Search

To investigate associations of self-reported walking pace (SRWP) with relative and absolute risks of cause-specific mortality. In 391,652 UK Biobank participants recruited in 2006–2010, we estimated sex- and cause-specific (cardiovascular disease [CVD], cancer, other causes) mortality hazard ratios (HRs) and 10-year mortality risks across categories of SRWP (slow, average, brisk), accounting for confounders and competing risk. Censoring occurred in September 30, 2021 (England, Wales) and October 31, 2021 (Scotland). Over a median follow-up of 12.6 years, 22,413 deaths occurred. In women, the HRs comparing brisk to slow SRWP were 0.74 (95% CI: 0.67, 0.82), 0.40 (0.33, 0.49), and 0.29 (0.26, 0.32) for cancer, CVD, and other causes of death, respectively, and 0.71 (0.64, 0.78), 0.38 (0.33, 0.44), and 0.29 (0.26, 0.32) in men. Compared to CVD, HRs were greater for other causes (women: 39.6% [6.2, 72.9]; men: 31.6% [9.8, 53.5]) and smaller for cancer (−45.8% [−58.3, −33.2] and − 45.9% [−54.8, −36.9], respectively). For all causes in both sexes, the 10-year mortality risk was higher in slow walkers, but varied across sex, age, and cause, resulting in different risk reductions comparing brisk to slow: the largest were for other causes of death at age 75 years [women: −6.8% (−7.7, −5.8); men: −9.5% (−10.6, −8.4)]. Compared to slow walkers, brisk SRWP was associated with reduced cancer (smallest reduction), CVD, and other (largest) causes of death and may therefore be a useful clinical predictive marker. As absolute risk reductions varied across age, cause, and SRWP, certain groups may particularly benefit from interventions to increase SRWP. [ABSTRACT FROM AUTHOR]

The SAFEHEART tool has shown good discrimination in predicting cardiovascular events in a bespoke genotyped cohort with familial hypercholesterolaemia (FH). We assessed whether the tool could aid clinical decision making in an English routine care cohort with FH. A historical (2000–2017) open cohort of 3643 participants aged 18–79 years and ≥6-months since FH diagnosis was derived from the Clinical Practice Research Datalink. Individual 10-year cardiovascular risks were predicted using the SAFEHEART model, with multiple imputation used to manage missing data. Outcomes were the first occurrence of myocardial infarction, coronary revascularisation, ischaemic stroke, carotid revascularisation, peripheral arterial revascularisation, non-traumatic lower limb amputation, or cardiovascular death. Model performance was assessed using standard measures of calibration and discrimination, and decision curve analysis. 147 outcome events were observed over a median 3.73 (IQR 1.59–6.48) years follow-up. While the model had some discriminatory value (Harrell's c-statistic 0.67 (95% CI 0.61–0.72)), observed outcome risks departed substantially from predicted risks. Calibration slopes for men and women by age decile were 10.09 (95% CI 7.40–12.77) and 2.85 (1.25–4.45), respectively. Recalibration-in-the-large led to closer alignment of observed and predicted risks (recalibration slopes 3.48 (2.55–4.41) and 1.14 (0.50–1.79), respectively). Decision curve analysis suggested the recalibrated model had net benefit at predicted risks of 10–30%. The original SAFEHEART model has limited generalisability to the routinely identifiable English primary care FH population. With recalibration it appears to have moderate utility at 10–30% predicted risk. It may have greater validity in more bespoke genetically defined FH populations. [Display omitted] • There are no well validated cardiovascular risk prediction tools for people with familial hypercholesterolaemia. • The SAFEHEART model was recently developed in a bespoke genetically defined cohort. • Outcomes departed substantially from predicted risks in a routine English cohort. • A recalibrated model had moderate utility across the 10–30% predicted risk range. • The model would likely be of limited utility in current practice in England. [ABSTRACT FROM AUTHOR]

