Miriam E. Tucker

Fewer than half of U.S. children under 6 years of age participated in an immunization information system in 2003, the Centers for Disease Control and Prevention reported.

One of the Healthy People 2010 goals is to increase to at least 95% the proportion of children under 6 years of age who participate in a fully operational, population-based immunization registry. Immunization registries collect data from multiple providers, generate recall and reminder notices, and assess vaccination coverage. An “immunization information system (IIS)” is defined as a registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records.

A 2003 survey of vaccine program managers in 50 states, five cities, and the District of Columbia revealed that approximately 44% of U.S. children under 6 years of age participated in an IIS, the CDC said (MMWR 2005;54:722–4).

Nine of the regions—Arkansas, Arizona, Delaware, the District of Columbia, Michigan, New York City, North Dakota, Oregon, and San Antonio—had achieved the 2010 goal of at least 95% participation of children less than 6 years of age. An additional eight were approaching the national objective, with participation of 81%–94%.

Nationwide, 76% of public vaccination provider sites and 36% of private provider sites submitted immunization data to an IIS during the last 6 months of 2003. Twenty-five of the 56 regions reported that 95% or more of public provider sites submitted data to an IIS, while only five reported that 95% or more of private sites had done so.

A substantial number of the respondents reported linkages between an IIS and other information systems or entities, a process which enables data consolidation. Among them were 22 reporting electronic data sharing with a Medicaid Management Information System, 36 reporting data linkages with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 26 reporting IIS data access by health plans.

Such linkages are expected to result in more comprehensive immunization histories, increased coverage levels, better support for outbreak containment, and decreased costs associated with overimmunization, as well as improved program effectiveness and efficiency, the CDC said.

Current efforts are being aimed at developing nationwide data standards, which will be essential for system interoperability, according to the report.

Fewer than half of U.S. children under 6 years of age participated in an immunization information system in 2003, the Centers for Disease Control and Prevention reported.

One of the Healthy People 2010 goals is to increase to at least 95% the proportion of children under 6 years of age who participate in a fully operational, population-based immunization registry. Immunization registries collect data from multiple providers, generate recall and reminder notices, and assess vaccination coverage. An “immunization information system (IIS)” is defined as a registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records.

A 2003 survey of vaccine program managers in 50 states, five cities, and the District of Columbia revealed that approximately 44% of U.S. children under 6 years of age participated in an IIS, the CDC said (MMWR 2005;54:722–4).

Nine of the regions—Arkansas, Arizona, Delaware, the District of Columbia, Michigan, New York City, North Dakota, Oregon, and San Antonio—had achieved the 2010 goal of at least 95% participation of children less than 6 years of age. An additional eight were approaching the national objective, with participation of 81%–94%.

Nationwide, 76% of public vaccination provider sites and 36% of private provider sites submitted immunization data to an IIS during the last 6 months of 2003. Twenty-five of the 56 regions reported that 95% or more of public provider sites submitted data to an IIS, while only five reported that 95% or more of private sites had done so.

A substantial number of the respondents reported linkages between an IIS and other information systems or entities, a process which enables data consolidation. Among them were 22 reporting electronic data sharing with a Medicaid Management Information System, 36 reporting data linkages with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 26 reporting IIS data access by health plans.

Such linkages are expected to result in more comprehensive immunization histories, increased coverage levels, better support for outbreak containment, and decreased costs associated with overimmunization, as well as improved program effectiveness and efficiency, the CDC said.

Current efforts are being aimed at developing nationwide data standards, which will be essential for system interoperability, according to the report.

Fewer than half of U.S. children under 6 years of age participated in an immunization information system in 2003, the Centers for Disease Control and Prevention reported.

One of the Healthy People 2010 goals is to increase to at least 95% the proportion of children under 6 years of age who participate in a fully operational, population-based immunization registry. Immunization registries collect data from multiple providers, generate recall and reminder notices, and assess vaccination coverage. An “immunization information system (IIS)” is defined as a registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records.

A 2003 survey of vaccine program managers in 50 states, five cities, and the District of Columbia revealed that approximately 44% of U.S. children under 6 years of age participated in an IIS, the CDC said (MMWR 2005;54:722–4).

Nine of the regions—Arkansas, Arizona, Delaware, the District of Columbia, Michigan, New York City, North Dakota, Oregon, and San Antonio—had achieved the 2010 goal of at least 95% participation of children less than 6 years of age. An additional eight were approaching the national objective, with participation of 81%–94%.

Nationwide, 76% of public vaccination provider sites and 36% of private provider sites submitted immunization data to an IIS during the last 6 months of 2003. Twenty-five of the 56 regions reported that 95% or more of public provider sites submitted data to an IIS, while only five reported that 95% or more of private sites had done so.

A substantial number of the respondents reported linkages between an IIS and other information systems or entities, a process which enables data consolidation. Among them were 22 reporting electronic data sharing with a Medicaid Management Information System, 36 reporting data linkages with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 26 reporting IIS data access by health plans.

Such linkages are expected to result in more comprehensive immunization histories, increased coverage levels, better support for outbreak containment, and decreased costs associated with overimmunization, as well as improved program effectiveness and efficiency, the CDC said.

Current efforts are being aimed at developing nationwide data standards, which will be essential for system interoperability, according to the report.

Hispanic women and those who receive prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the CDC began analyzing rates of universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based monthly mail/telephone survey of randomly selected women in the state who have recently delivered a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005:54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department, and lack of prenatal HIV testing. Those same factors also were associated with lack of knowledge of GBS screening, along with black race, other race, and Medicaid payment of delivery.

Hispanic women and those who receive prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the CDC began analyzing rates of universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based monthly mail/telephone survey of randomly selected women in the state who have recently delivered a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005:54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department, and lack of prenatal HIV testing. Those same factors also were associated with lack of knowledge of GBS screening, along with black race, other race, and Medicaid payment of delivery.

Hispanic women and those who receive prenatal care at a hospital or clinic were less likely to be screened for group B streptococcus in North Carolina during 2002–2003, the Centers for Disease Control and Prevention reported.

In 2002, the CDC began analyzing rates of universal prenatal screening for vaginal and rectal group B streptococcus (GBS) colonization at 35–37 weeks' gestation in the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based monthly mail/telephone survey of randomly selected women in the state who have recently delivered a live-born infant.

The data comprise responses from 3,027 women who were included in the sample. In 2002, 70% reported having been tested for GBS during their most recent pregnancy, 11% said they had not been tested, and 19% did not know whether they had been tested. In 2003, those proportions were 74%, 8%, and 18%, respectively, the CDC reported (MMWR 2005:54:700–3).

Among the women who knew their GBS status, the factors significantly associated with lack of prenatal screening on multivariate analysis were Hispanic ethnicity, receipt of prenatal care primarily at a hospital clinic or health department, and lack of prenatal HIV testing. Those same factors also were associated with lack of knowledge of GBS screening, along with black race, other race, and Medicaid payment of delivery.

WASHINGTON — A serum 25-hydroxyvitamin D level below 30 ng/mL appears to define vitamin D deficiency, Paraskevi Sapountzi, M.D., reported at the annual meeting of the American Association of Clinical Endocrinologists.

Vitamin D deficiency can lead to secondary hyperparathyroidism, decreased calcium absorption, and poor response to therapy. But recent reports of assay variability have led to confusion about interpretation of the metabolite 25(OH)D levels, and not enough data are available to guide clinicians regarding when to initiate vitamin D therapy, said Dr. Sapountzi, of Loyola University, Chicago.

In a retrospective analysis of 143 female and 20 male patients who had been evaluated for low bone mass at the university's Osteoporosis and Metabolic Bone Disease Center, the patients had a mean age of 62.5 years, a mean 25(OH)D level of 29.8 ng/mL, a mean parathyroid hormone (PTH) level of 61.7 pg/mL, a mean urine calcium level of 215.7 mg/24 hours, and a mean spine T score of −1.9. None of the patients were on vitamin D therapy or had primary hyperparathyroidism, Dr. Sapountzi said.

