The efficiency of cardiovascular risk assessment: do the right patients get statin treatment?

Objective: To evaluate targeting of statin prescribing for primary prevention to those with high cardiovascular disease (CVD) risk.

Design: Two cohort studies including the general population and initiators of statins aged 35-74 years.

Setting: UK primary care records in the Clinical Practice Research Datalink.

Variability of antibiotic prescribing in patients with chronic obstructive pulmonary disease exacerbations: a cohort study.

Background: The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations.

Method: A cohort of 62,747 patients with COPD was identified from primary care general practices (GP) in England, and linked to hospital admission and death certificate data.

Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study.

Objective: To determine the completeness and diagnostic validity of myocardial infarction recording across four national health record sources in primary care, hospital care, a disease registry, and mortality register.

Design: Cohort study.

Participants: 21 482 patients with acute myocardial infarction in England between January 2003 and March 2009, identified in four prospectively collected, linked electronic health record sources: Clinical Practice Research Datalink (primary care data), Hospital Episode Statistics (hospital admissions), the disease registry MINAP (Myocardial Ischaemia National Audit Project), and the Office for National Statistics mortality register (cause specific mortality data).

The "rule of halves" does not apply in Peru: awareness, treatment, and control of hypertension and diabetes in rural, urban, and rural-to-urban migrants.

Objective: To determine the awareness, treatment, and control of hypertension and diabetes by migration status.

Design: Cross-sectional study, secondary analyses of the PERU MIGRANT study.

Patients: Rural, rural-to-urban migrants, and urban participants.

A review of population-based studies on hypertension in Ghana.

Background: Hypertension is becoming a common health problem worldwide with increasing life expectancy and increasing prevalence of risk factors. Epidemiological data on hypertension in Ghana is necessary to guide policy and develop effective interventions.

Methods: A review of population-based studies on hypertension in Ghana was conducted by a search of the PUBMED database, supplemented by a manual search of bibliographies of the identified articles and through the Ghana Medical Journal.

Influenza-like illness in acute myocardial infarction patients during the winter wave of the influenza A H1N1 pandemic in London: a case-control study.

Objective: To investigate recent respiratory and influenza-like illnesses (ILIs) in acute myocardial infarction patients compared with patients hospitalised for acute non-vascular surgical conditions during the second wave of the 2009 influenza A H1N1 pandemic.

Design: Case-control study.

Setting: Coronary care unit, acute cardiology and acute surgical admission wards in a major teaching hospital in London, UK.

Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: a cohort study.

Background: Herpes zoster is common and has serious consequences, notably post-herpetic neuralgia (PHN). Vaccine efficacy against incident zoster and PHN has been demonstrated in clinical trials, but effectiveness has not been studied in unselected general populations unrestricted by region, full health insurance coverage, or immune status. Our objective was to assess zoster vaccine effectiveness (VE) against incident zoster and PHN in a general population-based setting.

Orlistat and the risk of acute liver injury: self controlled case series study in UK Clinical Practice Research Datalink.

Objective: To measure the association between orlistat and acute liver injury.

Design: Self controlled case series study.

Setting: Population based primary care setting, United Kingdom.

Apolipoprotein E genotype, cardiovascular biomarkers and risk of stroke: systematic review and meta-analysis of 14,015 stroke cases and pooled analysis of primary biomarker data from up to 60,883 individuals.

Background: At the APOE gene, encoding apolipoprotein E, genotypes of the ε2/ε3/ε4 alleles associated with higher LDL-cholesterol (LDL-C) levels are also associated with higher coronary risk. However, the association of APOE genotype with other cardiovascular biomarkers and risk of ischaemic stroke is less clear. We evaluated the association of APOE genotype with risk of ischaemic stroke and assessed whether the observed effect was consistent with the effects of APOE genotype on LDL-C or other lipids and biomarkers of cardiovascular risk.

Juvenile Huntington's disease: a population-based study using the General Practice Research Database.

Background: The juvenile form of Huntington's disease (HD) is a rare disorder. There are no population-based estimates of either its incidence or prevalence in any population in the world. The present study was undertaken to estimate the frequency of juvenile HD in the UK and to examine the range of pharmacological treatments used in its management.

Prevalence of adult Huntington's disease in the UK based on diagnoses recorded in general practice records.

Background And Purpose: The prevalence of Huntington's disease (HD) in the UK is uncertain. Recently, it has been suggested that the prevalence may be substantially greater than previously reported. This study was undertaken to estimate the overall UK prevalence in adults diagnosed with HD, using data from primary care.

The association between Parkinson's disease and anti-epilepsy drug carbamazepine: a case-control study using the UK General Practice Research Database.

Aims: To investigate whether the use of carbamazepine is associated with reduced risk of Parkinson's disease.

Methods: We conducted a population-based, matched case-control study of patients randomly selected from the UK General Research Practice Database. We identified 8549 patients with Parkinson's disease using diagnosis criteria with a positive predictive value of 90%.

Tackling non-communicable diseases in low- and middle-income countries: is the evidence from high-income countries all we need?

Shah Ebrahim and colleagues argue that more research on non-communicable diseases (NCDs) in both high-income countries and low- and middle-income countries can result in mutual benefits and will help better address the growing burden of NCDs.

