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Objective: To evaluate screening strategies based on fasting plasma glucose (FPG), clinical information, and the oral glucose tolerance test (OGTT) for detection of diabetes or other hyperglycemic states-impaired fasting glucose (IFG) and impaired glucose tolerance-meriting clinical intervention.Research Design and Methods: We studied 8,286 African-American and white men and women without known diabetes, aged 53-75 years, who received an OGTT during the fourth exam of the Atherosclerosis Risk in Communities Study. Using a split sample technique, we estimated the diagnostic properties of various clinical detection rules derived from logistic regression modeling. Screening strategies utilizing FPG, these detection rules, and/or the OGTT were then compared in terms of both the fraction of hyperglycemia cases detected and the sample fraction receiving different screening tests and identified as screen positive.Results: Screening based on the IFG cut point (> or =6.1 mmol/l), followed by a clinical detection rule for those below this value, detected 86.3% of diabetic case subjects and 66.0% of all hyperglycemia cases, identifying 42% of the sample as screen positive. Applying an OGTT for those positive by the rule provides diagnostic labeling and reduces the fraction that is screen positive to 29%. Another strategy, to apply an OGTT to those with an FPG cut point between 5.6 and 6.1 mmol/l, also identifies 29% of the sample as screen positive, although it detects slightly fewer hyperglycemia cases.Conclusions: Screening strategies based on FPG, complemented by clinical detection rules and/or an OGTT, are effective and practical in the detection of hyperglycemic states meriting clinical intervention. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to report trends in mortality due to coronary heart disease (CHD), rates of first and recurrent hospitalized myocardial infarction, and survival after myocardial infarction in the Atherosclerosis Risk in Communities (ARIC) Study from 1987 through 1996.Method: The ARIC study used retrospective community surveillance to monitor admissions to acute care hospitals and deaths due to CHD (both in- and out-of-hospital) among all residents 35-74 years of age. The surveillance areas included over 360 000 men and women in four communities: Forsyth County, North Carolina; the city of Jackson, Mississippi; eight northern suburbs of Minneapolis, Minnesota; and Washington County, Maryland.Results: The annual age-adjusted mortality rate of CHD fell 3.2% (95% CI: 2.0, 4.3) among men and 3.8% (95% CI: 1.9, 5.6) among women. The greater part of the decline took place between 1987 and 1991. Significant declines were observed for both in-hospital and out-of-hospital CHD death. Significant improvements in case-fatality were also observed. Recurrent hospitalized myocardial infarction event rate fell an average of 1.9% per year among men (95% CI: 0.7, 3.1) and 2.1% (95% CI: 0.3, 3.9) among women. Average annual per cent change in incident hospitalized myocardial infarction was not statistically significant, except in blacks where there was evidence of an increase over time.Conclusion: Factors associated with the occurrence of recurrent hospitalized myocardial infarction, as well as those creating a better chance of survival after an event (including reductions in sudden death), were likely the prominent components in the recent decline in CHD mortality in ARIC communities. [ABSTRACT FROM AUTHOR]

Lipid-lowering therapy has been shown to reduce cardiovascular disease risk in individuals with low-density lipoprotein cholesterol (LDL-C) levels of ≥130 mg/dL. Several methods have been developed for identifying those at highest risk for treatment. The objective was to compare the 1993 National Cholesterol Education Program guidelines to absolute risk assessment methods similar to those used by recently developed European and British cholesterol treatment guidelines. The design and setting was a population-based, prospective cohort study in four US communities. Among Atherosclerosis Risk in the Communities study participants aged 45-64 years followed for a mean of 7 years, 7314 women and 5762 men were included who had no evidence of clinical cardiovascular disease and were not receiving lipid-lowering drug therapy at entry. Main outcome measures were number meeting criteria for treatment, number of cardiovascular events expected to be prevented with treatment, number needed to treat to prevent one cardiovascular event, and sensitivity of criteria for detecting cases for the entire cohort and for those at or above the LDL-C treatment threshold (within-group). The 1993 National Cholesterol Education Program guidelines identified 16% of participants for treatment: n=2112; events expected to be prevented=77; number needed to treat=27; sensitivity=0.31 (0.28-0.35); sensitivity when LDL-C was ≥160 mg/dL=0.86. Use of a LDL-C treatment threshold of ≥130 mg/dL, a ≥20% 10-year absolute risk cut-point (similar to European guidelines) identified 13% for treatment: n=1701; events expected to be prevented=66; number needed to treat=26; sensitivity= 0.29 (0.25-0.32); sensitivity when LDL-C was ≥130 mg/dL=0.43. A ≥15% risk cut-point (similar to British guidelines) identified 17% for treatment: n=2233; events expected to be prevented= 82; number needed to treat=27; sensitivity= 0.37 (0.33-0.40); sensitivity when LDL-C was ≥130 mg/dL=0.55. Modified National Cholesterol Education Program guidelines (LDL-C treatment threshold lowered from 160 to 130 mg/dL for those with ≥2 risk factors) identified 30% for treatment: n=3867; events expected to be prevented=120; number needed to treat=32; sensitivity=0.55 (0.52-0.59); sensitivity when LDL-C was 130 mg/dL=0.83. A hybrid strategy using ≥15% risk, or 10%-14% risk with a parental history of premature coronary heart disease or treated, controlled hypertension, identified 20% for treatment: n=2646; events expected to be prevented=97; number needed to treat=27; sensitivity=0.44 (0.40-0.47); sensitivity when LDL-C was ≥130 mg/dL=0.66. Depending on the priorities of a health care system, higher absolute cut-points can be used for allocating health care resources to those at the highest risk. However, fewer cardiovascular events will be prevented and fewer patients who later experience cardiovascular events will be offered treatment despite acceptable numbers needed to treat to prevent one cardiovascular disease event. A hybrid absolute risk strategy incorporating family history and treated hypertension information appears to be superior to absolute risk strategies that do not include this information. [ABSTRACT FROM AUTHOR]