human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To derive a new cardiovascular disease risk score ( QRISK ) for the United Kingdom and to vali date its performance against the established Framingham cardiovascular disease algorithm and a newly developed Scottish score ( ASSIGN ) . Design Prospect i ve open cohort study using routinely collected data from general practice . Setting UK practice s contributing to the Q RESEARCH data base . Participants The derivation cohort consisted of 1.28 million patients , aged 35 - 74 years , registered at 318 practice s between 1 January 1995 and 1 April 2007 and who were free of diabetes and existing cardiovascular disease . The validation cohort consisted of 0.61 million patients from 160 practice s. Main outcome measures First recorded diagnosis of cardiovascular disease ( incident diagnosis between 1 January 1995 and 1 April 2007 ) : myocardial infa rct ion , coronary heart disease , stroke , and transient ischaemic attacks . Risk factors were age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol to high density lipoprotein , body mass index , family history of coronary heart disease in first degree relative aged less than 60 , area measure of deprivation , and existing treatment with antihypertensive agent . Results A cardiovascular disease risk algorithm ( QRISK ) was developed in the derivation cohort . In the validation cohort the observed 10 year risk of a cardiovascular event was 6.60 % ( 95 % confidence interval 6.48 % to 6.72 % ) in women and 9.28 % ( 9.14 % to 9.43 % ) in men . Overall the Framingham algorithm over-predicted cardiovascular disease risk at 10 years by 35 % , ASSIGN by 36 % , and QRISK by 0.4 % . Measures of discrimination tended to be higher for QRISK than for the Framingham algorithm and it was better calibrated to the UK population than either the Framingham or ASSIGN models . Using QRISK 8.5 % of patients aged 35 - 74 are at high risk ( 20 % risk or higher over 10 years ) compared with 13 % when using the Framingham algorithm and 14 % when using ASSIGN . Using QRISK 34 % of women and 73 % of men aged 64 - 75 would be at high risk compared with 24 % and 86 % according to the Framingham algorithm . UK estimates for 2005 based on QRISK give 3.2 million patients aged 35 - 74 at high risk , with the Framingham algorithm predicting 4.7 million and ASSIGN 5.1 million . Overall , 53 668 patients in the validation data set ( 9 % of the total ) would be reclassified from high to low risk or vice versa using QRISK compared with the Framingham algorithm . Conclusion QRISK performed at least as well as the Framingham model for discrimination and was better calibrated to the UK population than either the Framingham model or ASSIGN . QRISK is likely to provide more appropriate risk estimates to help identify high risk patients on the basis of age , sex , and social deprivation . It is therefore likely to be a more equitable tool to inform management decisions and help ensure treatments are directed towards those most likely to benefit . It includes additional variables which improve risk estimates for patients with a positive family history or those on antihypertensive treatment . However , since the validation was performed in a similar population to the population from which the algorithm was derived , it potentially has a “ home advantage . ” Further validation in other population s is therefore required Objectives Hypertension is common among patients with dyslipidemia but is often poorly treated . The objective of this analysis was to evaluate how a decision aid , used by primary care physicians to improve lipid therapy , impacted on the treatment of hypertension . Study Design Data were analyzed from patients enrolled in a r and omized trial focusing primarily on the treatment of dyslipidemia . Patients received usual care or a coronary risk profile every three months to monitor the risk reduction following lifestyle changes and /or pharmacotherapy to treat dyslipidemia . Hypertension management was assessed based on a post hoc analysis of individuals whose blood pressure exceeded current national hypertension guidelines . Results There were 2,631 subjects who completed the study . Among 1,352 patients without diagnosed hypertension , 30 % were above target on at least three consecutive visits . Among 1,279 individuals with known hypertension , 69 % were above target on at least two consecutive visits . Overall , patients receiving risk profiles were more likely to receive appropriate antihypertensive therapy  ( OR = 1.40 , 95 % CI 1.11 – 1.78 ) compared to those receiving usual care . After adjustment for inter-physician variability and potential confounders , the use of the risk profile was associated with an increased likelihood of starting therapy ( OR = 1.78 , 95 % CI 1.06 – 3.00 ) or modifying therapy ( OR = 1.40 , 95 % CI 1.03 – 1.91 ) . Conclusions In this clinical trial of dyslipidemia management , inadequately controlled hypertension was common , occurring in nearly 50 % of individuals . Ongoing coronary risk assessment was associated with more appropriate blood pressure management . Cardiovascular risk assessment decision aids should be further evaluated in a r and omized trial of hypertension therapy Cardiovascular disease causes the death of around 80 % of patients with type 2 diabetes.1 However , risk factors for cardiovascular disease in such patients are often untreated2 despite the proved benefits of intervention . 3 4 One way to help clinicians identify patients at high risk of cardiovascular disease is to use cardiovascular primary prevention risk tables . These tables integrate the multiple risk factors into a single score . We did a pilot study to test the hypothesis that documentation of a  cardiovascular risk score in the case notes would improve the management of cardiovascular risk factors . We recruited patients with type 2 diabetes who had no history of cardiovascular disease or renal disease . All patients were aged 35–75 years and attending a hospital OBJECTIVES Based on the data of the Prospect i ve Cardiovascular Münster ( PROCAM ) study , a prospect i ve study of men and women at work in the north-west of Germany , we aim ed ( i ) to develop a refined scoring scheme for calculating the risk of acute coronary events among adult and elderly men and women ; and ( ii ) to generate a new scoring scheme for calculating the risk of ischaemic stroke or transient ischaemic attack ( TIA ) . METHODS The coronary risk score was derived from a Weibull function using data from 18 460 men and 8515 women who were recruited before 1996 and had a mean follow-up period of 12+/-6 years . The stroke score was derived using a Cox proportional hazards model using data of 5905 men and 2225 women aged 35 - 65 years with at least 10 years of unbroken