormone therapy on cardiovascular disease

14 DAnish HOrmone Register Study (DAHORS)

15 DAnish Hormone Register Study (DAHORS)

16 DAnish Hormone Register Study (DAHORS)

17 DAnish Hormone Register Study (DAHORS)

18 National register based observational study 1995 National prescription registry 698,098 healthy women Above 51 years 2,987,068 person years Eur Heart Journal (2008) 29, HT Exposure 18% 8% 74% Never Previous Current

19 National register based observational study Endpoints 1995 National prescription registry 698,098 healthy women Above 51 years 2,987,068 person years Eur Heart Journal (2008) 29, Ult National Patient - and Cause of Death Registry 4947 incident cases of Myocardial infarctions (MI) (ICD I21-I22)

20 National register based observational study Covariates Age 51-54, 55-59, 60-64, Calendar year 1995, 1996, ) Other medications for Hypertension Diabetes Hypercholesterolemia Antiarrhythmics Geographical region Region Education No occupational practice Occupational practice Academic education Unknown Eur Heart Journal (2008) 29,

21 Risk of Myocardial Infarction for women aged Never 0,0 1,0 2,0 1,00 Estrogen 0,94 WHI E 0,95 Continous comb. 1,35 WHI E+P 1,24 Eur Heart Journal (2008) 29,

22 DAHORS versus Never 0,0 1,0 2,0 WHI 1,00 Estrogen 0,94 WHI E 0,95 Continous comb. 1,35 WHI E+P 1,24

23 Modification from concomitant intake of medication for diabetes No, previous 0,0 1,0 2,0 3,0 0,85 Diabetes, previous 1,07 No,current 1,10 P-value for interaction 0.51 Eur Heart Journal (2008) 29, Diabetes,current 1,01

24 Danish Nurse Cohorte vs. DaHoRS The interaction between use of hormone therapy and medication for diabetes and risk of cardiovascular disease found in the Danish Nurse Cohort Study was not retrieved. Mayby there is an unhealthy user bias in the Danish Nurse Cohort study implying nurses having severe diabetes use HT more often. No protective effect from hormone therapy on cardiovascular disease, rather increased risk with combined therapy.

Randomized trials versus observational studies

Randomized trials versus observational studies Randomized trials versus observational studies The case of postmenopausal hormone therapy and heart disease Miguel Hernán Harvard School of Public Health www.hsph.harvard.edu/causal Joint work with James

More information

EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA

EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA A CASE STUDY EXAMINING RISK FACTORS AND COSTS OF UNCONTROLLED HYPERTENSION ISPOR 2013 WORKSHOP

More information

Primary Prevention of Cardiovascular Disease with a Mediterranean diet

Primary Prevention of Cardiovascular Disease with a Mediterranean diet Primary Prevention of Cardiovascular Disease with a Mediterranean diet Alejandro Vicente Carrillo, Brynja Ingadottir, Anne Fältström, Evelyn Lundin, Micaela Tjäderborn GROUP 2 Background The traditional

More information

Quantifying Life expectancy in people with Type 2 diabetes

Quantifying Life expectancy in people with Type 2 diabetes School of Public Health University of Sydney Quantifying Life expectancy in people with Type 2 diabetes Alison Hayes School of Public Health University of Sydney The evidence Life expectancy reduced by

More information

Malmö Preventive Project. Cardiovascular Endpoints

Malmö Preventive Project. Cardiovascular Endpoints Malmö Preventive Project Department of Clinical Sciences Malmö University Hospital Lund University Malmö Preventive Project Cardiovascular Endpoints End of follow-up: 31 Dec 2008 * Report: 21 June 2010

More information

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention Robert B. Wallace, MD, MSc Departments of Epidemiology and Internal Medicine University of Iowa College of Public Health

More information

Malmö Preventive Project. Cardiovascular Endpoints

Malmö Preventive Project. Cardiovascular Endpoints Malmö Preventive Project Department of Clinical Sciences Skåne University Hospital, Malmö Lund University Malmö Preventive Project Cardiovascular Endpoints End of follow-up: 30 June 2009 Report: 7 October

More information

Cardiovascular Endpoints

Cardiovascular Endpoints The Malmö Diet and Cancer Study Department of Clinical Sciences Malmö University Hospital Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 31 Dec * Report:

More information

Cardiovascular Endpoints

Cardiovascular Endpoints The Malmö Diet and Cancer Study Department of Clinical Sciences Skåne University Hospital, Malmö Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 30

More information

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES Niteesh K. Choudhry, MD, PhD Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics

More information

PROMISE & PITFALLS OF OUTCOMES RESEARCH USING EMR DATABASES. Richard L. Tannen, M.D., Mark Weiner, Dawei Xie

PROMISE & PITFALLS OF OUTCOMES RESEARCH USING EMR DATABASES. Richard L. Tannen, M.D., Mark Weiner, Dawei Xie PROMISE & PITFALLS OF OUTCOMES RESEARCH USING EMR DATABASES Richard L. Tannen, M.D., Mark Weiner, Dawei Xie GOALS OF STUDY Determine Whether Studies Using EMR Database Yield Valid Outcome Assessment Major

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

More information

Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study

Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study DOI 10.1007/s00198-012-2224-2 ORIGINAL ARTICLE Health risks and benefits from calcium and vitamin D supplementation: Women's Health Initiative clinical trial and cohort study R. L. Prentice & M. B. Pettinger

More information

The Women s Health Initiative where are we a decade later?

The Women s Health Initiative where are we a decade later? The Women s Health Initiative where are we a decade later? Henry G. Burger MIMR-PHI Institute & Jean Hailes for Women s Health, Melbourne, Australia Disclosures: Henry Burger Sources of Funding Pharmaceutical

More information

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,

More information

With Big Data Comes Big Responsibility

With Big Data Comes Big Responsibility With Big Data Comes Big Responsibility Using health care data to emulate randomized trials when randomized trials are not available Miguel A. Hernán Departments of Epidemiology and Biostatistics Harvard

More information

Postmenopausal hormone replacement therapy (HRT)

Postmenopausal hormone replacement therapy (HRT) Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease Linda L. Humphrey, MD, MPH; Benjamin K.S. Chan, MS; and Harold C. Sox, MD Purpose: To evaluate the value

More information

Swedish Initiative for Research on Microdata in the Social And Medical Sciences

Swedish Initiative for Research on Microdata in the Social And Medical Sciences Swedish Initiative for Research on Microdata in the Social And Medical Sciences www.simsam.nu GOCARTS Kardiovaskulär epidemiologi hjärtinfarkt och stroke www.registerforskning.se GOCARTs (Gothenburg CArdiovascular

More information

Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources

Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources James Floyd, MD, MS Sep 17, 2015 UW Hospital Medicine Faculty Development Program Objectives Become more

More information

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic

More information

Guide to Biostatistics

Guide to Biostatistics MedPage Tools Guide to Biostatistics Study Designs Here is a compilation of important epidemiologic and common biostatistical terms used in medical research. You can use it as a reference guide when reading

More information

STROKE April 2011 Dr Amer Jafar A delay in recognizing early warning signs (WS) and risk factors (RF) of ischemic stroke causes a delay in treatment Evaluated: knowledge of RF and WS and the impact of

More information

Tips for surviving the analysis of survival data. Philip Twumasi-Ankrah, PhD

Tips for surviving the analysis of survival data. Philip Twumasi-Ankrah, PhD Tips for surviving the analysis of survival data Philip Twumasi-Ankrah, PhD Big picture In medical research and many other areas of research, we often confront continuous, ordinal or dichotomous outcomes

More information

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION NEW ENGLAND JOURNAL OF MEDICINE 2011; DOI: 10.

FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION NEW ENGLAND JOURNAL OF MEDICINE 2011; DOI: 10. FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION NEW ENGLAND JOURNAL OF MEDICINE 2011; DOI: 10.1056/NEJMSA1107913 Niteesh K. Choudhry, MD, PhD, 1 Jerry Avorn, MD, 1 Robert J. Glynn,

More information

Prognostic impact of uric acid in patients with stable coronary artery disease

Prognostic impact of uric acid in patients with stable coronary artery disease Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,

More information

Mortality Assessment Technology: A New Tool for Life Insurance Underwriting

Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Guizhou Hu, MD, PhD BioSignia, Inc, Durham, North Carolina Abstract The ability to more accurately predict chronic disease morbidity

More information

Hormone therapy and breast cancer: conflicting evidence. Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group

Hormone therapy and breast cancer: conflicting evidence. Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group Hormone therapy and breast cancer: conflicting evidence Cindy Farquhar Cochrane Menstrual Disorders and Subfertility Group The world of hormone therapy in the 1990 s Throughout the 1970s, 1980s and 1990s

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT?