Initially, vitamin D insufficiency was defined as a 25(OH)D level of less than 20 ng/mL, based on the laboratory's reference range and data from one study suggesting that 20 ng/mL represents the cutoff below which the risk for secondary hyperparathyroidism increases. Using that definition, 26.4% of the 163 patients had vitamin D insufficiency.

The 25(OH)D level was significantly correlated with PTH and with urinary calcium, with the difference between the means of PTH above and below a 25(OH)D level of 30 ng/mL being significant. At 35 ng/mL, the significance was lost. Using the new cutoff of 30 ng/mL for vitamin D deficiency raised the prevalence among the patients to 48%, she said.

A 25(OH)D level of 30 ng/mL also showed significant differences in the urinary calcium levels of patients with 25(OH)D above and below that threshold. This relationship also was significant at 35 ng/mL and was lost at 40 ng/mL.

The strong correlation between urinary calcium, PTH, and 25(OH)D emphasizes the importance of this test in the work-up of osteoporosis, she remarked.

WASHINGTON — A serum 25-hydroxyvitamin D level below 30 ng/mL appears to define vitamin D deficiency, Paraskevi Sapountzi, M.D., reported at the annual meeting of the American Association of Clinical Endocrinologists.

Vitamin D deficiency can lead to secondary hyperparathyroidism, decreased calcium absorption, and poor response to therapy. But recent reports of assay variability have led to confusion about interpretation of the metabolite 25(OH)D levels, and not enough data are available to guide clinicians regarding when to initiate vitamin D therapy, said Dr. Sapountzi, of Loyola University, Chicago.

In a retrospective analysis of 143 female and 20 male patients who had been evaluated for low bone mass at the university's Osteoporosis and Metabolic Bone Disease Center, the patients had a mean age of 62.5 years, a mean 25(OH)D level of 29.8 ng/mL, a mean parathyroid hormone (PTH) level of 61.7 pg/mL, a mean urine calcium level of 215.7 mg/24 hours, and a mean spine T score of −1.9. None of the patients were on vitamin D therapy or had primary hyperparathyroidism, Dr. Sapountzi said.

Initially, vitamin D insufficiency was defined as a 25(OH)D level of less than 20 ng/mL, based on the laboratory's reference range and data from one study suggesting that 20 ng/mL represents the cutoff below which the risk for secondary hyperparathyroidism increases. Using that definition, 26.4% of the 163 patients had vitamin D insufficiency.

The 25(OH)D level was significantly correlated with PTH and with urinary calcium, with the difference between the means of PTH above and below a 25(OH)D level of 30 ng/mL being significant. At 35 ng/mL, the significance was lost. Using the new cutoff of 30 ng/mL for vitamin D deficiency raised the prevalence among the patients to 48%, she said.

A 25(OH)D level of 30 ng/mL also showed significant differences in the urinary calcium levels of patients with 25(OH)D above and below that threshold. This relationship also was significant at 35 ng/mL and was lost at 40 ng/mL.

The strong correlation between urinary calcium, PTH, and 25(OH)D emphasizes the importance of this test in the work-up of osteoporosis, she remarked.

WASHINGTON — A serum 25-hydroxyvitamin D level below 30 ng/mL appears to define vitamin D deficiency, Paraskevi Sapountzi, M.D., reported at the annual meeting of the American Association of Clinical Endocrinologists.

Vitamin D deficiency can lead to secondary hyperparathyroidism, decreased calcium absorption, and poor response to therapy. But recent reports of assay variability have led to confusion about interpretation of the metabolite 25(OH)D levels, and not enough data are available to guide clinicians regarding when to initiate vitamin D therapy, said Dr. Sapountzi, of Loyola University, Chicago.

In a retrospective analysis of 143 female and 20 male patients who had been evaluated for low bone mass at the university's Osteoporosis and Metabolic Bone Disease Center, the patients had a mean age of 62.5 years, a mean 25(OH)D level of 29.8 ng/mL, a mean parathyroid hormone (PTH) level of 61.7 pg/mL, a mean urine calcium level of 215.7 mg/24 hours, and a mean spine T score of −1.9. None of the patients were on vitamin D therapy or had primary hyperparathyroidism, Dr. Sapountzi said.

Initially, vitamin D insufficiency was defined as a 25(OH)D level of less than 20 ng/mL, based on the laboratory's reference range and data from one study suggesting that 20 ng/mL represents the cutoff below which the risk for secondary hyperparathyroidism increases. Using that definition, 26.4% of the 163 patients had vitamin D insufficiency.

The 25(OH)D level was significantly correlated with PTH and with urinary calcium, with the difference between the means of PTH above and below a 25(OH)D level of 30 ng/mL being significant. At 35 ng/mL, the significance was lost. Using the new cutoff of 30 ng/mL for vitamin D deficiency raised the prevalence among the patients to 48%, she said.

A 25(OH)D level of 30 ng/mL also showed significant differences in the urinary calcium levels of patients with 25(OH)D above and below that threshold. This relationship also was significant at 35 ng/mL and was lost at 40 ng/mL.

The strong correlation between urinary calcium, PTH, and 25(OH)D emphasizes the importance of this test in the work-up of osteoporosis, she remarked.

WASHINGTON — More than half of North American women receiving treatment for osteoporosis have suboptimal serum vitamin D levels, Anne E. de Papp, M.D., and her associates reported in a poster at the annual meeting of the American Association of Clinical Endocrinologists.

Inadequate vitamin D concentrations can lead to alterations in calcium and phosphate homeostasis, secondary hypoparathyroidism, bone loss, osteoporosis, and an increased fracture risk.

Yet, data from a cross-sectional study of 1,536 postmenopausal women seen at 61 North American sites suggest that the problem is often overlooked in patients being treated for osteoporosis, said Dr. de Papp, of Merck & Co. Inc., West Point, Pa., and her associates.

The patients had a mean age of 71 years (range, 47–103 years) and a mean BMI of 26.4 kg/m

Vitamin D supplementation at a dosage of 400 IU/day or more was reported by 59.5% of the women, while the rest were taking less.

For the entire group, the mean serum level of the active vitamin D metabolite 25-hydroxyvitamin D was 30.4 ng/mL. Most of the women (52%) had levels below 30 ng/mL, considered the minimum concentration necessary to maintain optimal serum parathyroid hormone levels (Osteoporos. Int. 1997;7:439–43), while 36% had 25-hydroxyvitamin D levels below 25 ng/mL, and 18% were below 20 ng/mL.

Suboptimal 25-hydroxyvitamin D concentrations were found in 63% of women taking less than 400 IU/day of vitamin D, compared with 45% of those receiving 400 IU or more per day. Other significant risk factors for vitamin D inadequacy were having less than a 12th grade education, no discussion about vitamin D supplementation with a physician, lack of exercise, concomitant medication use, BMI of 30 or higher, nonwhite race, and age over 80 years.

The study was funded by Merck.

WASHINGTON — More than half of North American women receiving treatment for osteoporosis have suboptimal serum vitamin D levels, Anne E. de Papp, M.D., and her associates reported in a poster at the annual meeting of the American Association of Clinical Endocrinologists.

Inadequate vitamin D concentrations can lead to alterations in calcium and phosphate homeostasis, secondary hypoparathyroidism, bone loss, osteoporosis, and an increased fracture risk.

Yet, data from a cross-sectional study of 1,536 postmenopausal women seen at 61 North American sites suggest that the problem is often overlooked in patients being treated for osteoporosis, said Dr. de Papp, of Merck & Co. Inc., West Point, Pa., and her associates.

