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Mortality and Coronary Heart Disease in Women With Fasting Glucose Levels Within the Normal Range
S252
Canadian Journal of Cardiology Volume 29 2013
Canadian Cardiovascular Society (CCS) Vascular 2013 Oral PREVENTION OF VASCULAR DISEASE & PROMOTION OF HEALTHY POPULATIONS Friday, October 18, 2013 401 WORKING TOGETHER FOR PRIMARY PREVENTION: TRAINING MEDICAL STUDENTS’ TO PROVIDE SMOKING CESSATION COUNSELING A Henni, S Lee, S Kelly, J Zimmer, P Dehghani, AJ Lavoie Saskatoon, Saskatchewan BACKGROUND:
Tobacco use is a significant problem in community health. In 2011, Health Canada determined the national average smoking rate to be 19.9% with higher rates in Saskatchewan at 23.8%. Many medical students do not have sufficient training in tobacco cessation counseling in their curriculum and lack the skills to provide appropriate intervention. PURPOSE: To create and assess the effectiveness of the Prairie Vascular Research Network (PVRN) smoking cessation training program for medical students at the University of Saskatchewan. METHODS: The PVRN smoking cessation program has two components. First, twenty volunteer medical students were given one week to complete the Partnership to Assist with Cessation of Tobacco (PACT) online training program. Topics included nicotine addiction, tobacco trends in Saskatchewan, the importance of cessation, pharmacotherapy, and implementation in a practice site. The second component was a role-playing exercise where students took turns playing the clinician or the patient and enacted scenarios from the program “Rx for Change” by the University of California San Francisco. Students were given pre and post-training questionnaires to assess their (1) confidence in interacting with patients regarding smoking cessation counseling, (2) knowledge of the different components of smoking cessation counseling, and (3) confidence in delivering smoking cessation counseling. Questionnaires were designed for quantitative analysis and used a seven point Likert scale. The Wilcoxon signed rank test was used to determine if there were changes over time in the ratings given to each question. Pre and posttraining interviews provided additional descriptive data, and were analyzed for comparative results. RESULTS: Students’ knowledge about the different components of smoking cessation showed statistically significant improvements after completing the program. The most significant improvement was in knowledge of pharmacotherapies available for smoking cessation, with a median pre-test value of 2.0 and a post-test median value of 5.0. Students’ confidence in delivering smoking cessation counseling showed marked improvement after the training program. In particular, students showed increased confidence in helping their patients develop a cessation plan, with a pre-test median value of 3.0 and a post-test median value of 6.0 Students reported
positive experiences in their interview and praised the roleplaying component of the PVRN training program. Overall, after training, students felt they had the knowledge and skills to broach the topic of smoking cessation with patients. CONCLUSION: The PVRN program is successful in teaching medical students about smoking cessation and providing them with the knowledge and confidence to deliver smoking cessation counseling. 402 MORTALITY AND CORONARY HEART DISEASE IN WOMEN WITH FASTING GLUCOSE LEVELS WITHIN THE NORMAL RANGE D Pereg, M Mosseri Toronto, Ontario BACKGROUND: Diabetes mellitus and impaired fasting glucose are well established independent risk factors for cardiovascular events and death. Uncertainty remains regarding the relationship between fasting glucose levels within the normal range of <5.6mmol/L (<100mg/dl) and cardiovascular disease and mortality in the non diabetic population. We aimed to evaluate the association between fasting plasma glucose levels within the normal range and all-cause mortality and cardiovascular risk in a large cohort of non-diabetic women. METHODS: The study was conducted using the computerized database of a health maintenance organization in Israel. Included were women 40 years with fasting glucose levels within the normal range. Patients with a history of cardiovascular diseases or diabetes were excluded. The primary endpoints were all-cause mortality and coronary revascularization with either percutaneous coronary intervention or coronary artery bypass grafting. RESULTS: The 30,861 participants were stratified into 5 quintiles of glucose levels within the normal range (<4.5,4.54.7, 4.8-5, 5.1-5.2, 5.3-5.6mmol/L). During a mean followup of 6.21.1 years, 2,637 (8.5%) participants died and 394 (1.2%) underwent coronary revascularization. Comparison of mortality risk according to quintiles of fasting plasma glucose levels demonstrated a J-shaped relationship with the lowest observed death rates in the fasting glucose interval between 4.8-5mmol/L (85-89mg/dl). This association remained significant following a multivariate adjustment with significantly higher mortality rates observed among patients in the lowest and highest quintiles of fasting glucose levels within the normal range (HR¼1.25, 95CI¼1.11-1.4, P<0.0001, and HR¼1.18, 95CI¼1.05-1.32, P¼0.005, respectively). We observed a progressive increase in the risk for coronary revascularization as fasting glucose level was higher within the normal range. However, this association lost its statistical significance following a multivariate adjustment. CONCLUSION: Both low and high fasting glucose levels within the normal range are associated with increased all-cause mortality. Further investigation is needed for better understanding of this association before therapeutic recommendations can be made.