The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? AACE 23 rd Annual Scientific and Clinical Congress (2014) Syllabus Materials: The WHI 12 Years Later: What Have We Learned about Postmenopausal HRT? JoAnn E. Manson, MD, DrPH, FACP, FACE Chief, Division

More information

Main Effect of Screening for Coronary Artery Disease Using CT

Main Effect of Screening for Coronary Artery Disease Using CT Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,

More information

Using prescription registries to define continuous drug use: How to fill gaps between prescriptions

Using prescription registries to define continuous drug use: How to fill gaps between prescriptions Using prescription registries to define continuous drug use: How to fill gaps between prescriptions Lars Hougaard Nielsen 1,2, MSc Ellen Løkkegaard 3, MD PhD Anne Helms Andreasen 2, MSc Niels Keiding 1,

More information

Impact of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care

Impact of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care Impact of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care Michelle A. Albert MD MPH Treacy S. Silbaugh B.S, John Z. Ayanian MD MPP, Ann Lovett RN

More information

Appendix: Description of the DIETRON model

Appendix: Description of the DIETRON model Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough

More information

Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University

Cohort Studies. Sukon Kanchanaraksa, PhD Johns Hopkins University This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

More information

Incorrect Analyses of Radiation and Mesothelioma in the U.S. Transuranium and Uranium Registries Joey Zhou, Ph.D.

Incorrect Analyses of Radiation and Mesothelioma in the U.S. Transuranium and Uranium Registries Joey Zhou, Ph.D. Incorrect Analyses of Radiation and Mesothelioma in the U.S. Transuranium and Uranium Registries Joey Zhou, Ph.D. At the Annual Meeting of the Health Physics Society July 15, 2014 in Baltimore A recently

More information

Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health

Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Introduction Reader (Statistics and Epidemiology) Research team epidemiologists/statisticians/phd students Primary care

More information

CARDIOVASCULAR PROBLEMS IN SURVIVORS OF CHILDHOOD CANCER AND THEIR SIBLINGS

CARDIOVASCULAR PROBLEMS IN SURVIVORS OF CHILDHOOD CANCER AND THEIR SIBLINGS Swiss Childhood Cancer Registry (SCCR) CARDIOVASCULAR PROBLEMS IN SURVIVORS OF CHILDHOOD CANCER AND THEIR SIBLINGS Julien Caccia, Corina S. Rueegg, Eva-Maria Hau, Nicolas X. von der Weid, Gisela Michel,

More information

Drug discontinuation and switching during the Medicare Part D coverage gap

Drug discontinuation and switching during the Medicare Part D coverage gap Drug discontinuation and switching during the Medicare Part D coverage gap Jennifer M. Polinski, ScD, MPH William H. Shrank, MD, MSHS; Haiden A. Huskamp, PhD; Robert J. Glynn, PhD, ScD; Joshua N. Liberman,

More information

Diabetes Complications

Diabetes Complications Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation

More information

SUPPLEMENTARY MATERIALS. Rivaroxaban for Stroke Prevention in East Asian Patients from the ROCKET AF Trial

SUPPLEMENTARY MATERIALS. Rivaroxaban for Stroke Prevention in East Asian Patients from the ROCKET AF Trial 1 SUPPLEMENTARY MATERIALS Rivaroxaban for Stroke Prevention in East Asian Patients from the ROCKET AF Trial Professor Ka Sing Lawrence Wong on behalf of The Executive Steering Committee and the ROCKET

More information

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal

More information

Bios 6648: Design & conduct of clinical research

Bios 6648: Design & conduct of clinical research Bios 6648: Design & conduct of clinical research Section 1 - Specifying the study setting and objectives 1. Specifying the study setting and objectives 1.0 Background Where will we end up?: (a) The treatment

More information

Safety & Effectiveness of Drug Therapies for Type 2 Diabetes: Are pharmacoepi studies part of the problem, or part of the solution?

Safety & Effectiveness of Drug Therapies for Type 2 Diabetes: Are pharmacoepi studies part of the problem, or part of the solution? Safety & Effectiveness of Drug Therapies for Type 2 Diabetes: Are pharmacoepi studies part of the problem, or part of the solution? IDEG Training Workshop Melbourne, Australia November 29, 2013 Jeffrey

More information

An Application of the G-formula to Asbestos and Lung Cancer. Stephen R. Cole. Epidemiology, UNC Chapel Hill. Slides: www.unc.

