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Differences in practice patterns of family physicians and general internist respondents in managing CVD* risk |
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| Family Physicians (N = 562) |
General Internists (N = 326) |
p-value |
|
|
|
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| Antiplatelet therapy for prevention of myocardial infarction in a 45-year-old asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose |
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|
|
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| Aspirin 100 mg every other day |
0.9% |
0.9% |
< 0.01 |
| Aspirin 81 mg daily |
65.6% |
54.3% |
|
| Aspirin 325 mg daily |
4.8% |
5.8% |
|
| Clopidogrel 75 mg daily |
0.9% |
2.5% |
|
| No antiplatelet therapy** |
27.8% |
36.5% |
|
|
|
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| Dyslipidemia pharmacotherapy recommendation for a 45-year-old asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose |
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|
|
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| Atorvastatin 10 mg every evening |
42.4% |
41.0% |
0.84 |
| Ezetimide 10 mg daily |
2.5% |
4.3% |
|
| Niacin 500 mg twice daily |
3.9% |
3.7% |
|
| No specific therapy for dyslipidemia** |
51.2% |
50.9% |
|
|
|
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| Dietary recommendation (avoiding fat) for a 45-year-old asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose |
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|
|
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| Trans fatty acids** |
62.5% |
61.8% |
0.91 |
| Polyunsaturated fats |
9.6% |
9.2% |
|
| Mono-unsaturated fats |
3.2% |
5.8% |
|
| No specific fat as long as it does not exceed 30% of total intake |
24.6% |
23.1% |
|
|
|
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| LDL Goal for a 50-year-old asymptomatic man, negative family history of premature CHD, BP 170/94 mm Hg, BMI 26 kg/m2, total cholesterol 210 mg/dL, LDL 130 mg/dL, HDL 36 mg/dL, TG 256 mg/dl, Fasting glucose 140 mg/dL, and normal exercise stress test |
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|
|
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| LDL < 130 mg/dl |
11.8% |
12.3% |
0.36 |
| LDL < 100 mg/dl** |
59.0% |
56.0% |
|
| LDL < 70 mg/dl |
29.2% |
31.7% |
|
|
|
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| Hypertension and dyslipidemia management for a new asymptomatic 78-year- old female patient with questionable history of diabetes, BP 159/78 mm Hg, BMI 29 kg/m2, LDL 199 mg/dL, TG 479 mg/dL, and HbA1c of 6.0% |
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|
|
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| Lifestyle and dietary modification |
6.8% |
8.0% |
0.11 |
| Lifestyle and dietary modification and treatment with a thiazide diuretic |
6.6% |
5.2% |
|
| Lifestyle modification and treatment with a statin |
14.9% |
10.2% |
|
| Lifestyle and dietary modification and treatment with both a thiazide diuretic and a statin** |
71.7% |
76.5% |
|
|
|
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| Approach to stress testing for a new asymptomatic 78-year-old female patient with questionable history of diabetes, BP 159/78 mm Hg, BMI 29 kg/m2, LDL 199 mg/dL, TG 479 mg/dL, and HbA1c of 6.0% |
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|
|
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| I would order one as a follow up to today's visit |
39.6% |
33.0% |
0.88 |
| I would order one today and yearly thereafter |
5.6% |
10.5% |
|
| I would order a test if she develops symptoms of chest pain, shortness of breath or atypical angina** |
48.1% |
48.8% |
|
| I would not order a stress test on this elderly woman |
6.7% |
7.7% |
|
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*CVD, cardiovascular disease, CHD, coronary heart disease **Evidence-based guideline choice. T-test was performed comparing the two groups and their responses to the evidence-based guideline choice. | |||
Doroodchi et al. BMC Family Practice 2008 9:42 doi:10.1186/1471-2296-9-42 |
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