Canadian Journal of Cardiology Volume 29 2013
Canadian Cardiovascular Society (CCS) Vascular 2013 Oral PREVENTION OF VASCULAR DISEASE & PROMOTION OF HEALTHY POPULATIONS Friday, October 18, 2013 401 WORKING TOGETHER FOR PRIMARY PREVENTION: TRAINING MEDICAL STUDENTS’ TO PROVIDE SMOKING CESSATION COUNSELING A Henni, S Lee, S Kelly, J Zimmer, P Dehghani, AJ Lavoie Saskatoon, Saskatchewan BACKGROUND:
Tobacco use is a significant problem in community health. In 2011, Health Canada determined the national average smoking rate to be 19.9% with higher rates in Saskatchewan at 23.8%. Many medical students do not have sufficient training in tobacco cessation counseling in their curriculum and lack the skills to provide appropriate intervention. PURPOSE: To create and assess the effectiveness of the Prairie Vascular Research Network (PVRN) smoking cessation training program for medical students at the University of Saskatchewan. METHODS: The PVRN smoking cessation program has two components. First, twenty volunteer medical students were given one week to complete the Partnership to Assist with Cessation of Tobacco (PACT) online training program. Topics included nicotine addiction, tobacco trends in Saskatchewan, the importance of cessation, pharmacotherapy, and implementation in a practice site. The second component was a role-playing exercise where students took turns playing the clinician or the patient and enacted scenarios from the program “Rx for Change” by the University of California San Francisco. Students were given pre and post-training questionnaires to assess their (1) confidence in interacting with patients regarding smoking cessation counseling, (2) knowledge of the different components of smoking cessation counseling, and (3) confidence in delivering smoking cessation counseling. Questionnaires were designed for quantitative analysis and used a seven point Likert scale. The Wilcoxon signed rank test was used to determine if there were changes over time in the ratings given to each question. Pre and posttraining interviews provided additional descriptive data, and were analyzed for comparative results. RESULTS: Students’ knowledge about the different components of smoking cessation showed statistically significant improvements after completing the program. The most significant improvement was in knowledge of pharmacotherapies available for smoking cessation, with a median pre-test value of 2.0 and a post-test median value of 5.0. Students’ confidence in delivering smoking cessation counseling showed marked improvement after the training program. In particular, students showed increased confidence in helping their patients develop a cessation plan, with a pre-test median value of 3.0 and a post-test median value of 6.0 Students reported
positive experiences in their interview and praised the roleplaying component of the PVRN training program. Overall, after training, students felt they had the knowledge and skills to broach the topic of smoking cessation with patients. CONCLUSION: The PVRN program is successful in teaching medical students about smoking cessation and providing them with the knowledge and confidence to deliver smoking cessation counseling. 402 MORTALITY AND CORONARY HEART DISEASE IN WOMEN WITH FASTING GLUCOSE LEVELS WITHIN THE NORMAL RANGE D Pereg, M Mosseri Toronto, Ontario BACKGROUND: Diabetes mellitus and impaired fasting glucose are well established independent risk factors for cardiovascular events and death. Uncertainty remains regarding the relationship between fasting glucose levels within the normal range of <5.6mmol/L (<100mg/dl) and cardiovascular disease and mortality in the non diabetic population. We aimed to evaluate the association between fasting plasma glucose levels within the normal range and all-cause mortality and cardiovascular risk in a large cohort of non-diabetic women. METHODS: The study was conducted using the computerized database of a health maintenance organization in Israel. Included were women 40 years with fasting glucose levels within the normal range. Patients with a history of cardiovascular diseases or diabetes were excluded. The primary endpoints were all-cause mortality and coronary revascularization with either percutaneous coronary intervention or coronary artery bypass grafting. RESULTS: The 30,861 participants were stratified into 5 quintiles of glucose levels within the normal range (<4.5,4.54.7, 4.8-5, 5.1-5.2, 5.3-5.6mmol/L). During a mean followup of 6.21.1 years, 2,637 (8.5%) participants died and 394 (1.2%) underwent coronary revascularization. Comparison of mortality risk according to quintiles of fasting plasma glucose levels demonstrated a J-shaped relationship with the lowest observed death rates in the fasting glucose interval between 4.8-5mmol/L (85-89mg/dl). This association remained significant following a multivariate adjustment with significantly higher mortality rates observed among patients in the lowest and highest quintiles of fasting glucose levels within the normal range (HR¼1.25, 95CI¼1.11-1.4, P<0.0001, and HR¼1.18, 95CI¼1.05-1.32, P¼0.005, respectively). We observed a progressive increase in the risk for coronary revascularization as fasting glucose level was higher within the normal range. However, this association lost its statistical significance following a multivariate adjustment. CONCLUSION: Both low and high fasting glucose levels within the normal range are associated with increased all-cause mortality. Further investigation is needed for better understanding of this association before therapeutic recommendations can be made.