Background: High plasma lipoprotein(a) and high body mass index are both causal risk factors for calcific aortic valve disease.Objectives: This study sought to test the hypothesis that risk of calcific aortic valve disease is the highest when both plasma lipoprotein(a) and body mass index are extremely high.Methods: From the Copenhagen General Population Study, we used information on 69,988 randomly selected individuals recruited from 2003 to 2015 (median follow-up 7.4 years) to evaluate the association between high lipoprotein(a) and high body mass index with risk of calcific aortic valve disease.Results: Compared with individuals in the 1st to 49th percentiles for both lipoprotein(a) and body mass index, the multivariable adjusted HRs for calcific aortic valve disease were 1.6 (95% CI: 1.3-1.9) for the 50th to 89th percentiles of both (16% of all individuals) and 3.5 (95% CI: 2.5-5.1) for the 90th to 100th percentiles of both (1.1%) (P for interaction = 0.92). The 10-year absolute risk of calcific aortic valve disease increased with higher lipoprotein(a), body mass index, and age, and was higher in men than in women. For women and men 70-79 years of age with body mass index ≥30.0 kg/m2, 10-year absolute risks were 5% and 8% for lipoprotein(a) ≤42 mg/dL (88 nmol/L), 7% and 11% for 42-79 mg/dL (89-169 nmol/L), and 9% and 14% for lipoprotein(a) ≥80 mg/dL (170 nmol/L), respectively.Conclusions: Extremely high lipoprotein(a) levels and extremely high body mass index together conferred a 3.5-fold risk of calcific aortic valve disease. Ten-year absolute risk of calcific aortic valve disease by categories of lipoprotein(a) levels, body mass index, age, and sex ranged from 0.4% to 14%. [ABSTRACT FROM AUTHOR]

Introduction: The optimal length for clinical follow-up of renal cell carcinoma (RCC) patients is unclear. We evaluated the impact of ISUP/WHO tumor grade and histological subtype on short- and long-term survival and risk of recurrence/metastasis in a large cohort of RCC patients. Patients and Methods: We studied 1679 RCC patients from a single referral center in Italy. Adjusted hazard ratios for overall survival were estimated using Cox regression models. Adjusted absolute risk of developing recurrence or metastasis was computed considering competing risks of mortality. Results: During up to 13 years of follow-up, 175 (10.4%) RCC patients died, of whom 92% beyond 5 years. Hazard ratio of grade IV clear cell carcinomas (ccRCC) was 3.82 compared to grade II. Notably, 33% of recurrences and 56% of distant metastases occurred beyond 5 years of follow-up. The estimated probabilities of recurrence/metastasis were 15% and 45% within and beyond 5 years of follow-up, respectively. After 5 years, the absolute risk of recurrences increased also for papillary renal cell carcinoma type I (35.2%) and grade I ccRCC (17%). Conclusion: After 5 years of follow-up, both risk of mortality and recurrences or metastases were high and were modified by histological types and tumor grade. These data strongly support histology- and grade-tailored surveillance strategies and long-term follow-up for RCC patients. [ABSTRACT FROM AUTHOR]

Background Carotenoids represent 1 of few modifiable factors to reduce breast cancer risk. Elucidation of interactions between circulating carotenoids and genetic predispositions or mammographic density (MD) may help inform more effective primary preventive strategies in high-risk populations. Objectives We tested whether women at high risk for breast cancer due to genetic predispositions or high MD would experience meaningful and greater risk reduction from higher circulating levels of carotenoids in a nested case-control study in the Nurses' Health Studies (NHS and NHSII). Methods This study included 1919 cases and 1695 controls in a nested case-control study in the NHS and NHSII. We assessed both multiplicative and additive interactions. RR reductions and 95% CIs were calculated using unconditional logistic regressions, adjusting for matching factors and breast cancer risk factors. Absolute risk reductions (ARR) were calculated based on Surveillance, Epidemiology, and End Results incidence rates. Results We showed that compared with women at low genetic risk or low MD, those with higher genetic risk scores or high MD had greater ARRs for breast cancer as circulating carotenoid levels increase (additive P -interaction = 0.05). Among women with a high polygenic risk score, those in the highest quartile of circulating carotenoids had a significant ARR (28.6%; 95% CI, 14.8–42.1%) compared to those in the lowest quartile of carotenoids. For women with a high percentage MD (≥50%), circulating carotenoids were associated with a 37.1% ARR (95% CI, 21.7–52.1%) when comparing the highest to the lowest quartiles of circulating carotenoids. Conclusions The inverse associations between circulating carotenoids and breast cancer risk appeared to be more pronounced in high-risk women, as defined by germline genetic makeup or MD. [ABSTRACT FROM AUTHOR]

