Phil Mendys

Glycogen phosphorylase inhibitors for treatment of type 2 diabetes mellitus

Type 2 diabetes mellitus is a severe disease with large economic consequences, which is significantly under-diagnosed and incompletely treated in the general population. Control of blood glucose levels is a key objective in treating diabetic patients, who are most often prescribed one or more oral hypoglycaemic agents in addition to diet and exercise modification as well as insulin. In spite of the availability of different classes of hypoglycaemic drugs, treatment regimens are often unable to achieve an intensive degree of glucose control known to most effectively reduce the incidence and severity of diabetic complications. Hepatic glucose output is elevated in type 2 diabetic patients and current evidence indicates that glycogenolysis (release of monomeric glucose from the glycogen polymer storage form) is an important contributor to the abnormally high production of glucose by the liver. Glycogen phosphorylase is the enzyme that catalyses this release and recent advances in new inhibitors of this structurally and kinetically well studied enzyme have enabled work which further delineate the pharmacological and physiological consequences of inhibiting glucose production by this pathway. Most notably, these agents lower glucose in diabetic animal models, both acutely and chronically, appear to affect both gluconeogenic and glycogenolytic pathways and demonstrate potential for a beneficial effect on cardiovascular risk factors. Cumulatively, this information has bolstered interest and promise in glycogen phosphorylase inhibitors (GPIs) as potential new hypoglycaemic agents for treatment of type 2 diabetes mellitus.

Medication adherence: a call for action.

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.

Misperception among physicians and patients regarding the risks and benefits of statin treatment: the potential role of direct-to-consumer advertising

BACKGROUND Statins are commonly used to reduce the risk of heart attacks and strokes. Despite the benefit and limited risks in properly identified patients, clinicians are often challenged by patient acceptance and adherence to these medications. OBJECTIVES To assess if patients and physicians may have unfounded safety concerns about hepatotoxicity from these medications, we surveyed physicians and patients. RESULTS We found inconsistent liver function-monitoring practices as well as exaggerated fears of statin-induced hepatotoxicity. Patients who received risk information from their physician were more likely to accurately estimate hepatotoxic risk than patients receiving such information from other sources. CONCLUSIONS We believe these misperceptions about the relative risk and benefits of statin therapy are propagated by direct-to-consumer advertising, which may emphasize potential adverse events relative to treatment benefits. These perceptions are likely to adversely affect statin adherence, and may be addressed by patient education.

Improving Cardiovascular Risk Reduction for Primary Prevention—Utility of Lifetime Risk Assessment

Abstract The objective of this article is to review the evidence basis for short-term risk assessments of overall coronary heart disease (CHD) burden as compared with lifetime risk estimates of CHD, based on the current medical literature. We reviewed literature published in the last 6 years using the terms “cardiovascular prevention,” “Framingham risk scoring,” “lifetime risk,” and “cardiovascular risk assessment,” and subsequently evaluated 98 publications to determine the variation in these approaches to estimate cardiovascular risk factors and impact on clinical decision making. The current evidence base suggests that lifetime risk estimates offset the significant impact of age on traditional, short-term risk estimates of cardiovascular risk. We conclude that the use of lifetime risk estimates may be more clinically meaningful than traditional, short-term risk estimates to assess an individuals overall risk burden, and may prevent the potential delay of therapeutic interventions to reduce cardiovascular events. For primary care, this difference may be of relevance to patients and should be communicated to them.

Medication adherence: process for implementation

Improving medication adherence is a critically important, but often enigmatic objective of patients, providers, and the overall health care system. Increasing medication adherence has the potential to reduce health care costs while improving care quality, patient satisfaction and health outcomes. While there are a number of papers that describe the benefits of medication adherence in terms of cost, safety, outcomes, or quality of life, there are limited reviews that consider how best to seamlessly integrate tools and processes directed at improving medication adherence. We will address processes for implementing medication adherence interventions with the goal of better informing providers and health care systems regarding the safe and effective use of medications.

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

Medication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions.

Stroke prevention in atrial fibrillation: Closing the gap

Stroke prevention in atrial fibrillation: Closing the gap Sean D. Pokorney, MD, MBA, a Bernard J. Gersh, MB, ChB, b Azhar Ahmad, MD, c Sana M. Al-Khatib, MD, MHS, a Melanie Blank, MD, d Megan Coylewright, MD, MPH, e Peter DiBattiste, MD, f Jeff S. Healey, MD, g Olaf Hedrich, MD, h Elaine M. Hylek, MD, MPH, i Eva Kline-Rogers, RN, NP, j Eric D. Peterson, MD, MPH, a Phil Mendys, PharmD, k Michael J. Mirro, MD, l Gerald Naccarelli, MD, Parashar Patel, MPA, h Christian T. Ruff, MD, MPH, n Howard Rutman, MD, o Norman Stockbridge, MD, PhD, d Robert Temple, MD, d and Christopher B. Granger, MD a Durham, Chapel Hill, NC; Rochester, MN; Ridgefield, CT; Silver Spring, MD; Lebanon, NH; Raritan, Basking Ridge, NJ; Ontario, Canada; Marlborough, Boston, MA; Ann Arbor, MI; and Hershey, PA