AbstractSince 1997, the appetite suppressant drugs fenfluramine‐phentermine (fen‐phen) and dexfenfluramine have been associated with the development of valvular heart disease. As a result, the drugs have been withdrawn from the market and interim recommendations for evaluation and treatment of exposed patients were issued. However, subsequent studies showed lower prevalence rates for valve abnormalities than were initially reported, and the possibility of such drug‐induced lesions resolving has been raised. This article reviews relevant evidence and discusses concerns for the dental practitioner.
ABSTRACTThe prevalence of diabetes mellitus in the general population has been increasing sharply. Currently, much is feared but little is known about postoperative complications of oral surgery among persons with diabetes. Existing dental education and practice guidelines cite excess infectious risk among patients with diabetes; however, empiric evidence to support such concerns is lacking. In fact, dentists commonly prescribe antibiotics when dental surgical procedures involve bone. This practice may contribute to the rising problem of microbial resistance and may increase overall healthcare costs. The growing number of dental patients with diabetes warrants strengthening the evidence base to guide their dental care and prevent possible morbid complications.
ABSTRACTWe investigated disparities in the prescription of analgesics following dental procedures that were expected to cause acute postoperative pain. Patients over the age of 19 years who had been treated by surgical and/or endodontic dental procedures were included in this study. We reviewed 900 consecutive charts and abstracted data on procedures, patients, and providers. We used chi‐square and logistic regression models for analyses. There were 485 White subjects, 357 African American subjects included in this review; 81% of the African American and 78% of White patients received a postoperative narcotic prescription (p= .56). In multivariate regression models, patients over age 45 (p= .003), those with insurance that covered medication and those with preexisting pain (p= .004) were more likely to receive narcotic analgesics. Students prescribed more narcotics than residents (p= .001). No differences were found by race in prescribing analgesics.
<p><strong>Objectives: </strong> Recurrent stroke affects 5%-15% of stroke survivors, is higher among Blacks, and preventable with secondary stroke prevention medications. Our study aimed to examine racial differences in risk factors being addressed (defined as either on active treatment or within guideline levels) among stroke survivors and those at risk for stroke.</p><p><strong>Methods: </strong> A cross-sectional study using NHANES 2009-2010 standardized interviews of Whites and Blacks aged ≥18 years. Risk factors were defined as being addressed if: 1) for hypertension, SBP <140, DBP <90 (SBP<130, DBP<80 for diabetics) or using BP-lowering medications; 2) for current smoking, using cessation medications; and 3) for hyperlipidemia, LDL<100 (LDL<70 for stroke survivors) or using lipid-lowering medications. Participants were stratified by stroke history. Prevalence of addressed risk factors was compared by race.</p><p><strong>Results: </strong>Among 4005 participants (mean age 48, 52% women, 15% Black), 4% reported a history of stroke. Among stroke survivors, there were no statistically significant differences in Blacks and Whites having their hypertension or hyperlipidemia addressed. Among stroke naïve participants, the prevalence of addressed hypertension (P<.01) and hyperlipidemia (P<.01) was lower in Blacks compared with Whites. </p><strong>Conclusions: </strong> We found that addressed hypertension and hyperlipidemia in stroke naïve participants were significantly lower in Blacks than Whites. Our observations call attention to areas that require further investigation, such as why black Americans may not be receiving evidence-based pharmacologic therapy for hypertension and hyperlipidemia or why Black Americans are not at goal blood pressure or goal LDL. A better understanding of this information is critical to preventing stroke and other vascular diseases. <em>Ethn Dis</em>. 2016;26(1):9-16; doi:10.18865/ed.26.1.9
BACKGROUND: Prior studies suggest that persistence with and adherence to statin therapy is low. Interventions to improve statin persistence and adherence have been developed over the past decade. METHODS AND RESULTS: This was a retrospective cohort study of adults aged ≥21 y with commercial or government health insurance in the MarketScan (Truven Health Analytics) and Medicare databases who initiated statins in 2007–2014 and (1) started treatment after a myocardial infarction (n=201 573), (2) had diabetes mellitus but without coronary heart disease (CHD; n=610 049), or (3) did not have CHD or diabetes mellitus (n=2 244 868). Persistence with (ie, not discontinuing treatment) and high adherence to statin therapy were assessed using pharmacy fills in the year following treatment initiation. In 2007 and 2014, the proportions of patients persistent with statin therapy were 78.1% and 79.1%, respectively, among those initiating treatment following myocardial infarction; 66.5% and 67.3%, respectively, for those with diabetes mellitus but without CHD; and 64.3% and 63.9%, respectively, for those without CHD or diabetes mellitus. Between 2007 and 2014, high adherence to statin therapy increased from 57.9% to 63.8% among patients initiating treatment following myocardial infarction and from 34.9% to 37.6% among those with diabetes mellitus but without CHD (each P (trend)<0.001). Among patients without CHD or diabetes mellitus, high adherence did not improve between 2007 (35.7%) and 2014 (36.8%; P (trend)=0.14). In 2014, statin adherence was lower among younger, black, and Hispanic patients versus white patients and those initiating a high‐intensity statin dosage. Statin adherence was higher among men and patients with cardiologist care following treatment initiation. CONCLUSIONS: Persistence with and adherence to statin therapy remain low, particularly among those without CHD.