Background: Population screening and monitoring of cardiovascular risk is suboptimal in Australian primary care. The role of community pharmacy has increased considerably, but without any policy framework for development. The aim of this study was to explore the nature of community pharmacy-based screening models in Australia, capacity to increase delivery of pharmacy screening, and barriers and enablers to increasing capacity.Methods: An online survey weblink was emailed to pharmacy managers at every quality-accredited pharmacy in Australia by the Quality Pharmacy Care Program. The 122-item survey explored the nature of screening services, pharmacy capacity to deliver services, and barriers and enablers to service delivery in considerable detail. Adaptive questioning was used extensively to reduce the participant burden. Pharmacy location details were requested to facilitate geo-coding and removal of duplicate entries. A descriptive analysis of responses was undertaken.Results: There were 294 valid responses from 4890 emails, a 6% response rate. Most pharmacies (79%) had private counselling areas. Blood pressure assessment was nearly universal (96%), but other common risk factor assessments were offered by a minority. Most did not charge for assessments, and 59% indicated capacity to provide multiple risk factor assessments. Fewer than one in five (19%) reported any formal arrangements with general practice for care coordination. Financial viability was perceived as a key barrier to service expansion, amid concerns of patient willingness to pay. Support from government and non-governmental organisations for their role was seen as necessary.Conclusion: There appears to be a critical mass of pharmacies engaging in evidence-based and professional services. Considerable additional support appears required to optimise performance across the profession. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that common breast cancer risk alleles are associated with incidences of breast cancer and other cancers in the general population, and identify low risk women among those invited for screening mammography. Participants and methods: About 35 441 individuals from the Danish general population were followed in Danish health registries for up to 21 years after blood sampling. After genotyping 72 breast cancer risk loci, each with 0-2 alleles, the sum for each individual was calculated. We used the simple allele sum instead of the conventional polygenic risk score, as it is likely more sensitive in detecting associations with risks of other endpoints than breast cancer. Results: Breast cancer incidence in the 19 010 women was increased across allele sum quintiles (log-rank trend test; P=1×10-12), but not incidence of other cancers (P=0.41). Age- and study-adjusted hazard ratio for the fifth versus the first allele sum quintile was 1.82 (95% confidence interval; 1.53-2.18). Corresponding hazard ratios per allele were 1.04 (1.03-1.05) and 1.05 (1.02-1.08) for breast cancer incidence and mortality, similar across risk factors. In 50-year-old women, the starting age for screening mammography in Denmark, the average 5-year breast cancer risk was 1.5%, overall and 1.1%, 1.4%, 1.6%, 1.7%, 2.1%, for the first through fifth quintile, respectively. Based on age, nulliparity, familial history, and allele sum, 25% of women aged 50-69 years, and 94% of women aged 40-49 years, had absolute 5-year breast cancer risks≤1.5%. Using polygenic risk score led to similar results. Conclusion: Common breast cancer risk alleles are associated with incidence and mortality of breast cancer in the general population, but not with other cancers. After including breast cancer allele sum in risk assessment, 25% of women currently being offered screening mammography had an absolute 5-year risk below the cutoff of average risk for a 50-year-old woman. [ABSTRACT FROM AUTHOR]