The patients had a mean age of 71 years (range, 47–103 years) and a mean BMI of 26.4 kg/m

Vitamin D supplementation at a dosage of 400 IU/day or more was reported by 59.5% of the women, while the rest were taking less.

For the entire group, the mean serum level of the active vitamin D metabolite 25-hydroxyvitamin D was 30.4 ng/mL. Most of the women (52%) had levels below 30 ng/mL, considered the minimum concentration necessary to maintain optimal serum parathyroid hormone levels (Osteoporos. Int. 1997;7:439–43), while 36% had 25-hydroxyvitamin D levels below 25 ng/mL, and 18% were below 20 ng/mL.

Suboptimal 25-hydroxyvitamin D concentrations were found in 63% of women taking less than 400 IU/day of vitamin D, compared with 45% of those receiving 400 IU or more per day. Other significant risk factors for vitamin D inadequacy were having less than a 12th grade education, no discussion about vitamin D supplementation with a physician, lack of exercise, concomitant medication use, BMI of 30 or higher, nonwhite race, and age over 80 years.

The study was funded by Merck.

WASHINGTON — More than half of North American women receiving treatment for osteoporosis have suboptimal serum vitamin D levels, Anne E. de Papp, M.D., and her associates reported in a poster at the annual meeting of the American Association of Clinical Endocrinologists.

Inadequate vitamin D concentrations can lead to alterations in calcium and phosphate homeostasis, secondary hypoparathyroidism, bone loss, osteoporosis, and an increased fracture risk.

Yet, data from a cross-sectional study of 1,536 postmenopausal women seen at 61 North American sites suggest that the problem is often overlooked in patients being treated for osteoporosis, said Dr. de Papp, of Merck & Co. Inc., West Point, Pa., and her associates.

The patients had a mean age of 71 years (range, 47–103 years) and a mean BMI of 26.4 kg/m

Vitamin D supplementation at a dosage of 400 IU/day or more was reported by 59.5% of the women, while the rest were taking less.

For the entire group, the mean serum level of the active vitamin D metabolite 25-hydroxyvitamin D was 30.4 ng/mL. Most of the women (52%) had levels below 30 ng/mL, considered the minimum concentration necessary to maintain optimal serum parathyroid hormone levels (Osteoporos. Int. 1997;7:439–43), while 36% had 25-hydroxyvitamin D levels below 25 ng/mL, and 18% were below 20 ng/mL.

Suboptimal 25-hydroxyvitamin D concentrations were found in 63% of women taking less than 400 IU/day of vitamin D, compared with 45% of those receiving 400 IU or more per day. Other significant risk factors for vitamin D inadequacy were having less than a 12th grade education, no discussion about vitamin D supplementation with a physician, lack of exercise, concomitant medication use, BMI of 30 or higher, nonwhite race, and age over 80 years.

The study was funded by Merck.

Fewer than half of U.S. children under 6 years of age participated in an immunization information system in 2003, the Centers for Disease Control and Prevention reported.

One of the Healthy People 2010 goals is to increase to at least 95% the proportion of children under 6 years of age who participate in a fully operational, population-based immunization registry. Immunization registries collect data from multiple providers, generate recall and reminder notices, and assess vaccination coverage. An “immunization information system (IIS)” is defined as a registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records.

A 2003 survey of vaccine program managers in 50 states, five cities, and the District of Columbia revealed that approximately 44% of U.S. children under 6 years of age participated in an IIS (MMWR 2005;54:722–4). Nine of the regions—Arkansas, Arizona, Delaware, the District of Columbia, Michigan, New York City, North Dakota, Oregon, and San Antonio—had achieved the 2010 goal of at least 95% participation of children less than 6 years of age. An additional eight approached the 81%–94% objective.

Nationwide, 76% of public vaccination provider sites and 36% of private provider sites submitted immunization data to an IIS during the last 6 months of 2003. Twenty-five of the 56 regions reported that 95% or more of public provider sites submitted data to an IIS, while only five reported that 95% or more of private sites had done so.

A substantial number of the respondents reported linkages between an IIS and other information systems or entities, a process which enables data consolidation. Among them were 22 reporting electronic data sharing with a Medicaid Management Information System, 36 reporting data linkages with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 26 reporting IIS data access by health plans.

Such linkages are expected to result in more complete immunization histories, increased coverage levels, better support for outbreak containment, and decreased costs associated with overimmunization, as well as improved program effectiveness and efficiency, the CDC said. Efforts are being made to develop nationwide data standards, according to the report.

Fewer than half of U.S. children under 6 years of age participated in an immunization information system in 2003, the Centers for Disease Control and Prevention reported.

One of the Healthy People 2010 goals is to increase to at least 95% the proportion of children under 6 years of age who participate in a fully operational, population-based immunization registry. Immunization registries collect data from multiple providers, generate recall and reminder notices, and assess vaccination coverage. An “immunization information system (IIS)” is defined as a registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records.

A 2003 survey of vaccine program managers in 50 states, five cities, and the District of Columbia revealed that approximately 44% of U.S. children under 6 years of age participated in an IIS (MMWR 2005;54:722–4). Nine of the regions—Arkansas, Arizona, Delaware, the District of Columbia, Michigan, New York City, North Dakota, Oregon, and San Antonio—had achieved the 2010 goal of at least 95% participation of children less than 6 years of age. An additional eight approached the 81%–94% objective.

Nationwide, 76% of public vaccination provider sites and 36% of private provider sites submitted immunization data to an IIS during the last 6 months of 2003. Twenty-five of the 56 regions reported that 95% or more of public provider sites submitted data to an IIS, while only five reported that 95% or more of private sites had done so.

A substantial number of the respondents reported linkages between an IIS and other information systems or entities, a process which enables data consolidation. Among them were 22 reporting electronic data sharing with a Medicaid Management Information System, 36 reporting data linkages with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 26 reporting IIS data access by health plans.

Such linkages are expected to result in more complete immunization histories, increased coverage levels, better support for outbreak containment, and decreased costs associated with overimmunization, as well as improved program effectiveness and efficiency, the CDC said. Efforts are being made to develop nationwide data standards, according to the report.

Fewer than half of U.S. children under 6 years of age participated in an immunization information system in 2003, the Centers for Disease Control and Prevention reported.

One of the Healthy People 2010 goals is to increase to at least 95% the proportion of children under 6 years of age who participate in a fully operational, population-based immunization registry. Immunization registries collect data from multiple providers, generate recall and reminder notices, and assess vaccination coverage. An “immunization information system (IIS)” is defined as a registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records.

A 2003 survey of vaccine program managers in 50 states, five cities, and the District of Columbia revealed that approximately 44% of U.S. children under 6 years of age participated in an IIS (MMWR 2005;54:722–4). Nine of the regions—Arkansas, Arizona, Delaware, the District of Columbia, Michigan, New York City, North Dakota, Oregon, and San Antonio—had achieved the 2010 goal of at least 95% participation of children less than 6 years of age. An additional eight approached the 81%–94% objective.

Nationwide, 76% of public vaccination provider sites and 36% of private provider sites submitted immunization data to an IIS during the last 6 months of 2003. Twenty-five of the 56 regions reported that 95% or more of public provider sites submitted data to an IIS, while only five reported that 95% or more of private sites had done so.

A substantial number of the respondents reported linkages between an IIS and other information systems or entities, a process which enables data consolidation. Among them were 22 reporting electronic data sharing with a Medicaid Management Information System, 36 reporting data linkages with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 26 reporting IIS data access by health plans.

Such linkages are expected to result in more complete immunization histories, increased coverage levels, better support for outbreak containment, and decreased costs associated with overimmunization, as well as improved program effectiveness and efficiency, the CDC said. Efforts are being made to develop nationwide data standards, according to the report.

SAN DIEGO — Diabetic retinopathy can occur in people who do not yet have diabetes, Richard Hamman, M.D., reported at the annual scientific sessions of the American Diabetes Association.

