التفاصيل البيبلوغرافية
| العنوان: |
Individualized Cardiovascular Disease Prevention: Prediction of risk and treatment effect |
| المؤلفون: |
Leeuw, J. van der |
| المساهمون: |
Visseren, F.L.J., Graaf, Y. van der |
| بيانات النشر: |
Utrecht University |
| سنة النشر: |
2014 |
| مصطلحات موضوعية: |
Geneeskunde, individualized medicine, medical decision-making, heterogeneity, net benefit, cardiovasular disease, diabetes |
| الوصف: |
In the present era of evidence-based medicine, the study of groups is the dominant paradigm to establish causes of disease and to determine the efficacy of treatment. The results of these studies are usually presented as average group-level estimates, which are not informative of the individual patient’s effect. Clinicians are faced with the challenge to translate the evidence from such large (intervention) studies to the care for individual patients in clinical practice. Blood pressure-lowering, cholesterol-lowering and antiplatelet therapy can reduce the risk of adverse cardiovascular outcomes at a group level. However, some patients will benefit more than average, while others do not benefit or may even be harmed. We used data from large randomized controlled trials to develop multifactorial prediction models to estimate the absolute effect of treatment for individual patients. In a large clinical trial evaluating the effect of routine blood pressure-lowering treatment and intensive glucose control in type 2 diabetes, we demonstrated a wide distribution in treatment effect for individual patients. A proportion of 43% of trial participants was identified to have a large 5-year absolute risk reduction of cardiovascular events with blood pressure (BP)-lowering treatment. On the other hand, the absolute effect of BP-lowering was small in 17% of patients. Intensive glucose control reduced the risk of vascular events but increased the risk of severe hypoglycaemia at a group level. We quantified the beneficial and adverse effects of treatment at a patient-specific level and showed that the majority of patients had a positive net effect of intensive glucose control. Further, we investigated the individual effects of angiotensin converting enzyme-inhibition in a large clinical trial in patients with stable coronary artery disease. A prediction algorithm based on clinical and genetic characteristics was able to identify 27% of patients with a zero or adverse treatment effect, whereas 28% of patients had a large ... |
| نوع الوثيقة: |
doctoral or postdoctoral thesis |
| وصف الملف: |
image/pdf |
| اللغة: |
English |
| العلاقة: |
https://dspace.library.uu.nl/handle/1874/301059Test |
| الإتاحة: |
https://dspace.library.uu.nl/handle/1874/301059Test |
| حقوق: |
info:eu-repo/semantics/OpenAccess |
| رقم الانضمام: |
edsbas.985B775E |
| قاعدة البيانات: |
BASE |