Dimethyl fumarate (DMF), fingolimod, and teriflunomide are oral disease-modifying therapies (DMTs) indicated for the treatment of relapsing-remitting multiple sclerosis. Despite well-established limitations of cross-trial comparisons, DMTs are still frequently compared in terms of relative reductions in specific endpoints, most commonly annualized relapse rate. Consideration of absolute risk reduction and number needed to treat (NNT) provides an alternative approach to assess the magnitude of treatment effect and can provide valuable additional information on therapeutic gain. Using data from pivotal studies of DMF (DEFINE, NCT00420212; CONFIRM, NCT00451451), fingolimod (FREEDOMS, NCT00289978; FREEDOMS II, NCT00355134), and teriflunomide (TEMSO, NCT00134563; TOWER, NCT00751881), we calculated NNTs to prevent any relapse, more severe relapses (such as those leading to hospitalization or requiring intravenous corticosteroids), and disability worsening. Higher relative reductions were reported for DMF and fingolimod vs placebo on overall relapse and relapses requiring intravenous corticosteroids in both individual and pooled studies (pooled data unavailable for fingolimod). However, NNTs for each outcome were similar for DMF and teriflunomide, with marginally lower NNTs observed with fingolimod. By contrast, for relapses requiring hospitalization, relative reductions were higher and NNTs were substantially lower for teriflunomide compared with DMF. For fingolimod, there were inconsistent outcomes between the two studies for relapses requiring hospitalization; thus, comparative conclusions against DMF or teriflunomide cannot be clearly established. The risk of disability worsening was significantly reduced in both teriflunomide studies, but only in a single study for DMF (DEFINE) and fingolimod (FREEDOMS). NNTs to prevent one patient from experiencing disability worsening were similar in DEFINE, FREEDOMS, and TEMSO and TOWER but were higher in CONFIRM and FREEDOMS II. This NNT analysis demonstrates broadly comparable effects for DMF, fingolimod, and teriflunomide across key clinical outcomes. These observations are clinically relevant and may help to inform treatment decisions by providing additional information on therapeutic gain beyond informal assessments of relative reductions alone. [ABSTRACT FROM AUTHOR]

Abstract: Since 2001, the International Society for Clinical Densitometry Official Position has been to use a young female normative database in women and a young male normative in men for T-scores. Several prospective studies have shown that men and women with identical hip bone mineral density (BMD) have the same fracture rates, and so there has been reconsideration of whether female reference data should be adopted for men. We studied 4691 men age 50 yr and older with baseline dual-energy X-ray absorptiometry assessments to explore how a change in BMD reference data from male to female would affect the number of men meeting National Osteoporosis Foundation (NOF) intervention criteria. We found that use of male vs female BMD reference data for T-score calculation did affect individual eligibility criteria for treatment under the NOF guidelines, but that overall differences in treatment rates were small when eligibility for treatment considered any of the NOF intervention criteria. Specifically, the majority of men who no longer qualified for treatment based upon T-scores calculated from female as opposed to male reference data would still qualify for treatment based upon other NOF intervention criteria. In addition, men only eligible for treatment under NOF criteria when using male reference data were at low fracture risk. We conclude that choice of male or female reference data for T-score calculation in men has little effect on overall treatment eligibility rates under NOF guidelines. [Copyright &y& Elsevier]

Abstract: Background: We determined the predictive power of tobacco smoking on aortic aneurysm as opposed to other risk factors in the general population. Methods: We recorded tobacco smoking and other risk factors at baseline, and assessed hospitalization and death from aortic aneurysm in 15,072 individuals from the Copenhagen City Heart Study followed for up to 34years and in 56,211 individuals from the Copenhagen General Population Study followed for up to 7years. Results: During follow-up, 335 and 169 individuals developed aortic aneurysm outcomes in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic aneurysm in males and females consuming above 20g tobacco daily was 3.5% and 1.3%, among those >60years with plasma cholesterol >5mmol/L and a systolic blood pressure >140mmHg. Conclusions: Tobacco smoking is the most important predictor of future aortic aneurysm outcomes in the general population, with population attributable risks at or above 47%. [Copyright &y& Elsevier]