An Application of the G-formula to Asbestos and Lung Cancer. Stephen R. Cole. Epidemiology, UNC Chapel Hill. Slides: www.unc. An Application of the G-formula to Asbestos and Lung Cancer Stephen R. Cole Epidemiology, UNC Chapel Hill Slides: www.unc.edu/~colesr/ 1 Acknowledgements Collaboration with David B. Richardson, Haitao

More information

Stage 1 Meaningful Use for Specialists. NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene

Stage 1 Meaningful Use for Specialists. NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene Stage 1 Meaningful Use for Specialists NYC REACH Primary Care Information Project NYC Department of Health & Mental Hygiene 1 Today s Agenda Meaningful Use Overview Meaningful Use Measures Resources Primary

More information

Η δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου

Η δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου ΠΡΟΓΡΑΜΜΑ ΜΕΤΑΠΤΥΧΙΑΚΩΝ ΣΠΟΥΔΩΝ «Η ΔΙΑΤΡΟΦΗ ΣΤΗΝ ΥΓΕΙΑ ΚΑΙ ΣΤΗ ΝΟΣΟ» Η δίαιτα στην πρόληψη του αγγειακού εγκεφαλικού επεισοδίου Γεώργιος Ντάιος Παθολογική Κλινική Πανεπιστημίου Θεσσαλίας Stroke Statistics

More information

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center

More information

COMPRESSION OF MORBIDITY: NEW INSIGHTS IN THE ROLE OF LIFESTYLE FACTORS JOHAN MACKENBACH & WILMA NUSSELDER DEPARTMENT OF PUBLIC HEALTH ERASMUS MC

COMPRESSION OF MORBIDITY: NEW INSIGHTS IN THE ROLE OF LIFESTYLE FACTORS JOHAN MACKENBACH & WILMA NUSSELDER DEPARTMENT OF PUBLIC HEALTH ERASMUS MC COMPRESSION OF MORBIDITY: NEW INSIGHTS IN THE ROLE OF LIFESTYLE FACTORS JOHAN MACKENBACH & WILMA NUSSELDER DEPARTMENT OF PUBLIC HEALTH ERASMUS MC FRIES JF. Aging, natural death, and the compression of

More information

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY

2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:

More information

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly

More information

CASE B1. Newly Diagnosed T2DM in Patient with Prior MI

CASE B1. Newly Diagnosed T2DM in Patient with Prior MI Newly Diagnosed T2DM in Patient with Prior MI 1 Our case involves a gentleman with acute myocardial infarction who is newly discovered to have type 2 diabetes. 2 One question is whether anti-hyperglycemic

More information

A MODEL FOR ISCHAEMIC HEART DISEASE AND STROKE III: APPLICATIONS. By T. Chatterjee, A. S. Macdonald and H. R. Waters. abstract.

A MODEL FOR ISCHAEMIC HEART DISEASE AND STROKE III: APPLICATIONS. By T. Chatterjee, A. S. Macdonald and H. R. Waters. abstract. 1 A MODEL FOR ISCHAEMIC HEART DISEASE AND STROKE III: APPLICATIONS By T. Chatterjee, A. S. Macdonald and H. R. Waters abstract This is the third in a series of three papers. In the first paper we describe

More information

Universität Zürich. Institut für Sozial- und Präventivmedizin

Universität Zürich. Institut für Sozial- und Präventivmedizin The physical environment and cardiovascular mortality David Fäh ) on years 000 pers 325 300 275 (per 100, ality rate CHD mort 250 225 200 175 Men 1500 Circulation.

