Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update

Tobe, Sheldon W.; Stone, James A.; Anderson, Todd J.; Bacon, Simon; Cheng, Alice; Daskalopoulou, Stella S.; Ezekowitz, Justin A.; Grégoire, Jean; Gubitz, Gord; Jain, Rahul; Keshavjee, Karim; Lindsay, Patty; L’Abbé, Mary R.; Lau, David C.W.; Leiter, Lawrence A.; O’Meara, Eileen; Pearson, Glen J.; Rabi, Doreen M.; Sherifali, Diana; Selby, Peter; Tu, Jack V.; Wharton, Sean; Walker, Kevin D.; Hua‐Stewart, Diane; Liu, Peter P.

doi:10.1503/cmaj.180194

Cited by 45 publications

(54 citation statements)

References 103 publications

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“…This review has highlighted that various metrics of quality carbohydrates exist, and will resonate differently for consumers depending on their food values and needs. Canada’s position on GI labelling contradicts Canadian expert opinions for the management of diabetes and cardiovascular disease risk since guidelines recommend low-GI dietary patterns [ 92 , 96 ]. A recent study demonstrated that Canadians would be receptive to GI labelling as a tool to destigmatize carbohydrates and assist with choosing healthy carbohydrate foods [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines for the management of diabetes in Canada, Australia, Europe, the UK, and the US acknowledge that low GI dietary patterns can be used to assist with blood glucose management [ 92 , 93 , 94 , 95 ]. In Canada, low glycemic index diets have also been acknowledged as a strategy for the prevention and management for cardiovascular disease [ 96 ].…”

Section: Labelling Foods For Carbohydrate Qualitymentioning

confidence: 99%

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Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods

Marinangeli¹,

Harding

Glenn

et al. 2020

Nutrients

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Dietary carbohydrates are components of healthy foods, but many carbohydrate foods have recently been stigmatized as primary causes of diet-related risk factors for chronic disease. There is an opportunity to enhance efforts within the food landscape to encourage the consumption of higher quality carbohydrate foods. The use of labelling is one strategy that permits consumers to identify healthy carbohydrate foods at the point-of-purchase. This review discusses the regulatory frameworks and examples of associated non-mandatory food labelling claims that are currently employed to highlight healthy carbohydrate foods to consumers. The existing labelling frameworks discussed here align with established measures of carbohydrate quality, such as 1. dietary fibre nutrient content claims and associated dietary fibre-based health claims; 2. the presence of whole carbohydrate foods and ingredients that are intact or reconstituted, such as whole grains; and 3. low glycemic index and glycemic response claims. Standards from Codex Alimentarius, and regulations from Australia and New Zealand, Canada, Europe, and the United States will be used to illustrate the means by which food labelling can be used by consumers to identify quality carbohydrate foods.

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Section: Discussionmentioning

confidence: 99%

Section: Labelling Foods For Carbohydrate Qualitymentioning

confidence: 99%

Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods

Marinangeli¹,

Harding

Glenn

et al. 2020

Nutrients

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show abstract

“…This analysis focused on a cohort of patients with hypertension, as guidelines recommend that tobacco use status should be updated on a regular basis for these patients [8]. Patients were identified as hypertensive if they met the validated definition developed by CPCSSN, which includes a combination of diagnostic codes related to hypertension and antihypertensive medications [9].…”

Section: Samplementioning

confidence: 99%

Methods to improve the quality of smoking records in a primary care EMR database: exploring multiple imputation and pattern-matching algorithms