Abstract: Ratio estimators of effect are ordinarily obtained by exponentiating maximum-likelihood estimators (MLEs) of log-linear or logistic regression coefficients. These estimators can display marked positive finite-sample bias, however. We propose a simple correction that removes a substantial portion of the bias due to exponentiation. By combining this correction with bias correction on the log scale, we demonstrate that one achieves complete removal of second-order bias in odds ratio estimators in important special cases. We show how this approach extends to address bias in odds or risk ratio estimators in many common regression settings. We also propose a class of estimators that provide reduced mean bias and squared error, while allowing the investigator to control the risk of underestimating the true ratio parameter. We present simulation studies in which the proposed estimators are shown to exhibit considerable reduction in bias, variance, and mean squared error compared to MLEs. Bootstrapping provides further improvement, including narrower confidence intervals without sacrificing coverage. [Copyright &y& Elsevier]

Abstract: The WHO fracture risk assessment tool (FRAX®) estimates an individual’s 10-yr major osteoporotic and hip fracture probabilities using a tool customized to the fracture epidemiology of a specific population. Incorrect model calibration could therefore affect performance of the model in clinical practice. The current analysis was undertaken to explore how simulated miscalibration in the FRAX® tool would affect the numbers of individuals meeting specific intervention criteria (10-yr major osteoporotic fracture probability ≥20%, 10-yr hip fracture probability ≥3%). The study cohort included 36,730 women and 2873 men aged 50yr and older with FRAX® probability estimates using femoral neck bone mineral density. We simulated relative miscalibration error in 10% increments from −50% to +50% relative to a correctly calibrated FRAX® model. We found that small changes in model calibration (even on the order of 10%) had large effects on the number of individuals qualifying for treatment. There was a steep gradient in the relationship between relative change in calibration and relative change in intervention rates: for every 1% change in calibration, there was a 2.5% change in intervention rates for women and 4.1% for men. For hip fracture probability, the gradient of the relationship was closer to unity. These results highlight the importance of FRAX® model calibration, and speak to the importance of using high-quality fracture epidemiology in constructing FRAX® tools. [Copyright &y& Elsevier]

Abstract: Background: An important aspect of cost-effectiveness analysis of osteoporosis is to accurately model the fracture risk and mortality related to the patient groups in the analysis. The estimation of fracture risk is based on a number of factors, such as the level of general risk of the normal population, the effect of treatment and the prevalence of clinical risk factors (CRFs) for fracture. Fracture risk has traditionally been calculated with risk adjustments based on age, bone mineral density and prior vertebral fracture. The treatment effect has been derived from clinical trials and, in the absence of subgroup analyses, the same efficacy has been assumed irrespective of the fracture risk of the population. The FRAX® tool enables the estimation of risk based on a wider range of risk factors, and treatment efficacy that is dependent on the level of risk in the analyzed population. The objective was to describe the implementation of the FRAX® algorithms into health economic osteoporosis models and to highlight how it differs from traditional risk assessment. Methods: The selective estrogen receptor modulator, bazedoxifene, was evaluated in a Swedish setting with traditional and FRAX®-based risk assessment in a previously developed Markov model that included fractures and thromboembolic events, and also was adapted to accommodate risk-dependent efficacy, which is available for bazedoxifene. Results: The traditional approach gave lower ICERs at ages up to 60 years compared to the FRAX® method when only considering age, BMD and prior fracture. At 70years and older and when adding more CRFs with the FRAX® approach, the FRAX® ICER decreased and fell below the traditional approach. The risk dependant efficacy was the main reason for lower ICERs with FRAX® in women at higher risk of fracture. Discussion: FRAX® applied in cost-effectiveness analyses is a more granular method for the estimation of fracture risk, mortality and efficacy compared to previous approaches that can also improve case finding. Furthermore, it facilitates the estimation of cost-effectiveness for various types of patients with different combinations of CRFs, which more closely matches patients in clinical practice. [Copyright &y& Elsevier]