Comparative efficacy and tolerability of anti-epileptic drugs for refractory focal epilepsy: systematic review and network meta-analysis reveals the need for long term comparator trials.

Aims: To evaluate the comparative efficacy (50% reduction in seizure frequency) and tolerability (premature withdrawal due to adverse events) of anti-epileptic drugs (AEDs) for refractory epilepsy.

Methods: We searched Cochrane Central Register of Controlled Trials (Cochrane Library 2009, issue 2) including Epilepsy Group's specialized register, MEDLINE (1950 to March 2009), EMBASE (1980 to March 2009), and Current Contents Connect (1998 to March 2009) to conduct a systematic review of published studies, developed a treatment network and undertook a network meta-analysis.

Results: Forty-three eligible trials with 6346 patients and 12 interventions, including placebo, contributed to the analysis.

Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database.

Objective: To quantify the association between exposure to higher temperatures and the risk of myocardial infarction at an hourly temporal resolution.

Design: Case-crossover study.

Setting: England and Wales Myocardial Ischaemia National Audit Project (MINAP) database.

Data resource profile: cardiovascular disease research using linked bespoke studies and electronic health records (CALIBER).

The goal of cardiovascular disease (CVD) research using linked bespoke studies and electronic health records (CALIBER) is to provide evidence to inform health care and public health policy for CVDs across different stages of translation, from discovery, through evaluation in trials to implementation, where linkages to electronic health records provide new scientific opportunities. The initial approach of the CALIBER programme is characterized as follows: (i) Linkages of multiple electronic heath record sources: examples include linkages between the longitudinal primary care data from the Clinical Practice Research Datalink, the national registry of acute coronary syndromes (Myocardial Ischaemia National Audit Project), hospitalization and procedure data from Hospital Episode Statistics and cause-specific mortality and social deprivation data from the Office of National Statistics. Current cohort analyses involve a million people in initially healthy populations and disease registries with ∼10(5) patients.

Prescription of antiviral therapy after herpes zoster in general practice: who receives therapy?

Background: Antivirals can accelerate rash healing during an acute zoster episode and can limit the severity and duration of pain. Their use within 7 days of rash onset is recommended among specific patient groups.

Aim: To describe antiviral prescription patterns and patient characteristics associated with antiviral receipt after zoster diagnosis.

Body mass index and self-perception of overweight and obesity in rural, urban and rural-to-urban migrants: PERU MIGRANT study.

Objective: This study aimed to compare self-reported weight and body mass index (BMI) in order to determine discrepancies between subjective and objective obesity-related markers, and possible explanatory factors of overweight and obesity underestimation, in urban, rural and migrant populations.

Materials And Methods: Data from the PERU MIGRANT study, a cross-sectional study, in low-income settings, of urban, migrant (rural-to-urban), and rural groups, including BMI, self-reported weight and socio-demographic indicators were analyzed. Percentage of concurrences between BMI and self-reported weight and Kappa coefficients for inter-rater agreement were calculated.

[Transitions in context: findings related to rural-to-urban migration and chronic non-communicable diseases in Peru].

In order to better understand the emergence of chronic non-communicable diseases in low- and middle-income countries this article seeks to present, in context, different transitional processes which societies and populations are currently undergoing. Relevant factors for specific contexts such as Peru are described, including internal migration, urbanization and profiles of adversity in early life, all of them linked to chronic non-communicable diseases, including obesity and overweight. The capacity-load model, which considers chronic disease risk in adulthood as a function of two generic traits, metabolic capacity and metabolic load, is described.

Polymorphisms in ARMS2/HTRA1 and complement genes and age-related macular degeneration in India: findings from the INDEYE study.

Purpose: Association between genetic variants in complement factor H (CFH), factor B (CFB), component 2 (C2), and in the ARMS2/HTRA1 region with age-related macular degeneration (AMD) comes mainly from studies of European ancestry and case-control studies of late-stage disease. We investigated associations of both early and late AMD with these variants in a population-based study of people aged 60 years and older in India.

Methods: Fundus images were graded using the Wisconsin Age-Related Maculopathy Grading System and participants assigned to one of four mutually exclusive stages based on the worse affected eye (0 = no AMD, 1-3 = early AMD, 4 = late AMD).

Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study.

Background: An association between infections and vascular events has been observed, but the specific effect of influenza and influenza-like illnesses on triggering acute myocardial infarction (AMI) is unclear.

Methods: Episodes of first AMI from 1 January 2003 through 31 July 2009 were identified using linked anonymized electronic medical records from the Myocardial Ischaemia National Audit Project and the General Practice Research Database. Self-controlled case series analysis was used to investigate AMI risks after consultation for acute respiratory infection.

Clopidogrel and interaction with proton pump inhibitors: comparison between cohort and within person study designs.

Objective: To measure the association between use of proton pump inhibitors and a range of harmful outcomes in patients using clopidogrel and aspirin.

Design: Observational cohort study and self controlled case series.

Setting: United Kingdom General Practice Research Database with linked data from the Myocardial Ischaemia National Audit Project (MINAP) and the Office for National Statistics (the cardiovascular disease research using linked bespoke studies and electronic records (CALIBER) collaboration)

Population: 24,471 patients receiving clopidogrel and aspirin.