The incongruous finding, among patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) who had participated in the Diabetes Prevention Program (DPP), suggests that the current cutoffs used to diagnose diabetes may need to be revised, said Dr. Hamman, professor and chair of the department of preventive medicine and biometrics at the University of Colorado, Denver.

More patients will need to be studied to determine whether the retinal lesions found in these “prediabetic” individuals represent early diabetic changes or perhaps are more indicative of arteriolar changes in people who are at risk for atherosclerotic vascular disease in general. Still, the finding does suggest that “a good retinal exam during the transition from prediabetes to early diabetes is important,” Dr. Hamman said at a press briefing at the ADA meeting.

Little is known about exactly when retinopathy develops in patients with type 2 diabetes, because the diagnosis often lags years behind the actual onset of high blood sugar. The DPP, which followed 3,234 high-risk individuals at 6-month intervals, afforded a unique opportunity to date precisely the development of retinopathy in relation to diabetes onset, he noted.

At a mean of 5.5 years between randomization in DPP and the taking of retinal photos, retinopathy of any degree was found in 15% of the 301 who developed diabetes during the trial and in 10% of 585 who did not. Retinopathy of grade 20 or higher—considered more indicative of true diabetes-related changes—was found in 12.5% of those with diabetes of short duration and in 8% of those who remained as IGT or IFG.

Similarly, the proportions who had only microaneurysms were 11% and 7%, respectively. Moderate nonproliferative diabetic retinopathy was detected in 2% of those who did not meet the criteria for diabetes during the trial and in 1% of those who did, a nonsignificant difference that nonetheless follows the same trend.

These data also show that retinopathy may appear far earlier in the course of diabetes than was previously thought. “Just 6–12 months after diabetes onset, almost 13% had retinopathy,” Dr. Hamman remarked at the press briefing.

Among the subjects who did not develop diabetes, triglycerides were the only other risk factor associated with the development of retinopathy, with no differences in other lipid parameters, hemoglobin A_1c, or blood pressure between those who developed retinopathy and those who did not.

But among those who developed diabetes, blood pressure and HbA_1c levels were associated with the presence of retinopathy. Prior to their diabetes diagnosis, those with retinopathy had a mean blood pressure of 129/80 mm Hg, compared with 124/78 mm Hg among those without retinopathy, a significant difference. After the diabetes diagnosis, those values were 127/79 mm Hg and 123/77 mm Hg, respectively.

The study is being funded by the National Institutes of Health and the Centers for Disease Control and Prevention.

SAN DIEGO — Diabetic retinopathy can occur in people who do not yet have diabetes, Richard Hamman, M.D., reported at the annual scientific sessions of the American Diabetes Association.

The incongruous finding, among patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) who had participated in the Diabetes Prevention Program (DPP), suggests that the current cutoffs used to diagnose diabetes may need to be revised, said Dr. Hamman, professor and chair of the department of preventive medicine and biometrics at the University of Colorado, Denver.

More patients will need to be studied to determine whether the retinal lesions found in these “prediabetic” individuals represent early diabetic changes or perhaps are more indicative of arteriolar changes in people who are at risk for atherosclerotic vascular disease in general. Still, the finding does suggest that “a good retinal exam during the transition from prediabetes to early diabetes is important,” Dr. Hamman said at a press briefing at the ADA meeting.

Little is known about exactly when retinopathy develops in patients with type 2 diabetes, because the diagnosis often lags years behind the actual onset of high blood sugar. The DPP, which followed 3,234 high-risk individuals at 6-month intervals, afforded a unique opportunity to date precisely the development of retinopathy in relation to diabetes onset, he noted.

At a mean of 5.5 years between randomization in DPP and the taking of retinal photos, retinopathy of any degree was found in 15% of the 301 who developed diabetes during the trial and in 10% of 585 who did not. Retinopathy of grade 20 or higher—considered more indicative of true diabetes-related changes—was found in 12.5% of those with diabetes of short duration and in 8% of those who remained as IGT or IFG.

Similarly, the proportions who had only microaneurysms were 11% and 7%, respectively. Moderate nonproliferative diabetic retinopathy was detected in 2% of those who did not meet the criteria for diabetes during the trial and in 1% of those who did, a nonsignificant difference that nonetheless follows the same trend.

These data also show that retinopathy may appear far earlier in the course of diabetes than was previously thought. “Just 6–12 months after diabetes onset, almost 13% had retinopathy,” Dr. Hamman remarked at the press briefing.

Among the subjects who did not develop diabetes, triglycerides were the only other risk factor associated with the development of retinopathy, with no differences in other lipid parameters, hemoglobin A_1c, or blood pressure between those who developed retinopathy and those who did not.

But among those who developed diabetes, blood pressure and HbA_1c levels were associated with the presence of retinopathy. Prior to their diabetes diagnosis, those with retinopathy had a mean blood pressure of 129/80 mm Hg, compared with 124/78 mm Hg among those without retinopathy, a significant difference. After the diabetes diagnosis, those values were 127/79 mm Hg and 123/77 mm Hg, respectively.

The study is being funded by the National Institutes of Health and the Centers for Disease Control and Prevention.

SAN DIEGO — Diabetic retinopathy can occur in people who do not yet have diabetes, Richard Hamman, M.D., reported at the annual scientific sessions of the American Diabetes Association.

The incongruous finding, among patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) who had participated in the Diabetes Prevention Program (DPP), suggests that the current cutoffs used to diagnose diabetes may need to be revised, said Dr. Hamman, professor and chair of the department of preventive medicine and biometrics at the University of Colorado, Denver.

More patients will need to be studied to determine whether the retinal lesions found in these “prediabetic” individuals represent early diabetic changes or perhaps are more indicative of arteriolar changes in people who are at risk for atherosclerotic vascular disease in general. Still, the finding does suggest that “a good retinal exam during the transition from prediabetes to early diabetes is important,” Dr. Hamman said at a press briefing at the ADA meeting.

Little is known about exactly when retinopathy develops in patients with type 2 diabetes, because the diagnosis often lags years behind the actual onset of high blood sugar. The DPP, which followed 3,234 high-risk individuals at 6-month intervals, afforded a unique opportunity to date precisely the development of retinopathy in relation to diabetes onset, he noted.

At a mean of 5.5 years between randomization in DPP and the taking of retinal photos, retinopathy of any degree was found in 15% of the 301 who developed diabetes during the trial and in 10% of 585 who did not. Retinopathy of grade 20 or higher—considered more indicative of true diabetes-related changes—was found in 12.5% of those with diabetes of short duration and in 8% of those who remained as IGT or IFG.

Similarly, the proportions who had only microaneurysms were 11% and 7%, respectively. Moderate nonproliferative diabetic retinopathy was detected in 2% of those who did not meet the criteria for diabetes during the trial and in 1% of those who did, a nonsignificant difference that nonetheless follows the same trend.

These data also show that retinopathy may appear far earlier in the course of diabetes than was previously thought. “Just 6–12 months after diabetes onset, almost 13% had retinopathy,” Dr. Hamman remarked at the press briefing.

Among the subjects who did not develop diabetes, triglycerides were the only other risk factor associated with the development of retinopathy, with no differences in other lipid parameters, hemoglobin A_1c, or blood pressure between those who developed retinopathy and those who did not.

But among those who developed diabetes, blood pressure and HbA_1c levels were associated with the presence of retinopathy. Prior to their diabetes diagnosis, those with retinopathy had a mean blood pressure of 129/80 mm Hg, compared with 124/78 mm Hg among those without retinopathy, a significant difference. After the diabetes diagnosis, those values were 127/79 mm Hg and 123/77 mm Hg, respectively.

The study is being funded by the National Institutes of Health and the Centers for Disease Control and Prevention.