Abstract: A simplified (semiquantitative) approach developed by the Canadian Association of Radiologists and Osteoporosis Canada (denoted as CAROC) for absolute fracture risk assessment incorporates age, sex, prior fragility fracture, and systemic corticosteroid use, together with bone mineral density (BMD) to define absolute fracture risk. The CAROC system has been shown to predict fracture rates in women referred for clinical BMD testing, but it is uncertain how this system performs in routine clinical practice in men who are much less likely to undergo BMD testing with potential for referral biases. Thirty-six thousand seven hundred and thirty women and 2873 men aged 50yr or older at the time of baseline BMD testing were identified in a database containing all clinical dual-energy X-ray absorptiometry test results for the Province of Manitoba, Canada. Population-based health service records from 1987 to 2008 were assessed for fracture codes and medication use. Fracture risk under the CAROC model was categorized as low (<10%), moderate (10–20%), or high (>20%). Ten-year fracture risk estimated by the Kaplan-Meier method showed the same gradient in observed fracture risk for men and women. Despite evidence of greater referral bias in men resulting in a higher rate of clinical risk factors, the performance of the prediction algorithm was not affected. [Copyright &y& Elsevier]

Abstract: The role of quantitative ultrasound (QUS) in clinical practice is debatable. An unanswered question is that whether combining QUS and BMD measurements could improve the prediction of fracture risk. We examined this in a sample of men and women in the European Prospective Investigation into Cancer (EPIC)-Norfolk who had both heel QUS and hip DXA between 1995 and 1997 and were followed for any incident fracture up to 2007. From 1455 participants (703 men) aged 65–76 years at baseline, 79 developed a fracture over 10.3±1.4 years of follow-up. Two separate sex-stratified Cox proportional-hazard models were used including clinical risk factors and total hip BMD. Heel broadband ultrasound attenuation (BUA) was also included in the second model. Global measures of model fit, area under ROC curve, and the Hosmer–Lemeshow statistic showed relative superiority of the model including BUA. Using each model, we calculated 10-year absolute risk of fracture for all participants and categorized them in groups of <5%, 5% to <15%, and ≥15%. Comparison of groupings showed a total re-classification of 16.6% of participants after inclusion of BUA with the greatest re-classification (30.7%) among the group with intermediate risk. Adding a QUS measurement to models based on clinical risk factors and BMD improves the predictive power of models and suggests that further attention should be paid to QUS as a clinical tool for fracture risk assessment. [Copyright &y& Elsevier]

Abstract: Introduction: Absolute 10-year fracture risk is the preferred method for fracture risk assessment. The validity of applying published fracture rates from one population to another population is uncertain. Methods: 20,579 women age 47.5 years or older at the time of baseline femoral neck bone mineral density (BMD) were identified in a database containing all clinical DXA results for the Province of Manitoba, Canada. Individual 10-year fracture risk was predicted from age-only and age plus femoral neck T-score using published 10-year fracture risk for Swedish women. Health service records were assessed for the presence of non-trauma ‘osteoporotic’ fracture codes (hip, clinical spine, wrist, humerus) subsequent to BMD testing (86,447 person-y follow up, 1173 patients with osteoporotic fractures). Fracture rates were derived for subgroups stratified by age (5-year strata) and estimated risk (5% strata). 10-year fracture rates were computed directly by the Kaplan–Meier method (10-year continuous data) and by the actuarial method (two 5-year periods with adjustments for aging, death and expected BMD loss). Results: Direct and actuarial methods gave nearly identical point estimates, but the latter were more precise. There was a strong linear correlation between predicted and observed fracture rates based upon age-only (r = 0.95) and age plus BMD (r = 0.99). For age strata 50 to 75, and for estimated risk strata from 0–5% to 20–25%, the confidence intervals overlapped the line of identity. For women age >77.5 or estimated risk >25%, observed exceeded estimated fracture rates. This is explained by healthy selection bias whereby elderly women referred for BMD testing have lower mortality than expected, hence more years at risk for fracture. Corrected for survival bias, women age >77.5 had observed fracture rates no different than predicted. Conclusion: Swedish 10-year fracture risk data are generally applicable to the Canadian female population referred for clinical BMD testing, though fracture rates were underestimated in the oldest and highest risk subgroups due to healthy selection bias. [Copyright &y& Elsevier]

