Cardiovascular risk management of different ethnic groups with type 2 diabetes in primary care in New Zealand

Elley, C Raina; Kenealy, Tim; Robinson, Elizabeth; Bramley, Dale; Selak, Vanessa; Drury, Paul; Kerse, Ngaire; Pearson, Janet; Lay‐Yee, Roy; Arroll, Bruce

doi:10.1016/j.diabres.2007.09.018

Cited by 20 publications

(20 citation statements)

References 24 publications

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“…Hence, levels of treatment in this rural cohort were better than previously published levels of 28% of those with CVD history alone, 26 and 66% in those with diabetes and CVD history. 27 Despite high rates of treatment, further treatment may be necessary to achieve target thresholds for blood pressure and cholesterol.…”

Section: Discussionmentioning

confidence: 99%

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Faatoese

Pitama

Gillies

et al. 2011

Australian and New Zealand Journal of Public Health

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Māori are the indigenous people of New Zealand (NZ), comprising approximately 15% of the national population. A major disparity exists between Māori and non-Māori in cardiovascular mortality, which remains the leading cause of premature death and disability in New Zealand.1,2 Furthermore, recent health statistics indicate that those living in rural areas are worse off than urban New Zealanders, including for prevalence of ischaemic heart disease.3 Rural Māori have a shorter life expectancy than urban Māori, with 1.2 years difference for women and 1.5 years difference for men. 3 The combination of resource accessibility and ethnic disparities may additionally disadvantage rural Māori communities with respect to health outcomes.Recent data on cardiovascular disease (CVD) and its risk factors in Māori has been obtained from mortality or hospital statistics, 1,4 from diagnoses in general practice, 5 and in urban Auckland communities, 6-10 but we lack information about the state of Māori cardiovascular health in rural communities. In addition, disease rates and risk factors in indigenous population groups may be underestimated if these groups do not have equivalent access to health care or CVD screening. This underestimation will occur in studies based on clinical databases. It will also occur in population studies that rely on self-report of doctor-diagnosed conditions, such as the New Zealand Health Survey. Results: Mean age of participants (n=252) was 45.7±0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese.Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes.Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. Conclusions

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Section: Discussionmentioning

confidence: 99%

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Faatoese

Pitama

Gillies

et al. 2011

Australian and New Zealand Journal of Public Health

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“…[9], [10], [11] Despite guidelines, high proportions of those at high cardiovascular risk are not prescribed these preventive medications, particularly in low income countries. [12], [13], [14] Besides relatively low rates of prescribing of recommended medications, long-term adherence to medications is also low, which further compromises the preventive potential of these medications. A 2003 World Health Organisation (WHO) report estimated that less than 50% of those prescribed long-term medications for chronic conditions take their medications regularly.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Tolerability of ‘Polypills’: Meta-Analysis of Randomised Controlled Trials

et al. 2012

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BackgroundTo assess the blood pressure and lipid-lowering efficacy and tolerability of ‘polypills’ used in cardiovascular disease prevention trials.Methodology/Principal FindingsSystematic review and meta-analysis. Search strategy: The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised controlled trials of at least six weeks duration, which compared a ‘polypill’ (that included at least one anti-hypertensive and one lipid-lowering medication) with a placebo (or one active component). Outcome measures: Change from baseline in systolic and diastolic blood pressures, and total and LDL-cholesterol; discontinuation of study medication and reported adverse effects. Of 44 potentially eligible studies, six trials (including 2,218 patients without previous cardiovascular disease) fulfilled the inclusion criteria. Compared with placebo, ‘polypills’ reduced systolic blood pressure by −9.2 mmHg (95% confidence interval (CI): −13.4, −5.0) diastolic blood pressure by −5.0 mmHg (95%CI: −7.4, −2.6), total cholesterol by −1.22 mmol/L (95%CI: −1.60, −0.84) and LDL-cholesterol by −1.02 mmol/L (95%CI: −1.37, −0.67). However, those taking a ‘polypill’ (vs. placebo or component) were more likely to discontinue medication (20% vs 14%) (Odds ratio: 1.5 (95% CI: 1.2, 1.9)). There was no significant difference in reported adverse effects amongst those on a ‘polypill’ (36% vs. 28%) (OR: 1.3 (95%CI: 0.7, 2.5)). There was high statistical heterogeneity in comparisons for blood pressure and lipid-lowering but use of random-effects and quality-effects models produced very similar results.Conclusions/SignificanceCompared with placebo, the ‘polypills’ reduced blood pressure and lipids. Tolerability was lower amongst those on ‘polypills’ than those on placebo or one component, but differences were moderate. Effectiveness trials are needed to help clarify the status of ‘polypills’ in primary care and prevention strategies.

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“…Poorer glycaemic control and higher obesity and smoking rates may also be responsible for the increased progression rate among Maoris. Maori and Pacific people with type 2 diabetes who attended the diabetes annual review in 2004 received similar high rates of appropriate preventive drug therapy for cardiovascular disease and renal disease to NZ Europeans, but their prevalence of smoking, obesity, raised HbA 1c and albuminuria were substantially higher [10]. It was not possible to estimate the impact of these risk factors in the present study since the relevant information is not collected as part of routine retinal screening data collection.…”

Section: Discussionmentioning

confidence: 48%

Ethnic differences in the natural progression of nephropathy among diabetes patients in New Zealand: hospital admission rate for renal complications, and incidence of end-stage renal disease and renal death

et al. 2009

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Cardiovascular risk management of different ethnic groups with type 2 diabetes in primary care in New Zealand

Cited by 20 publications

References 24 publications

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

The Efficacy and Tolerability of ‘Polypills’: Meta-Analysis of Randomised Controlled Trials

Ethnic differences in the natural progression of nephropathy among diabetes patients in New Zealand: hospital admission rate for renal complications, and incidence of end-stage renal disease and renal death

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