SAN DIEGO — Rosiglitazone has shown no hint of excess liver toxicity in 10 years of safety monitoring by GlaxoSmithKline, Alexander R. Cobitz, M.D., Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

The withdrawal of the first thiazolidinedione, troglitazone, from the market in 2000 because of liver toxicity prompted concern about the entire thiazolidinedione class of glucose-lowering agents, and resulted in strict label requirements for frequent liver monitoring in patients using the second-generation agents rosiglitazone and pioglitazone. These requirements have since been relaxed to simply measuring liver function at the time of initiation of therapy and as clinically indicated.

Now, after 10 years of safety monitoring in more than 7,000 patients, no cumulative evidence of hepatotoxicity has been seen in nearly 9,000 patient-years of exposure. “In the shadow of troglitazone, there were requirements put on the other two. … However, each of these molecules is markedly different,” said Dr. Cobitz, director of metabolism, clinical development, and medical affairs at GlaxoSmithKline, King of Prussia, Pa.

Included in his analysis were the phase III data on 4,327 patients with 2,493 patient-years of exposure that were submitted to the U.S. Food and Drug Administration for the new drug application for rosiglitazone (Avandia) in 1998, along with subsequent postmarketing surveillance data comprising an additional 256% in drug exposure since it entered the U.S. market. In all, the data include 38 double-blind and open-label clinical studies of rosiglitazone treatment in North America and Europe.

Patients in all the trials had baseline liver function test results at or below 2.5 times the upper limit of normal. Liver function was assessed at screening, at baseline, every 4 weeks for the first 3 months, and at 6- to 12-week intervals thereafter.

Among 7,429 patients enrolled in the trials—including 3,194 on rosiglitazone monotherapy and the rest on rosiglitazone in combination with metformin, sulfonylurea, or insulin—a total of 0.3% experienced a serum alanine aminotransferase (ALT) level more than 3 times the upper limit of normal. That same proportion was also seen among the 2,792 patients who received comparators without rosiglitazone in the trials—placebo, metformin, sulfonylurea, or insulin.

The number of person-years of exposure among the rosiglitazone subjects ranged from 892 with rosiglitazone plus insulin to 8,851 with monotherapy. Among the comparator groups, the range was from 186 person-years of exposure to placebo up to 1,186 person-years of exposure to sulfonylurea.

“The rate of hepatic events per patient-year is similar, if not better, than for the comparators,” Dr. Cobitz pointed out.

There were no differences between rosiglitazone and the comparators in threefold elevations of aspartate aminotransferase or alkaline phosphatase levels, or for elevations of 1.5 times the upper limit of normal in total bilirubin levels.

In all groups, those proportions ranged from 0% to 0.8%, with 0.8% being the percentage of 1.5-fold total elevations in bilirubin levels in the placebo group. Among the rosiglitazone recipients, 0.5% had that amount of elevation in bilirubin levels.

Further analysis showed no differences in ALT levels between three and five times the upper limit of normal (0%–0.3% for all rosiglitazone and comparator groups) or in ALT between five and eight times the upper limit of normal (0%–0.2%).

These data support the idea that although the chemical structures of all thiazolidinediones are identical on the right-hand side, their different left-hand structures result in very different biochemical and metabolic features, Dr. Cobitz said.

SAN DIEGO — Rosiglitazone has shown no hint of excess liver toxicity in 10 years of safety monitoring by GlaxoSmithKline, Alexander R. Cobitz, M.D., Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

The withdrawal of the first thiazolidinedione, troglitazone, from the market in 2000 because of liver toxicity prompted concern about the entire thiazolidinedione class of glucose-lowering agents, and resulted in strict label requirements for frequent liver monitoring in patients using the second-generation agents rosiglitazone and pioglitazone. These requirements have since been relaxed to simply measuring liver function at the time of initiation of therapy and as clinically indicated.

Now, after 10 years of safety monitoring in more than 7,000 patients, no cumulative evidence of hepatotoxicity has been seen in nearly 9,000 patient-years of exposure. “In the shadow of troglitazone, there were requirements put on the other two. … However, each of these molecules is markedly different,” said Dr. Cobitz, director of metabolism, clinical development, and medical affairs at GlaxoSmithKline, King of Prussia, Pa.

Included in his analysis were the phase III data on 4,327 patients with 2,493 patient-years of exposure that were submitted to the U.S. Food and Drug Administration for the new drug application for rosiglitazone (Avandia) in 1998, along with subsequent postmarketing surveillance data comprising an additional 256% in drug exposure since it entered the U.S. market. In all, the data include 38 double-blind and open-label clinical studies of rosiglitazone treatment in North America and Europe.

Patients in all the trials had baseline liver function test results at or below 2.5 times the upper limit of normal. Liver function was assessed at screening, at baseline, every 4 weeks for the first 3 months, and at 6- to 12-week intervals thereafter.

Among 7,429 patients enrolled in the trials—including 3,194 on rosiglitazone monotherapy and the rest on rosiglitazone in combination with metformin, sulfonylurea, or insulin—a total of 0.3% experienced a serum alanine aminotransferase (ALT) level more than 3 times the upper limit of normal. That same proportion was also seen among the 2,792 patients who received comparators without rosiglitazone in the trials—placebo, metformin, sulfonylurea, or insulin.

The number of person-years of exposure among the rosiglitazone subjects ranged from 892 with rosiglitazone plus insulin to 8,851 with monotherapy. Among the comparator groups, the range was from 186 person-years of exposure to placebo up to 1,186 person-years of exposure to sulfonylurea.

“The rate of hepatic events per patient-year is similar, if not better, than for the comparators,” Dr. Cobitz pointed out.

There were no differences between rosiglitazone and the comparators in threefold elevations of aspartate aminotransferase or alkaline phosphatase levels, or for elevations of 1.5 times the upper limit of normal in total bilirubin levels.

In all groups, those proportions ranged from 0% to 0.8%, with 0.8% being the percentage of 1.5-fold total elevations in bilirubin levels in the placebo group. Among the rosiglitazone recipients, 0.5% had that amount of elevation in bilirubin levels.

Further analysis showed no differences in ALT levels between three and five times the upper limit of normal (0%–0.3% for all rosiglitazone and comparator groups) or in ALT between five and eight times the upper limit of normal (0%–0.2%).

These data support the idea that although the chemical structures of all thiazolidinediones are identical on the right-hand side, their different left-hand structures result in very different biochemical and metabolic features, Dr. Cobitz said.

SAN DIEGO — Rosiglitazone has shown no hint of excess liver toxicity in 10 years of safety monitoring by GlaxoSmithKline, Alexander R. Cobitz, M.D., Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

The withdrawal of the first thiazolidinedione, troglitazone, from the market in 2000 because of liver toxicity prompted concern about the entire thiazolidinedione class of glucose-lowering agents, and resulted in strict label requirements for frequent liver monitoring in patients using the second-generation agents rosiglitazone and pioglitazone. These requirements have since been relaxed to simply measuring liver function at the time of initiation of therapy and as clinically indicated.

Now, after 10 years of safety monitoring in more than 7,000 patients, no cumulative evidence of hepatotoxicity has been seen in nearly 9,000 patient-years of exposure. “In the shadow of troglitazone, there were requirements put on the other two. … However, each of these molecules is markedly different,” said Dr. Cobitz, director of metabolism, clinical development, and medical affairs at GlaxoSmithKline, King of Prussia, Pa.

Included in his analysis were the phase III data on 4,327 patients with 2,493 patient-years of exposure that were submitted to the U.S. Food and Drug Administration for the new drug application for rosiglitazone (Avandia) in 1998, along with subsequent postmarketing surveillance data comprising an additional 256% in drug exposure since it entered the U.S. market. In all, the data include 38 double-blind and open-label clinical studies of rosiglitazone treatment in North America and Europe.

