KeyArticles#fbgroup Flashcards
Your next patient is Jenny, a 51 year old lady attending for blood results. Her fasting glucose is 5.7mmol/L (102mg/dL), and her OGTT shows a 2 hour reading of 7.8mmol/L (140mg/dL). You discuss her elevated risk of developing diabetes. In your discussion you mention a study published in 2002 looking at diabetes prevention in patients with IGT which included 3 arms; placebo, metformin and lifestyle intervention (with the aim of 150minutes/week of exercise and 7% weight loss). Which of the following statements regarding this trial is correct?
a. Most of the patients in the metformin arm received 850mg per day of metformin
b. The lifestyle intervention included 16 one-on-one sessions with a case manager – these sessions were standardised across all participants
c. The results showed that when compared with placebo, metformin decreased the incidence of diabetes by 31% and the lifestyle intervention decreased incidence of diabetes by 58%
d. The advantage of the lifestyle intervention over metformin was greater in younger persons and those with a higher BMI
Answer: C (Reduction in the incidence of T2DM – NEJM 2002) 84% of metformin group took 850mg BD, 16% took once daily due to side effects. The case manager sessions were flexible, culturally sensitive, and individualised. The advantage of lifestyle interventions over metformin was greater in older persons and those with a lower BMI.
Elsie presents for help with losing weight. She has tried “everything” herself, but has not previously sought help from a health professional for weight loss support. You discuss a primary care-based trial which included a remote behavioural intervention vs in person plus remote behavioural intervention for weight loss support. Which of the following is correct regarding this study?
a. The trial occurred over 2 years, and although weight loss was initially significant in the intervention groups vs controls, the difference was no longer significant at 2 years, suggesting that the weight loss benefits of behavioural interventions alone are not sustainable long term
b. The 2 intervention groups were offered the same levels of contact with health coaches over the 24 month study period
c. Primary care providers played a central role in the behavioural weight loss intervention
d. The percentage of participants at the end of the study whose weight was <5% below their baseline weight was approximately double in the intervention groups compared with controls (41.4 and 38.2% in in-person and remote groups respectively, vs 18.8% in controls)
Answer D: “Comparative effectiveness of weight loss interventions in clinical practice” (NEJM 2011) The changes were significant at the 2 year mark, both for mean weight loss and for loss of 5% or more. The face to face intervention group had more opportunities for contact with health coaches, especially post the first 3 months. PCPs played a supportive role in this study – the bulk of the intervention was performed by health coaches.
With respect to a review article from 2004 regarding the benefits of exercise for the clinically depressed, which of the following is most accurate?
a. Aerobic exercise in many studies appears to be superior in terms of reduction in depression scores
b. When compared to treatment with an SSRI, walking or running 3 times a week was as effective at 16 weeks for depressive symptoms, and at a 10 month follow-up exercise involvement was a predictor of lower depression rates
c. Increased fitness levels are necessary to see positive effects for depression
d. Exercise program characteristics such as intensity and frequency were all associated with reductions in depression, and mode of exercise was important
Answer B: The benefits of exercise for the clinically depressed, 2004) Exercise was equally effective compared with cognitive therapy or both. Fitness gains are not necessary for patients to experience benefits. Exercise program characteristics such as duration, intensity, frequency, and mode of exercise did not moderate the effect. In fact, only the length of the exercise program was a significant moderator, with programs 9 weeks or longer being associated with larger reductions in depression.
In a study of 1,152 patients with established cardiovascular disease enrolled in a Multisite Cardiac Lifestyle Intervention Program, which of the following statements is TRUE?
a. The study compared a 12 week intensive lifestyle program with a “usual care” control group and assessed changes in angina symptoms, coronary risk factors, quality of life and lifestyle behaviours
b. There were no patients who experienced a worsening of their angina symptoms over the 12 week period
c. It can be concluded from this study that the improvements in cardiac risk factors, angina symptoms and quality of life was a direct result of participation in the intensive lifestyle program (consisting of a low fat plant based diet, a tailored exercise program based on an initial exercise test, stress management and group support)
d. At 12 weeks, 74% of patients who reported initial symptoms of angina pectoris no longer had angina, and an additional 9% had improved from limiting to mild angina
Answer D: (Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac Lifestyle Intervention Program, AmJCardiol 2008) There was no control group. Twenty-four patients (3%) who were angina free at baseline reported symptoms of angina at 3 months
With regard to a large, international case-control study looking at potentially modifiable risk factors for acute AMI, which of the following statements are FALSE (choose all that apply)?
a. There were 9 risk factors identified which together accounted for over 90% of the PAR for AMI. The two most important risk factors worldwide were hypertension and smoking
b. Current smoking, hypertension, raised apolipoproteins, diabetes mellitus, abdominal obesity and psychosocial factors were found to be risk factors associated with developing CVD, whilst alcohol, consuming daily fruit and vegetables and regular physical activity (defined as >4 hours per week of moderate or strenuous exercise) were found to be protective
c. The associations found were noted in women and men, young and old, and in all regions of the world
d. BMI had a stronger relationship to AMI than waist:hip ratio
Answer A & D: Interheart Lancet 2004)
- The most important RFs were lipids and smoking.
With regard to a large, international case-control study looking at potentially modifiable risk factors for stroke, which of the following statements are TRUE?
a. 9 risk factors were found, which collectively account for 90% of the PAR for all stroke; these are hypertension, smoking, diabetes mellitus, physical activity, diet, apolipoproteins, abdominal obesity, alcohol and cardiac causes
b. The study found that hypertension had a greater association with haemorrhagic stroke than with ischaemic stroke, whilst smoking, lipids, cardiac causes and diabetes mellitus were more associated with ischaemic stroke
c. It enrolled over 15,000 cases and 14,000 controls over 4 years
d. PAR of all risk factors was 87.1% for ischaemic stroke and 91.5% for haemorrhagic stroke
Answer B: (Interstroke Lancet 2016)
10 RFs were found (not 9) - the above plus psychosocial factors. 13.5K cases and 13K controls over 8 years (the above numbers are from interheart). PAR was the other way around (higher for ischaemic stroke).