Garies

Cummings

Quan

et al. 2020

BMC Med Inform Decis Mak

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Background: Primary care electronic medical record (EMR) data are emerging as a useful source for secondary uses, such as disease surveillance, health outcomes research, and practice improvement. These data capture clinical details about patients' health status, as well as behavioural risk factors, such as smoking. While the importance of documenting smoking status in a healthcare setting is recognized, the quality of smoking data captured in EMRs is variable. This study was designed to test methods aimed at improving the quality of patient smoking information in a primary care EMR database. Methods: EMR data from community primary care settings extracted by two regional practice-based research networks in Alberta, Canada were used. Patients with at least one encounter in the previous 2 years (2016-2018) and having hypertension according to a validated definition were included (n = 48,377). Multiple imputation was tested under two different assumptions for missing data (smoking status is missing at random and missing not-atrandom). A third method tested a novel pattern matching algorithm developed to augment smoking information in the primary care EMR database. External validity was examined by comparing the proportions of smoking categories generated in each method with a general population survey. Results: Among those with hypertension, 40.8% (n = 19,743) had either no smoking information recorded or it was not interpretable and considered missing. Those with missing smoking data differed statistically by demographics, clinical features, and type of EMR system used in the clinic. Both multiple imputation methods produced fully complete smoking status information, with the proportion of current smokers estimated at 25.3% (data missing at random) and 12.5% (data missing not-at-random). The pattern-matching algorithm classified 18.2% of patients as current smokers, similar to the population-based survey (18.9%), but still resulted in missing smoking information for 23.6% of patients. The algorithm was estimated to be 93.8% accurate overall, but varied by smoking status category.

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“…Finally, it is important to recommend that patients engage in a multifaceted approach to lower their cardiovascular risk, such as healthy eating, regular physical activity, smoking cessation, healthy weight goals, stress reduction and appropriate blood pressure and lipid control. 3 It is recommended that any patient with cardiovascular risk factors undergo an objective assessment of their cardiovascular risk (e.g., Framingham Risk Score), which can be discussed with the patient to help inform and motivate their approach to lowering their cardiovascular risk. 26…”

Section: Stepwise Approachmentioning

confidence: 99%

“…2 ASA is recommended in patients with established CVD (i.e., secondary prevention). 3 However, the role of ASA in those without CVD (i.e., primary prevention) is less clear. Previous meta-analyses have shown that ASA reduces the risk of cardiovascular events in patients without CVD but also increases the risk of major bleeding.…”

Section: Introductionmentioning

confidence: 99%

Use of low-dose acetylsalicylic acid for cardiovascular disease prevention: A practical, stepwise approach for pharmacists

et al. 2020

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Low-dose acetylsalicylic acid (ASA) is recommended in patients with established cardiovascular disease. However, the role of ASA in those without cardiovascular disease (i.e., primary prevention) is less clear, which has led to discordance among Canadian guidelines. In 2018, 3 double-blind, randomized controlled trials were published that evaluated ASA 100 mg daily versus placebo in patients without established cardiovascular disease. In the ASPREE trial, ASA did not reduce the risk of all-cause death, dementia, or persistent physical disability in patients ≥70 years of age but increased the risk of major bleeding. In the ARRIVE trial, ASA failed to lower the risk of a composite of cardiovascular events but increased any gastrointestinal bleeding in patients at intermediate risk of cardiovascular disease. In the ASCEND trial, ASA significantly reduced the primary composite cardiovascular outcome in patients with diabetes for a number needed to treat of 91 over approximately 7.4 years. Yet major bleeding was increased with ASA for a number needed to harm of 112. Therefore, in most situations, ASA should not be recommended for primary cardiovascular prevention. However, there are additional indications for ASA beyond cardiovascular disease. Thus, a sequential algorithm was developed based on contemporary evidence to help pharmacists determine the suitability of ASA in their patients and play an active role in educating their patients about the potential benefits (or lack thereof) and risks of ASA. Can Pharm J (Ott) 2020;153:xx-xx.

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Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update

Cited by 45 publications

References 103 publications

Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods

Destigmatizing Carbohydrate with Food Labeling: The Use of Non-Mandatory Labelling to Highlight Quality Carbohydrate Foods

Methods to improve the quality of smoking records in a primary care EMR database: exploring multiple imputation and pattern-matching algorithms

Use of low-dose acetylsalicylic acid for cardiovascular disease prevention: A practical, stepwise approach for pharmacists

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