Patients in all the trials had baseline liver function test results at or below 2.5 times the upper limit of normal. Liver function was assessed at screening, at baseline, every 4 weeks for the first 3 months, and at 6- to 12-week intervals thereafter.

Among 7,429 patients enrolled in the trials—including 3,194 on rosiglitazone monotherapy and the rest on rosiglitazone in combination with metformin, sulfonylurea, or insulin—a total of 0.3% experienced a serum alanine aminotransferase (ALT) level more than 3 times the upper limit of normal. That same proportion was also seen among the 2,792 patients who received comparators without rosiglitazone in the trials—placebo, metformin, sulfonylurea, or insulin.

The number of person-years of exposure among the rosiglitazone subjects ranged from 892 with rosiglitazone plus insulin to 8,851 with monotherapy. Among the comparator groups, the range was from 186 person-years of exposure to placebo up to 1,186 person-years of exposure to sulfonylurea.

“The rate of hepatic events per patient-year is similar, if not better, than for the comparators,” Dr. Cobitz pointed out.

There were no differences between rosiglitazone and the comparators in threefold elevations of aspartate aminotransferase or alkaline phosphatase levels, or for elevations of 1.5 times the upper limit of normal in total bilirubin levels.

In all groups, those proportions ranged from 0% to 0.8%, with 0.8% being the percentage of 1.5-fold total elevations in bilirubin levels in the placebo group. Among the rosiglitazone recipients, 0.5% had that amount of elevation in bilirubin levels.

Further analysis showed no differences in ALT levels between three and five times the upper limit of normal (0%–0.3% for all rosiglitazone and comparator groups) or in ALT between five and eight times the upper limit of normal (0%–0.2%).

These data support the idea that although the chemical structures of all thiazolidinediones are identical on the right-hand side, their different left-hand structures result in very different biochemical and metabolic features, Dr. Cobitz said.

WASHINGTON — African American patients with dyslipidemia are less likely than non-Hispanic whites to achieve LDL cholesterol treatment goals, Luther T. Clark, M.D., and his associates reported in a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

In a national survey of physician compliance with guidelines that were issued in the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III), African American ethnicity remained a strong predictor of lower success in reaching low-density lipoprotein (LDL) cholesterol goals, even after adjustment for cardiovascular disease risk factors, said Dr. Clark, chief of cardiovascular medicine at the State University of New York Downstate Medical Center, Brooklyn.

In the study, supported by AstraZeneca PLC, a total of 376 U.S. physicians who were high prescribers of lipid-modifying medications each enrolled 10 or 20 consecutive dyslipidemic patients.

Data associated with a single office visit were entered into special software on a personal digital assistant device and then uploaded to a central database via the Internet.

The 4,885 patients studied were aged 20–75 years and had been on diet and/or a stable dose of drug therapy for at least 3 months. Most patients (80%) were non-Hispanic whites, 8% were African American or black, 4% were Hispanic, and 3% were Asian.

Physician specialties included family practice (40%), general internal medicine (40%), cardiology (15%), and endocrinology (2%). Most physicians were male (90%), board certified (90%), and office based (99%).

Achievement of NCEP ATP III treatment goals for LDL cholesterol level was significantly lower overall among African Americans than in non-Hispanic whites (54% vs. 69%).

This was true in all risk categories—those with fewer than two cardiovascular risk factors (82% vs. 90%), those with two or more risk factors (59% vs. 77%), and those at highest risk by virtue of having either coronary heart disease (CHD) or a CHD risk equivalent (44% vs. 58%), Dr. Clark and his associates wrote.

The disparity in LDL goal achievement remained, even after adjustment for age, gender, smoking status, family history of CHD, hypertension, HDL cholesterol category, type of therapy (diet vs. drug), hypertriglyceridemia, obesity, and physician specialty.

After the full adjustment, African Americans were less than half as likely (odds ratio 0.48) to have reached their LDL cholesterol goals, they said.

“These findings are disappointing, but not surprising. [They] are consistent with those from other surveys that have shown that CHD risk factors are less well controlled in African Americans,” Dr. Clark told this newspaper in a follow-up interview.

Although the reasons are not clear, the fact that the difference persisted after adjustment for both physician specialty and receipt of statins suggests that patient behavior is at least a contributing factor. But physiologic variation may be at work as well.

“Surprisingly little data have been published directly comparing lipid responses to available treatments in African American and non-Hispanic white patients. Therefore, it is also possible that physiologic factors could have played a role in the lower frequency of goal achievement in African Americans,” Dr. Clark commented.

WASHINGTON — African American patients with dyslipidemia are less likely than non-Hispanic whites to achieve LDL cholesterol treatment goals, Luther T. Clark, M.D., and his associates reported in a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

In a national survey of physician compliance with guidelines that were issued in the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III), African American ethnicity remained a strong predictor of lower success in reaching low-density lipoprotein (LDL) cholesterol goals, even after adjustment for cardiovascular disease risk factors, said Dr. Clark, chief of cardiovascular medicine at the State University of New York Downstate Medical Center, Brooklyn.

In the study, supported by AstraZeneca PLC, a total of 376 U.S. physicians who were high prescribers of lipid-modifying medications each enrolled 10 or 20 consecutive dyslipidemic patients.

Data associated with a single office visit were entered into special software on a personal digital assistant device and then uploaded to a central database via the Internet.

The 4,885 patients studied were aged 20–75 years and had been on diet and/or a stable dose of drug therapy for at least 3 months. Most patients (80%) were non-Hispanic whites, 8% were African American or black, 4% were Hispanic, and 3% were Asian.

Physician specialties included family practice (40%), general internal medicine (40%), cardiology (15%), and endocrinology (2%). Most physicians were male (90%), board certified (90%), and office based (99%).

Achievement of NCEP ATP III treatment goals for LDL cholesterol level was significantly lower overall among African Americans than in non-Hispanic whites (54% vs. 69%).

This was true in all risk categories—those with fewer than two cardiovascular risk factors (82% vs. 90%), those with two or more risk factors (59% vs. 77%), and those at highest risk by virtue of having either coronary heart disease (CHD) or a CHD risk equivalent (44% vs. 58%), Dr. Clark and his associates wrote.

The disparity in LDL goal achievement remained, even after adjustment for age, gender, smoking status, family history of CHD, hypertension, HDL cholesterol category, type of therapy (diet vs. drug), hypertriglyceridemia, obesity, and physician specialty.

After the full adjustment, African Americans were less than half as likely (odds ratio 0.48) to have reached their LDL cholesterol goals, they said.

“These findings are disappointing, but not surprising. [They] are consistent with those from other surveys that have shown that CHD risk factors are less well controlled in African Americans,” Dr. Clark told this newspaper in a follow-up interview.

Although the reasons are not clear, the fact that the difference persisted after adjustment for both physician specialty and receipt of statins suggests that patient behavior is at least a contributing factor. But physiologic variation may be at work as well.

“Surprisingly little data have been published directly comparing lipid responses to available treatments in African American and non-Hispanic white patients. Therefore, it is also possible that physiologic factors could have played a role in the lower frequency of goal achievement in African Americans,” Dr. Clark commented.

WASHINGTON — African American patients with dyslipidemia are less likely than non-Hispanic whites to achieve LDL cholesterol treatment goals, Luther T. Clark, M.D., and his associates reported in a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

In a national survey of physician compliance with guidelines that were issued in the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III), African American ethnicity remained a strong predictor of lower success in reaching low-density lipoprotein (LDL) cholesterol goals, even after adjustment for cardiovascular disease risk factors, said Dr. Clark, chief of cardiovascular medicine at the State University of New York Downstate Medical Center, Brooklyn.

In the study, supported by AstraZeneca PLC, a total of 376 U.S. physicians who were high prescribers of lipid-modifying medications each enrolled 10 or 20 consecutive dyslipidemic patients.

