Am Fam Physician. 2004;69(8):2018-2019
CDC Report on Disease Characteristics
The Centers for Disease Control and Prevention (CDC) has released its surveillance summary on chronic disease-related characteristics. “State-Specific Prevalence of Selected Chronic Disease-Related Characteristics—Behavioral Risk Factor Surveillance System, 2001” is available online at:http://www.cdc.gov/mmwr/PDF/ss/ss5208.pdf.
The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, telephone survey of persons 18 years and older. The results of the 2001 survey indicate changes in certain high-risk behaviors from 1991 to 2000.
Among the findings are substantial increases in the prevalence of obesity among adults 20 years and older. From 1991 to 2001, the median prevalence of obesity for all participating states and territories increased from 12.9 percent to 21.6 percent. In 1991, no state had an obesity prevalence of more than 20 percent; in 2001, 37 states had a prevalence of more than 20 percent. Percentage increases in prevalence of obesity, from 1991 to 2001, ranged from 24.9 percent in the District of Columbia to 140.2 percent in New Mexico.
Greater percentages of men than women reported cigarette smoking, binge drinking, and heavy drinking, and were classified as overweight; greater percentages of women reported no leisure-time physical activity.
Comparison of 2001 BRFSS data with 12 targets of the “Healthy People 2010” initiative indicates that, in 2001, no state had met the targets for obesity, cigarette smoking, binge drinking, receiving a fecal occult blood test within the past two years, receiving annual influenza vaccinations, receiving pneumococcal vaccinations, and receiving Papanicolaou (Pap) smear tests. Certain states had already met targets for no leisure-time activity, receiving a sigmoidoscopy or colonoscopy, having blood cholesterol levels checked within the past five years, and receiving a mammogram within the past two years.
BRFSS data in this report indicate that despite certain improvements, persons in a high proportion of U.S. states and territories continue to engage in high-risk behaviors and do not report making sufficient use of preventive health practices. Substantial variations (i.e., by state, sex, age group, and race/ethnicity) in prevalence of behaviors, awareness of medical conditions, and use of preventive services indicate a continued need to monitor these factors at state and local levels and assess progress toward reducing morbidity and mortality.
AHA Guidelines on Cardiovascular Disease
The American Heart Association (AHA) has released new guidelines on the prevention of heart disease and stroke based on a woman's individual cardiovascular health. “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women” appears in the February 10, 2004, issue of Circulation and is available online at:http://circ.ahajour-nals.org/cgi/content/full/109/5/672.
The guidelines describe cardiovascular disease (CVD) as a condition that develops over time and that should be viewed as a continuum, rather than a have-or-have-not condition. According to the new recommendations, the aggressiveness of treatment should be linked to whether a woman has low, intermediate, or high risk of having a myocardial infarction in the next 10 years, based on a standardized scoring method developed by the Framingham Heart Study. Low risk means a woman has a less than 10 percent chance of having a myocardial infarction in the next 10 years, intermediate risk is a 10 to 20 percent chance, and high risk is a greater than 20 percent chance.
Aspirin therapy guidelines illustrate how recommended therapy varies across the three levels of risk. For all high-risk women and for those who have documented cardiovascular disease, aspirin therapy is recommended, but it is not recommended for low-risk women. Among intermediate-risk women, aspirin therapy can be considered as long as blood pressure is controlled and the benefit is likely to outweigh the risk of side effects (e.g., gastrointestinal bleeding or hemorrhagic stroke).
Lifestyle interventions such as smoking cessation, regular physical activity, heart-healthy diet, and weight maintenance were given a strong priority in all women, not only because of their potential to reduce existing CVD, but also because heart-healthy lifestyles may prevent major risk factors from developing.
Angiotensin-converting enzyme inhibitors and beta blockers are recommended for all high-risk women.
The guidelines also include a strong recommendation that high-risk women, even those with low-density lipoprotein cholesterol levels below 100 mg per dL (2.59 mmol per L), receive cholesterol-lowering drugs, preferably statins. Routine statin therapy has not previously been recommended for these women, but recent studies have shown a benefit in this subgroup. The use of niacin and fibrates, other cholesterol-lowering drugs of particular benefit in specific cases, also is discussed.
For stroke prevention, warfarin is recommended for women who have atrial fibrillation and are at intermediate or high risk of embolic stroke. If the use of warfarin is contraindicated in a woman, or if a woman is at low risk for stroke, aspirin therapy should be considered.
Prevention measures in the guidelines, both lifestyle and medical, are divided into classes based on the strength of the recommendation for each level of risk. Class I is the most strongly recommended intervention, followed by Class IIa and IIb. The guidelines also provide information on what not to do, with certain interventions labeled Class III—indicating that an intervention is not useful or may be harmful, or both (e.g., hormone therapy, antioxidant supplements). Another example is aspirin use, which is Class III for low-risk women because the side effects may outweigh the benefits. According to the AHA, until more research is available, it is prudent to wait before recommending aspirin therapy in this group of women.
CDC Information on Ricin
The Centers for Disease Control and Prevention (CDC) has updated its emergency preparedness and response information on ricin, a poison made from the waste material from processing castor beans. The information is available online at:http://www.bt.cdc.gov/agent/ricin/erc9009-86-3.asp.
The biotoxin information includes routes of exposure, such as inhalation, skin contact, and eye contact; symptoms and preventive actions; and measures for first aid.
A fact sheet, appropriate for concerned patients, is available online at:http://www.bt.cdc.gov/agent/ricin/facts.asp.
MRI in Suspected MS
A committee of the American Academy of Neurology has released a report on the use of magnetic resonance imaging (MRI) in patients with suspected multiple sclerosis (MS). The report was published in the September 2003 issue of Neurology and is available online at:http://www.neurology.org/cgi/content/full/61/5/602.
Until recently, confirmation of the diagnosis of MS generally has required two or more distinct events separated in time (generally by more than one month) and involvement of at least two areas of the central nervous system. Alternative diagnoses also must be excluded by laboratory and radiographic tests.
With the advent of MRI techniques, occult disease activity now can be demonstrated in 50 to 80 percent of patients at the time of the first clinical presentation. Prospective studies have shown that the presence of lesions predicts future conversion to clinically definite MS. Among young to middle-aged adults with a clinically isolated syndrome and alternative diagnoses excluded at baseline, more than 80 percent with three or more white-matter lesions on a T2-weighted MRI scan develop clinically definite MS within seven to 10 years. The presence of at least two gadolinium (Gd)-enhancing lesions at baseline and the appearance of new T2 lesions or new Gd enhancement on follow-up scans also are highly predictive of the development of clinically definite MS in the near future.