More information

Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival

Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival Maintenance Steroid Avoidance in Pediatric Heart Transplantation is Associated with Excellent Graft Survival Scott Auerbach, MD, Jane Gralla, PhD, Shelley Miyamoto, MD, David Campbell, MD, and Biagio Pietra,

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

General and Abdominal Adiposity and Risk of Death in Europe

General and Abdominal Adiposity and Risk of Death in Europe Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke General and Abdominal Adiposity and Risk of Death in Europe Tobias Pischon Department of Epidemiology German Institute of Human Nutrition Potsdam-Rehbruecke

More information

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Anders Svensson MD, PhD Head of Global Clinical Development Metabolism, F Hoffmann LaRoche Ltd. Basel, Switzerland Overview of

More information

Design and principal results

Design and principal results International Task Force for Prevention Of Coronary Heart Disease Coronary heart disease and stroke: Risk factors and global risk Slide Kit 1 (Prospective Cardiovascular Münster Heart Study) Design and

More information

DEVELOPING AN ANALYTICAL PLAN

DEVELOPING AN ANALYTICAL PLAN The Fundamentals of International Clinical Research Workshop February 2004 DEVELOPING AN ANALYTICAL PLAN Mario Chen, PhD. Family Health International 1 The Analysis Plan for a Study Summary Analysis Plan:

More information

Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology

Atrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of

More information

New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013

New Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7

More information

Coronary Heart Disease (CHD) Brief

Coronary Heart Disease (CHD) Brief Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs

More information

ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes

ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,

More information

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators

Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University

More information

OUTCOMES RESEARCH USING A LEARNING HEALTH SYSTEM: PROMISE & PITFALLS

OUTCOMES RESEARCH USING A LEARNING HEALTH SYSTEM: PROMISE & PITFALLS OUTCOMES RESEARCH USING A LEARNING HEALTH SYSTEM: PROMISE & PITFALLS Richard L. Tannen, M.D. University of Pennsylvania Perelman School of Medicine KFF director of Medical research u More than a decade

More information

Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires

Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires Hôpitaux Universitaires de Genève Lipides, métabolisme des hydrates de carbonne et maladies cardio-vasculaires Prof. J. Philippe Effect of estrogens on glucose metabolism : Fasting Glucose, HbA1c and C-Peptide

More information

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN)

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN) NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia Produced by: National Cardiovascular Intelligence Network (NCVIN) Date: August 2015 About Public Health England Public Health England

More information

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke

More information

Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer

Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer Linköping University Medical Dissertations No. 1430 Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer Johan Rosell Linköping University, Faculty of Health Sciences

More information

By submitting this essay, I attest that it is my own work, completed in accordance with University regulations. Sudhakar Nuti

By submitting this essay, I attest that it is my own work, completed in accordance with University regulations. Sudhakar Nuti 1 HLTH 230: Global Health: Challenges and Responses Professor Richard Skolnik Teaching Fellow: Nidhi Parekh By submitting this essay, I attest that it is my own work, completed in accordance with University

More information

Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)

Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) open access Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) Christopher E Ramsden, 1,2 Daisy Zamora, 3 Sharon Majchrzak-Hong,

More information

Are We Too Hesitant to Anticoagulate Elderly Patients with Atrial Fibrillation? A risk-benefit analysis Sunny Shah

Are We Too Hesitant to Anticoagulate Elderly Patients with Atrial Fibrillation? A risk-benefit analysis Sunny Shah The American Journal of Medicine June 11, 2014 http://dx.doi.org/10.1016/j.amjmed.2014.05.035 Prior History of Falls and Risk of Outcomes in Atrial Fibrillation: The Loire Valley Atrial Fibrillation Project

More information

Analysis of Population Cancer Risk Factors in National Information System SVOD

Analysis of Population Cancer Risk Factors in National Information System SVOD Analysis of Population Cancer Risk Factors in National Information System SVOD Mužík J. 1, Dušek L. 1,2, Pavliš P. 1, Koptíková J. 1, Žaloudík J. 3, Vyzula R. 3 Abstract Human risk assessment requires

More information

Mediterranean diet: A heart-healthy eating plan Source: mayoclinic.org/mediterranean-diet

Mediterranean diet: A heart-healthy eating plan Source: mayoclinic.org/mediterranean-diet Mediterranean diet: A heart-healthy eating plan Source: mayoclinic.org/mediterranean-diet The heart-healthy Mediterranean is a healthy eating plan based on typical foods and recipes of Mediterranean-style

More information

A Multi-locus Genetic Risk Score for Abdominal Aortic Aneurysm

A Multi-locus Genetic Risk Score for Abdominal Aortic Aneurysm A Multi-locus Genetic Risk Score for Abdominal Aortic Aneurysm Zi Ye, 1 MD, Erin Austin, 1,2 PhD, Daniel J Schaid, 2 PhD, Iftikhar J. Kullo, 1 MD Affiliations: 1 Division of Cardiovascular Diseases and