Data associated with a single office visit were entered into special software on a personal digital assistant device and then uploaded to a central database via the Internet.

The 4,885 patients studied were aged 20–75 years and had been on diet and/or a stable dose of drug therapy for at least 3 months. Most patients (80%) were non-Hispanic whites, 8% were African American or black, 4% were Hispanic, and 3% were Asian.

Physician specialties included family practice (40%), general internal medicine (40%), cardiology (15%), and endocrinology (2%). Most physicians were male (90%), board certified (90%), and office based (99%).

Achievement of NCEP ATP III treatment goals for LDL cholesterol level was significantly lower overall among African Americans than in non-Hispanic whites (54% vs. 69%).

This was true in all risk categories—those with fewer than two cardiovascular risk factors (82% vs. 90%), those with two or more risk factors (59% vs. 77%), and those at highest risk by virtue of having either coronary heart disease (CHD) or a CHD risk equivalent (44% vs. 58%), Dr. Clark and his associates wrote.

The disparity in LDL goal achievement remained, even after adjustment for age, gender, smoking status, family history of CHD, hypertension, HDL cholesterol category, type of therapy (diet vs. drug), hypertriglyceridemia, obesity, and physician specialty.

After the full adjustment, African Americans were less than half as likely (odds ratio 0.48) to have reached their LDL cholesterol goals, they said.

“These findings are disappointing, but not surprising. [They] are consistent with those from other surveys that have shown that CHD risk factors are less well controlled in African Americans,” Dr. Clark told this newspaper in a follow-up interview.

Although the reasons are not clear, the fact that the difference persisted after adjustment for both physician specialty and receipt of statins suggests that patient behavior is at least a contributing factor. But physiologic variation may be at work as well.

“Surprisingly little data have been published directly comparing lipid responses to available treatments in African American and non-Hispanic white patients. Therefore, it is also possible that physiologic factors could have played a role in the lower frequency of goal achievement in African Americans,” Dr. Clark commented.

WASHINGTON — Obese patients with coronary disease don't always see their excess weight as being part of the problem, Francisco Lopez-Jimenez, M.D., and his associates reported in a conference on cardiovascular disease epidemiology and prevention, sponsored by the American Heart Association.

A prospective survey of 229 patients who had recently been hospitalized for a coronary syndrome or revascularization revealed that, despite being aware of their excess weight, few actually perceived that it was related to their heart problems.

“Don't assume your patients understand this. You must make them aware of the implications of obesity with regard to heart disease, because how people perceive themselves drives their behavior,” Dr. Lopez-Jimenez told FAMILY PRACTICE NEWS.

The patients had a mean age of 66 years and a mean body mass index of 30.5 kg/m

The investigators looked for factors that were correlated with self-perception of risk for heart disease. After adjustment for sex, comorbidities, socioeconomic status, and other potential confounders, only four factors—age, history of diabetes, and levels of readiness to change for weight loss and exercise—were significantly correlated with the patient's perceived risk for heart disease.

There was no such correlation with self-perception of obesity, despite 67% of patients endorsing the general concept that obesity is a risk factor for MI.

“It is complicated. … In general, we tend to recognize risky habits, but fail to recognize ourselves at risk,” he said, adding that studies in patients who smoke, have AIDS, and engage in other risky behaviors have shown similar tendencies.

At the 6-month follow-up, the belief that obesity is a risk factor for heart disease was the strongest predictor of weight loss.

History of diabetes and self-perceived excess weight were also significantly correlated with weight loss, but self-perceived risk for heart disease was not, the investigators reported.

Although these data suggest some denial on the part of patients, a previous study by Dr. Lopez-Jimenez and his associates indicated that underappreciation of obesity as a cardiovascular disease risk factor extends to clinicians as well. In a randomly selected sample of 627 patients discharged after an MI during 2001–2002 from five U.S. teaching hospitals, BMI had been documented in the charts of only 14% and waist circumference in none, despite the fact that 83% were overweight, including 55% who were obese and 8% who were morbidly obese (Int. J. Obes. Relat. Metab. Disord. 2005;29:137–41).

In only 20% of patients with a BMI at or above 30 was the diagnosis of obesity documented as a current medical problem, part of the past medical history, or as a final diagnosis. The proportion that received dietary counseling (61%) was identical for those with a BMI at or above 25 and for those with a BMI below 25.

Weight loss was described as part of treatment or among goals at discharge for just 7% of overweight and 9% of obese patients.

WASHINGTON — Obese patients with coronary disease don't always see their excess weight as being part of the problem, Francisco Lopez-Jimenez, M.D., and his associates reported in a conference on cardiovascular disease epidemiology and prevention, sponsored by the American Heart Association.

A prospective survey of 229 patients who had recently been hospitalized for a coronary syndrome or revascularization revealed that, despite being aware of their excess weight, few actually perceived that it was related to their heart problems.

“Don't assume your patients understand this. You must make them aware of the implications of obesity with regard to heart disease, because how people perceive themselves drives their behavior,” Dr. Lopez-Jimenez told FAMILY PRACTICE NEWS.

The patients had a mean age of 66 years and a mean body mass index of 30.5 kg/m

The investigators looked for factors that were correlated with self-perception of risk for heart disease. After adjustment for sex, comorbidities, socioeconomic status, and other potential confounders, only four factors—age, history of diabetes, and levels of readiness to change for weight loss and exercise—were significantly correlated with the patient's perceived risk for heart disease.

There was no such correlation with self-perception of obesity, despite 67% of patients endorsing the general concept that obesity is a risk factor for MI.

“It is complicated. … In general, we tend to recognize risky habits, but fail to recognize ourselves at risk,” he said, adding that studies in patients who smoke, have AIDS, and engage in other risky behaviors have shown similar tendencies.

At the 6-month follow-up, the belief that obesity is a risk factor for heart disease was the strongest predictor of weight loss.

History of diabetes and self-perceived excess weight were also significantly correlated with weight loss, but self-perceived risk for heart disease was not, the investigators reported.

Although these data suggest some denial on the part of patients, a previous study by Dr. Lopez-Jimenez and his associates indicated that underappreciation of obesity as a cardiovascular disease risk factor extends to clinicians as well. In a randomly selected sample of 627 patients discharged after an MI during 2001–2002 from five U.S. teaching hospitals, BMI had been documented in the charts of only 14% and waist circumference in none, despite the fact that 83% were overweight, including 55% who were obese and 8% who were morbidly obese (Int. J. Obes. Relat. Metab. Disord. 2005;29:137–41).

In only 20% of patients with a BMI at or above 30 was the diagnosis of obesity documented as a current medical problem, part of the past medical history, or as a final diagnosis. The proportion that received dietary counseling (61%) was identical for those with a BMI at or above 25 and for those with a BMI below 25.

Weight loss was described as part of treatment or among goals at discharge for just 7% of overweight and 9% of obese patients.

WASHINGTON — Obese patients with coronary disease don't always see their excess weight as being part of the problem, Francisco Lopez-Jimenez, M.D., and his associates reported in a conference on cardiovascular disease epidemiology and prevention, sponsored by the American Heart Association.

A prospective survey of 229 patients who had recently been hospitalized for a coronary syndrome or revascularization revealed that, despite being aware of their excess weight, few actually perceived that it was related to their heart problems.

“Don't assume your patients understand this. You must make them aware of the implications of obesity with regard to heart disease, because how people perceive themselves drives their behavior,” Dr. Lopez-Jimenez told FAMILY PRACTICE NEWS.

The patients had a mean age of 66 years and a mean body mass index of 30.5 kg/m

The investigators looked for factors that were correlated with self-perception of risk for heart disease. After adjustment for sex, comorbidities, socioeconomic status, and other potential confounders, only four factors—age, history of diabetes, and levels of readiness to change for weight loss and exercise—were significantly correlated with the patient's perceived risk for heart disease.