Abstract: The relation between fracture risk and bone mineral density (BMD) is commonly expressed as a multiplicative factor which is said to represent the increase in risk for each standard deviation fall in BMD. This practice assumes that risk increases multiplicatively with each unit fall in bone density, which is not correct. Although odds increase multiplicatively, absolute risk, which lies between 0 and 1, cannot do so though it can be derived from odds by the term Odds/(1+Odds). This concept is illustrated in a prospective study of 1098 women over age 69 followed for 6 years in a calcium trial in which hip BMD was measured in the second year. 304 Women (27.6%) had prevalent fractures and 198 (18.1%) incident fractures with a significant association between them (P 0.005). Age-adjusted hip BMD and T-score were significantly lower in those with prevalent fractures than in those without (P 0.003) and significantly lower in those with incident fractures than in those without (P 0.001). When the data were analysed by univariate logistic regression, the fracture odds at zero T-score were 0.130 and the rise in odds for each unit fall in hip T-score was 1.55. When these odds were converted to risks, there was a progressive divergence between odds and risk at T-scores below zero. Multiple logistic regression yielded significant odds ratios of 1.47 for each 5-year increase in age, 1.47 for prevalent fracture and 1.49 for each unit fall in hip T-score. Calcium therapy was not significant. Poisson regression, logistic regression and Cox''s proportional hazards yielded very similar outcomes when converted into absolute risks. A nomogram was constructed to enable clinicians to estimate the approximate 6-year fracture risk from hip T-score, age and prevalent fracture which can probably be applied (with appropriate correction) to men as well as to women. We conclude that multiplicative factors can be applied to odds but not to risk and that multipliers of risk tend to overstate the effect of continuous variables, such as age and T-score, particularly towards the end of their ranges. [Copyright &y& Elsevier]

Abstract: Objective: To assess the effectiveness of absolute risk, relative risk, and number needed to harm formats for medicine side effects, with and without the provision of baseline risk information. Methods: A two factor, risk increase format (relative, absolute and NNH)×baseline (present/absent) between participants design was used. A sample of 268 women was given a scenario about increase in side effect risk with third generation oral contraceptives, and were required to answer written questions to assess their understanding, satisfaction, and likelihood of continuing to take the drug. Results: Provision of baseline information significantly improved risk estimates and increased satisfaction, although the estimates were still considerably higher than the actual risk. No differences between presentation formats were observed when baseline information was presented. Without baseline information, absolute risk led to the most accurate performance. Conclusion: The findings support the importance of informing people about baseline level of risk when describing risk increases. In contrast, they offer no support for using number needed to harm. Practice implications: Health professionals should provide baseline risk information when presenting information about risk increases or decreases. More research is needed before numbers needed to harm (or treat) should be given to members of the general populations. [Copyright &y& Elsevier]

Abstract: Accurate risk estimates for individuals with a family history of colorectal cancer are important for surveillance strategies. We systematically reviewed the literature on familial risks of colorectal cancer to determine relative risk estimates for categories of family history and translated these relative risk estimates into absolute risk estimates. A random-effects meta-analysis pooled the effect estimates from individual studies and actuarial life-table methods converted relative into absolute risks. Fifty-nine studies were identified including 47 that estimated the relative risk of developing colorectal cancer given at least one affected first-degree relative. The pooled risk estimate was 2.24 (95% CI 2.06 to 2.43) which rose to 3.97 (95% CI 2.60 to 6.06) with at least two affected relatives. A population lifetime risk of 1.8% for a 50-year old increased to 3.4% (95% CI 2.8 to 4.0) with at least one affected relative or 6.9% (95% CI 4.5 to 10.4) with two or more. Accurate absolute risk estimates show how cancer risks vary over time, particularly by pattern of family history and age of individual at-risk. [Copyright &y& Elsevier]

Japan Atherosclerosis Society (JAS) published Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases 2002. According to the global risk, the patients are categorized into six groups in the guidelines. The global risks in ATP III is 5–10 times higher than JAS guidelines. For this reason, clinical guidelines for prevention of Coronary heart disease (CHD) must be adapted and modified according to national and regional requirements. [Copyright &y& Elsevier]