More information

An Introduction to Medication Adherence

An Introduction to Medication Adherence An Introduction to Medication Adherence Medication Adherence Project (MAP) A project of the Cardiovascular Prevention & Control Program and the Fund for Public Health in New York Drugs don t work in patients

More information

Managing diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ)

Managing diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Managing diabetes in the post-guideline world Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Overview Pathogenesis of T2DM Aims of treatment The place of glycaemic control Strategies to improve glycaemic

More information

Summary ID# 13614. Clinical Study Summary: Study F3Z-JE-PV06

Summary ID# 13614. Clinical Study Summary: Study F3Z-JE-PV06 CT Registry ID# Page 1 Summary ID# 13614 Clinical Study Summary: Study F3Z-JE-PV06 INSIGHTS; INSulin-changing study Intending to Gain patients insights into insulin treatment with patient-reported Health

More information

Diabetes Prevention in Latinos

Diabetes Prevention in Latinos Diabetes Prevention in Latinos Matthew O Brien, MD, MSc Assistant Professor of Medicine and Public Health Northwestern Feinberg School of Medicine Institute for Public Health and Medicine October 17, 2013

More information

The Danish Healthcare System and the Danish Registers

The Danish Healthcare System and the Danish Registers The Danish Healthcare System and the Danish Registers Jens Søndergaard, MD, PhD Professor, family physician, clinical pharmacologist Research Unit for General Practice, Institute of Public Health, University

More information

Le conferme dalla real life superano gli studi registrativi

Le conferme dalla real life superano gli studi registrativi Le conferme dalla real life superano gli studi registrativi E. Gronda, MD, FESC Cardiologyand and Research Unit IRCCS MultiMedicaSesto S. Giovanni CardiovascularDepartment MultiMedicaGroup. Rate (% / yr)

More information

Chapter 3: Review of Literature Stroke

Chapter 3: Review of Literature Stroke Chapter 3: Review of Literature Stroke INTRODUCTION Cerebrovascular accident (also known as stroke) is a serious health problem in the United States and a leading cause of long-term disability. In this

More information

Are Men Losing Their Gonads?

Are Men Losing Their Gonads? Are Men Losing Their Gonads? Andre B. Araujo, Ph.D. Director, Epidemiology New England Research Institutes Watertown, MA 02472 USA aaraujo@neriscience.com NIA R01AG020727 Endocrine Society Annual Meeting

More information

Selected Health Status Indicators DALLAS COUNTY. Jointly produced to assist those seeking to improve health care in rural Alabama

Selected Health Status Indicators DALLAS COUNTY. Jointly produced to assist those seeking to improve health care in rural Alabama Selected Health Status Indicators DALLAS COUNTY Jointly produced to assist those seeking to improve health care in rural Alabama By The Office of Primary Care and Rural Health, Alabama Department of Public

More information

Basic Study Designs in Analytical Epidemiology For Observational Studies

Basic Study Designs in Analytical Epidemiology For Observational Studies Basic Study Designs in Analytical Epidemiology For Observational Studies Cohort Case Control Hybrid design (case-cohort, nested case control) Cross-Sectional Ecologic OBSERVATIONAL STUDIES (Non-Experimental)

More information

Obesity and risk of breast cancer in the WHI clinical trial MS 1895; accepted by JAMA-Oncology

Obesity and risk of breast cancer in the WHI clinical trial MS 1895; accepted by JAMA-Oncology Obesity and risk of breast cancer in the WHI clinical trial MS 1895; accepted by JAMA-Oncology Marian L Neuhouser, PhD, RD WHI Clinical Coordinating Center Fred Hutchinson Cancer Research Center WHI 2015

More information

Renal cell carcinoma and body composition:

Renal cell carcinoma and body composition: Renal cell carcinoma and body composition: Results from a case-control control study Ryan P. Theis, MPH Department of Epidemiology and Biostatistics College of Public Health and Health Professions University

More information

What are confidence intervals and p-values?

