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Americans' best efforts not enough to cut heart disease deaths

Embargoed news from Annals of Internal Medicine

American College of Physicians

1. Americans' best efforts not enough to cut heart disease deaths

Five modifiable risk factors continue to account for half of cardiovascular deaths in U.S.

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Despite decades of progress in reducing cardiovascular mortality, preventable risk factors continue to account for half of heart disease deaths. The findings from national survey data are published in Annals of Internal Medicine.

Cardiovascular disease remains a leading cause of death nationally. The top five leading preventable risk factors for heart disease are elevated cholesterol, diabetes, hypertension, obesity, and smoking. Researchers studied data from Behavioral Risk Factor Surveillance System (BRFSS) national surveys from 2009 to 2010 to determine the extent to which national cardiovascular mortality could be expected to decrease if all states were successful at reducing those modifiable risk factor levels to specified target levels. The author report the fraction of cardiovascular deaths that could have been prevented in 2009 to 2010 under two scenarios: complete elimination of risk factors, and reduction of risk factors to the best achieved levels in U.S. states in 2009-2010 (a more realistic goal).

The data showed that about half of deaths could be prevented if the modifiable risk factors were completely eliminated. Fewer than 10 percent of cardiovascular deaths could be prevented if all states were to achieve risk factor levels observed in the best-performing states. The authors conclude that all states could benefit from more aggressive policies and programs to help reduce risk of death from heart disease.

Notes: For an embargoed PDF, please contact Angela Collom. To reach the lead author, Dr. Shivani Patel, please contact Melva Robertson at or 404-727-5692.

2. Harvard doc warns against lifting restrictions on marketing drugs for off-label use

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"The summer of 2015 could mark the beginning of a step back to the pre-1960s era for prescription drugs," warns Jerry Avorn M.D., Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, referencing the thalidomide tragedy of that era that prompted Congress to give the FDA new authority over regulating prescription drugs. This summer, the FDA will hold a public meeting to discuss whether its restrictions on what drug manufacturers can claim about their products improperly infringes the freedom of those companies. Under current rules, physicians are allowed to prescribe medicines for any condition they want, regardless of what the drug is approved to treat. However, drug companies are not allowed to promote their drugs for uses that have not been approved by the FDA. In a commentary published in Annals of Internal Medicine, Dr. Avorn suggests that lifting restrictions on marketing drugs for off-label use threatens the liberty of Americans who trust that medications prescribed to them have been properly studied and are proven reasonably safe and effective. He uses the marketing of dietary supplements as an example of the kind of "ludicrous" claims that could be expected if off-label marketing is not restricted.

Notes: For an embargoed PDF, please contact Angela Collom. To speak with Dr. Avorn, please contact Elaine St. Peter at or 617-525-6375.

3. ACP recommends six strategies for integrating of behavioral health into primary care

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The American College of Physicians (ACP) recommends six policy changes for integrating behavioral health into primary care. ACP's policy position paper, The Integration of Care for Mental Health, Substance Abuse and Other Behavioral Health Conditions into Primary Care, examines various approaches of delivering integrated care and offers a series of evidence-based policy recommendations to advance advocacy, research, and practice.

The authors note that treating the "whole person" requires addressing both physical and behavioral health. Most patients with behavioral health needs use the primary care office as their main source of care and given the nation's shortage of behavioral health providers, this may be the only setting in which behavioral health can be broadly recognized and treated. As such, ACP advocates changes to the health care system, as well as changes that will alter societal and cultural perceptions. An executive summary of ACP's recommendations can be accessed for free in Annals of Internal Medicine at

Notes: For an embargoed PDF, please contact Angela Collom. To speak with someone from ACP, please contact David Kinsman at

4. Hepatitis C virus may be much more prevalent than previously believed

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The national incidence of hepatitis C virus (HCV) infection may be underreported when current surveillance methods are used, according to an article published in Annals of Internal Medicine.

In 2010, the incidence of HCV infection in the United States was estimated to be 17,000 cases annually. The estimate is based on acute HCV cases reported to the Centers for Disease Control and Prevention (CDC) by local public health authorities. Researchers suggest that absence of symptomatic disease and lack of a specific laboratory test for acute infection may complicate diagnosis and surveillance of HCV.

The authors reviewed medical records from two hospitals and the state correctional health care system in Massachusetts to validate estimates of the incidence of acute HCV infection. They found that fewer than 1 percent of clinically diagnosed acute cases of HCV infection were reported to the CDC. The authors conclude that a reexamination of methods used for measuring the burden of HCV in the United States is necessary.

Notes: For an embargoed PDF, please contact Angela Collom. To reach the lead author, Dr. Arthur Kim, please contact Sue McGreevey at or 617-724-2764.

Also in this issue:

Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States

Soumitri Barua; Robert Greenwald, JD; Jason Grebely, PhD; Gregory J. Dore, MBBS, PhD; Tracy Swan; and Lynn E. Taylor, MD

Medicine and Public Issues


Limited Access to New Hepatitis C Virus Treatment Under State Medicaid Programs

Lauren A. Canary, MPH; R. Monina Klevens, DDS, MPH; and Scott D. Holmberg, MD, MPH

Ideas and Opinions


Hepatitis C Virus Treatment and Injection Drug Users: It Is Time to Separate Fact From Fiction

Elinore F. McCance-Katz, MD, PhD, and Ronald O. Valdiserri, MD, MPH

Ideas and Opinions


Clinical tool facilitates careful monitoring of patients receiving direct oral anticoagulants

David J. Gladstone, MD, PhD; William H. Geerts, MD; James Douketis, MD; Noah Ivers, MD, PhD; Jeff S. Healey, MD; and Kori Leblanc, PharmD

Ideas and Opinions


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