Primary Care Audit of Global Risk Management
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 3,015
- 试验地点
- 1
- 主要终点
- The Primary objective of the PARADIGM study is to evaluate the impact of an educational and peer-practice pattern intervention on primary care physician behavior towards global cardiovascular risk prediction in otherwise healthy individuals.
研究概览
简要总结
- Assessing the perception of Canadian Primary Care Physicians towards global cardiovascular risk assessment.
- Correlating physician perceptions to actual practice data, gathered via a retrospective chart audit.
- Evaluating the impact of a prospective educational and peer-practice pattern intervention on future assessment o cardiovascular risk and
- Assessing the role of carotid atherosclerosis assessment(Carotid IMT and plaque) as an adjunct to global risk prediction.
详细描述
The majority of cardiovascular events occur in people with low to intermediate Framingham Risk Score. Despite evidence-based guidelines, the appropriate use of lipid-lowering therapies in this population remains limited and controversial. Strategies to refine risk stratification in primary prevention have been poorly adopted. Dissemination of practice-changing trials and closing the care gap in primary care remain a priority and a challenge. Considerable confusion remains regarding the optimal application of lipid-lowering therapy in primary prevention. Importantly, it remains largely unknown which tools or techniques are used by Canadian primary care physicians to identify global vascular risk, and what barriers exist to implementing risk reduction therapies in such individuals.
For primary prevention of patients with normal levels of LDL-Cholesterol who are at increased risk on the basis of elevated hsCRP, it remains unproven whether statin therapy will effectively reduce vascular event rates. The JUPITER trial was launched in 2003 comparing rosuvastatin with placebo in 18,000 primary prevention patients with LDL-cholesterol of less than 3.36mM who also have an hsCRP of greater than 2 mg/L. This trial has been stopped early due to unequivocal morbidity and mortality benefits in favor of the treatment strategy, and the final results will be available in early November, 2008. JUPITER, once published, will require a major change in physician behavior with respect to screening and treating cardiovascular risk.
研究设计
- 研究类型
- Observational
- 时间视角
- Prospective
入排标准
- 年龄范围
- 40 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Men more than or equal to 40 yrs old and women more than or equal to 50 yrs old;
- •No previous history of atherosclerosis( angina, TIA, myocardial infarction, stroke, peripheral arterial disease);
- •Non-diabetic;
- •Absence of lipid lowering treatment (current or past).
排除标准
- •Known history of atherosclerosis or diabetes;
- •Use of lipid lowering therapies (statins, ezetimibe, fibrates, niacin, fish oil);
- •Use of postmenopausal hormone replacement therapy;
- •Use of immunosuppressant's or steroids;
- •Active liver disease or hepatic dysfunction(ALT>2times the ULN);
- •Active renal disease (baseline Creatinine >170 umol/L);
- •History of malignancy within the past 5-years;
- •Chronic inflammatory conditions such as arthritis, lupus or inflammatory bowel disease;
- •Known alcohol or drug abuse;
- •Failure to provide informed consent.
结局指标
主要结局
The Primary objective of the PARADIGM study is to evaluate the impact of an educational and peer-practice pattern intervention on primary care physician behavior towards global cardiovascular risk prediction in otherwise healthy individuals.
时间窗: 1 year
次要结局
- Evaluate the prevalence of classic and novel markers of risk (hsCRP and ApoB/ApoA1).(1 year)
- Evaluate within a sub-study, the feasibility of carotid atherosclerosis assessment.(1 year)
研究者
Dr. Milan Gupta
MD
Canadian Collaborative Research Network