What are confidence intervals and p-values? What is...? series Second edition Statistics Supported by sanofi-aventis What are confidence intervals and p-values? Huw TO Davies PhD Professor of Health Care Policy and Management, University of St Andrews

More information

BMJ Open. Secondary Subject Heading: Epidemiology, Public health, Cardiovascular medicine

BMJ Open. Secondary Subject Heading: Epidemiology, Public health, Cardiovascular medicine Waist circumference values equivalent to body mass index points for predicting absolute cardiovascular disease risks among adults in an Aboriginal Australian community: a prospective cohort study. Journal:

More information

HTA OF TRASTUZUMAB IN ADJUVANT TREATMENT FOR HER2 POSITIVE BREAST CANCER

HTA OF TRASTUZUMAB IN ADJUVANT TREATMENT FOR HER2 POSITIVE BREAST CANCER HTA OF TRASTUZUMAB IN ADJUVANT TREATMENT FOR HER2 POSITIVE BREAST CANCER Karianne Johansen, PhD, Senior Advisor, Torbjørn Wisløff, Researcher Inger Natvig Norderhaug, Research Director Norwegian Health

More information

Study Design and Statistical Analysis

Study Design and Statistical Analysis Study Design and Statistical Analysis Anny H Xiang, PhD Department of Preventive Medicine University of Southern California Outline Designing Clinical Research Studies Statistical Data Analysis Designing

More information

Case Study 11: Hormone Replacement Therapy

Case Study 11: Hormone Replacement Therapy Case Study 11: Hormone Replacement Therapy October 2000 Scenario Ann McDonnald is a successful 55 year old business executive She starts her first consult with you by saying I m getting hot flushes It

More information

Occupational heavy lifting and risk of ischemic heart disease and all-cause mortality

Occupational heavy lifting and risk of ischemic heart disease and all-cause mortality Petersen et al. BMC Public Health 2012, 12:1070 RESEARCH ARTICLE Open Access Occupational heavy lifting and risk of ischemic heart disease and all-cause mortality Christina B Petersen 1, Louise Eriksen

More information

Electronic health records to study population health: opportunities and challenges

Electronic health records to study population health: opportunities and challenges Electronic health records to study population health: opportunities and challenges Caroline A. Thompson, PhD, MPH Assistant Professor of Epidemiology San Diego State University Caroline.Thompson@mail.sdsu.edu

More information

Insulin Resistance and PCOS: A not uncommon reproductive disorder

Insulin Resistance and PCOS: A not uncommon reproductive disorder Insulin Resistance and PCOS: A not uncommon reproductive disorder Joyce L. Ross, MSN, CRNP, CS, FNLA, FPCNA Diplomate Accrediation Council for Clinical Lipidology President Preventive Cardiovascular Nurses

More information

Impact of a nurse telephone intervention among high cardiovascular risk health fair participants. Lisa H. Jensen, BSN, RN Colorado Prevention Center

Impact of a nurse telephone intervention among high cardiovascular risk health fair participants. Lisa H. Jensen, BSN, RN Colorado Prevention Center Impact of a nurse telephone intervention among high cardiovascular risk health fair participants Lisa H. Jensen, BSN, RN Colorado Prevention Center Co-authors Bonnie Leaman-Castillo PhD, Behavioral Scientist

More information

HEALTH MANAGEMENT PLAN PROGRAMME

HEALTH MANAGEMENT PLAN PROGRAMME HEALTH MANAGEMENT PLAN PROGRAMME Medical Controls for Referees and Candidates The FIVB believes that Referees and Referees Candidates health is very important therefore in accordance with the Medical and

More information

3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1

3/2/2010 Post CABG R h e bili a i tat on Ahmed Elkerdany Professor o f oof C ardiac Cardiac Surgery Ain Shams University 1 Post CABG Rehabilitation i Ahmed Elkerdany Professor of Cardiac Surgery Ain Shams University 1 Definition Cardiac rehabilitation services are comprehensive, long-term programs involving : medical evaluation.

More information

on behalf of the AUGMENT-HF Investigators

on behalf of the AUGMENT-HF Investigators One Year Follow-Up Results from AUGMENT-HF: A Multicenter Randomized Controlled Clinical Trial of the Efficacy of Left Ventricular Augmentation with Algisyl-LVR in the Treatment of Heart Failure* Douglas

More information

Understanding Diseases and Treatments with Canadian Real-world Evidence

Understanding Diseases and Treatments with Canadian Real-world Evidence Understanding Diseases and Treatments with Canadian Real-world Evidence Real-World Evidence for Successful Market Access WHITEPAPER REAL-WORLD EVIDENCE Generating real-world evidence requires the right

More information