There was no such correlation with self-perception of obesity, despite 67% of patients endorsing the general concept that obesity is a risk factor for MI.

“It is complicated. … In general, we tend to recognize risky habits, but fail to recognize ourselves at risk,” he said, adding that studies in patients who smoke, have AIDS, and engage in other risky behaviors have shown similar tendencies.

At the 6-month follow-up, the belief that obesity is a risk factor for heart disease was the strongest predictor of weight loss.

History of diabetes and self-perceived excess weight were also significantly correlated with weight loss, but self-perceived risk for heart disease was not, the investigators reported.

Although these data suggest some denial on the part of patients, a previous study by Dr. Lopez-Jimenez and his associates indicated that underappreciation of obesity as a cardiovascular disease risk factor extends to clinicians as well. In a randomly selected sample of 627 patients discharged after an MI during 2001–2002 from five U.S. teaching hospitals, BMI had been documented in the charts of only 14% and waist circumference in none, despite the fact that 83% were overweight, including 55% who were obese and 8% who were morbidly obese (Int. J. Obes. Relat. Metab. Disord. 2005;29:137–41).

In only 20% of patients with a BMI at or above 30 was the diagnosis of obesity documented as a current medical problem, part of the past medical history, or as a final diagnosis. The proportion that received dietary counseling (61%) was identical for those with a BMI at or above 25 and for those with a BMI below 25.

Weight loss was described as part of treatment or among goals at discharge for just 7% of overweight and 9% of obese patients.

WASHINGTON — Metabolic syndrome increases the risk for peripheral arterial disease as well as coronary artery disease, Andy Menke and his associates reported in a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The relationship between metabolic syndrome and coronary artery disease are well established.

Now, data from 2,175 participants in the 1999–2002 National Health and Nutrition Examination Survey (NHANES) suggest that the association also extends to the peripheral arteries, and in a dose-response fashion—that is, the more metabolic syndrome components a person has, the greater the risk for peripheral arterial disease (PAD), said Mr. Menke, a doctoral student in the department of epidemiology at Tulane University, New Orleans.

A total of 827 participants had metabolic syndrome, defined as the presence of three or more of the following:

▸ Systolic blood pressure greater than or equal to 130 mm Hg, and/or diastolic blood pressure greater than or equal to 85 mm Hg, and/or the use of antihypertensive medication.

▸ Serum HDL cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women.

▸ Serum triglyceride level greater than or equal to 150 mg/dL.

▸ Plasma glucose greater than or equal to 110 mg/dL and/or use of insulin or glucose-lowering medication.

▸ Abdominal obesity (waist circumference greater than 102 cm for men and greater than 88 cm for women).

Those with metabolic syndrome were significantly older, had a higher body mass index, and were more likely to have a low glomerular filtration rate.

The age-adjusted prevalence of PAD, defined as the average of the left and right ankle-brachial index being less than 0.9, was present in 5.3% of those with metabolic syndrome and in 3.2% of those without, a significant difference.

After adjustment for BMI, age, race/ethnicity, sex, high school education, physical inactivity, alcohol consumption, glomerular filtration rate, and current and former smoking, subjects with the metabolic syndrome were nearly three times more likely to have PAD than were those who did not.

Those with three metabolic syndrome components had an odds ratio of 1.68 for PAD, compared with subjects who had just 1 or 2 components, while the odds ratio for those with 4 or 5 components was 1.54.

Among the individual metabolic syndrome components, the subjects with elevated blood pressure had an odds ratio of 1.83 for PAD, compared with those who were normotensive, they said.

The conference was also sponsored by the National Heart, Lung, and Blood Institute.

WASHINGTON — Metabolic syndrome increases the risk for peripheral arterial disease as well as coronary artery disease, Andy Menke and his associates reported in a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The relationship between metabolic syndrome and coronary artery disease are well established.

Now, data from 2,175 participants in the 1999–2002 National Health and Nutrition Examination Survey (NHANES) suggest that the association also extends to the peripheral arteries, and in a dose-response fashion—that is, the more metabolic syndrome components a person has, the greater the risk for peripheral arterial disease (PAD), said Mr. Menke, a doctoral student in the department of epidemiology at Tulane University, New Orleans.

A total of 827 participants had metabolic syndrome, defined as the presence of three or more of the following:

▸ Systolic blood pressure greater than or equal to 130 mm Hg, and/or diastolic blood pressure greater than or equal to 85 mm Hg, and/or the use of antihypertensive medication.

▸ Serum HDL cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women.

▸ Serum triglyceride level greater than or equal to 150 mg/dL.

▸ Plasma glucose greater than or equal to 110 mg/dL and/or use of insulin or glucose-lowering medication.

▸ Abdominal obesity (waist circumference greater than 102 cm for men and greater than 88 cm for women).

Those with metabolic syndrome were significantly older, had a higher body mass index, and were more likely to have a low glomerular filtration rate.

The age-adjusted prevalence of PAD, defined as the average of the left and right ankle-brachial index being less than 0.9, was present in 5.3% of those with metabolic syndrome and in 3.2% of those without, a significant difference.

After adjustment for BMI, age, race/ethnicity, sex, high school education, physical inactivity, alcohol consumption, glomerular filtration rate, and current and former smoking, subjects with the metabolic syndrome were nearly three times more likely to have PAD than were those who did not.

Those with three metabolic syndrome components had an odds ratio of 1.68 for PAD, compared with subjects who had just 1 or 2 components, while the odds ratio for those with 4 or 5 components was 1.54.

Among the individual metabolic syndrome components, the subjects with elevated blood pressure had an odds ratio of 1.83 for PAD, compared with those who were normotensive, they said.

The conference was also sponsored by the National Heart, Lung, and Blood Institute.

WASHINGTON — Metabolic syndrome increases the risk for peripheral arterial disease as well as coronary artery disease, Andy Menke and his associates reported in a poster at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The relationship between metabolic syndrome and coronary artery disease are well established.

Now, data from 2,175 participants in the 1999–2002 National Health and Nutrition Examination Survey (NHANES) suggest that the association also extends to the peripheral arteries, and in a dose-response fashion—that is, the more metabolic syndrome components a person has, the greater the risk for peripheral arterial disease (PAD), said Mr. Menke, a doctoral student in the department of epidemiology at Tulane University, New Orleans.

A total of 827 participants had metabolic syndrome, defined as the presence of three or more of the following:

▸ Systolic blood pressure greater than or equal to 130 mm Hg, and/or diastolic blood pressure greater than or equal to 85 mm Hg, and/or the use of antihypertensive medication.

▸ Serum HDL cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women.

▸ Serum triglyceride level greater than or equal to 150 mg/dL.

▸ Plasma glucose greater than or equal to 110 mg/dL and/or use of insulin or glucose-lowering medication.

▸ Abdominal obesity (waist circumference greater than 102 cm for men and greater than 88 cm for women).

Those with metabolic syndrome were significantly older, had a higher body mass index, and were more likely to have a low glomerular filtration rate.

The age-adjusted prevalence of PAD, defined as the average of the left and right ankle-brachial index being less than 0.9, was present in 5.3% of those with metabolic syndrome and in 3.2% of those without, a significant difference.

After adjustment for BMI, age, race/ethnicity, sex, high school education, physical inactivity, alcohol consumption, glomerular filtration rate, and current and former smoking, subjects with the metabolic syndrome were nearly three times more likely to have PAD than were those who did not.

Those with three metabolic syndrome components had an odds ratio of 1.68 for PAD, compared with subjects who had just 1 or 2 components, while the odds ratio for those with 4 or 5 components was 1.54.

Among the individual metabolic syndrome components, the subjects with elevated blood pressure had an odds ratio of 1.83 for PAD, compared with those who were normotensive, they said.

The conference was also sponsored by the National Heart, Lung, and Blood Institute.