follow-up . RESULTS The coronary risk score was based on 511 major coronary events , 462 ( 168 fatal , 294 non-fatal ) in men and 49 ( 18 fatal , 31 non-fatal ) in women and included the risk factors LDL cholesterol , HDL cholesterol , systolic blood pressure , smoking status , triglycerides and diabetes mellitus status . It was accurate in both sexes over an age range from 20 to 75 years with an area under the receiver-operating characteristics ( ROC ) curve of 0.82 . The stroke score was based on 85 cerebral ischaemic events ( 21 TIAs , 64 ischaemic strokes ) and included the risk factors age , sex , diabetes mellitus status , smoking status and systolic blood pressure . It had an area under the ROC curve of 0.78 and identified a high-risk group comprising only 4 % of the study population that contained 31 % of all cerebral ischaemic events . CONCLUSION Both new PROCAM risk scores provide simple and effective ways to assess the risk of acute coronary events and ischaemic stroke in the general population and will improve the ability of physicians to target measures in an effort to prevent these potentially devastating conditions BACKGROUND The Coronary Health Assessment Study ( CHAS ) was developed to determine the feasibility of using patient-specific , multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD . METHODS Study participants included 253 community based physicians , r and omized into profile and control groups , and 958 of their patients . The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback . The control group received their profiles only if the patient was clinical ly reevaluated during a 3-month follow-up visit . Patients ' coronary risk factors were evaluated at baseline and at follow-up . RESULTS The profile group had a significantly higher ( P < 0.05 ) ratio of high-risk/low-risk patients who returned for a follow-up visit compared to the control group ( 1.23 vs 0.77 ) . The patients in the profile group also had significantly ( P < 0.05 ) greater mean reductions in total cholesterol ( -0.5 vs -0.1 mmol/L ) , LDL cholesterol ( -0.4 vs 0.0 mmol/L ) , the total cholesterol/ HDL ratio ( -0.6 vs -0.2 ) , and the predicted 8-year coronary risk ( -1.8 vs -0.3 % ) . CONCLUSIONS Computer-generated coronary risk profiles can be effective in assisting physicians to identify high-risk patients . Their use is also associated with significantly greater improvements in the serum lipid profiles and the overall coronary risk of these patients Objective : To improve equity in cardiovascular disease prevention by developing a cardiovascular risk score including social deprivation and family history . Design : The ASSIGN score was derived from cardiovascular outcomes in the Scottish Heart Health Extended Cohort ( SHHEC ) . It was tested against the Framingham cardiovascular risk score in the same data base . Setting : R and om- sample , risk-factor population surveys across Scotl and 1984–87 and North Glasgow 1989 , 1992 and 1995 . Participants : 6540 men and 6757 women aged 30–74 , initially free of cardiovascular disease , ranked for social deprivation by residence postcode using the Scottish Index of Multiple Deprivation ( SIMD ) and followed for cardiovascular mortality and morbidity through 2005 . Results : Classic risk factors , including cigarette dosage , plus deprivation and family history but not obesity , were significant factors in constructing ASSIGN scores for each sex . ASSIGN scores , lower on average , correlated closely with Framingham values for 10-year cardiovascular risk . Discrimination of risk in the SHHEC population was significantly , but marginally , improved overall by ASSIGN . However , the social gradient in cardiovascular event rates was inadequately reflected by the Framingham score , leaving a large social disparity in future victims not identified as high risk . ASSIGN classified more people with social deprivation and positive family history as high risk , anticipated more of their events , and abolished this gradient . Conclusion : Conventional cardiovascular scores fail to target social gradients in disease . By including unattributed risk from deprivation , ASSIGN shifts preventive treatment towards the socially deprived . Family history is valuable not least as an approach to ethnic susceptibility . ASSIGN merits further evaluation for clinical use AIMS To estimate the potential effectiveness of different " high-risk " and " population " approaches to the primary prevention of  cardiovascular disease ( CVD ) in middle-aged British men , after correction for regression dilution bias . METHODS AND RESULTS We used a combination of cohort and r and omised controlled trial evidence to estimate the effectiveness of high-risk strategies , based on the identification of high-risk factors or high absolute risk , and strategies based on population -wide reductions in cholesterol and blood pressure . High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population . Aggressive pharmacological treatment ( using statins , beta-blockers , ACE-inhibitors and aspirin ) in individuals with a 10-year Framingham event risk of > or=30 % ( 6 % of population ) would have reduced major CVD by at most 11 % . This figure increased to 34 % at a > or=20 % treatment threshold ( 26 % of population ) . In contrast , modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD . Taking regression dilution bias into account , 10 % reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45 % . CONCLUSIONS If high-risk strategies are to have a major impact on CVD in the population , they need to be more widely used than previously envisaged . Population -wide reduction of major risk factors is needed if CVD is to be substantially reduced CONTEXT Despite improved underst and ing of atherothrombosis , cardiovascular prediction algorithms for women have largely relied on traditional risk factors . OBJECTIVE To develop and vali date cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors . DESIGN , SETTING , AND PARTICIPANTS Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years ( through March 2004 ) for incident cardiovascular events ( an adjudicated composite of myocardial infa rct ion , ischemic stroke , coronary revas 
    Output:
    
agent
The heterogeneity of the studies limited the analysis , but together they showed that provision of risk information to patients improved the accuracy of risk perception without decreasing quality of life or increasing anxiety , but had little effect on lifestyle .
There seems evidence that providing CVD risk model estimates to professionals and patients improves perceived CVD risk and medical prescribing , with little evidence of harm on psychological well-being
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To derive a new cardiovascular disease risk score ( QRISK ) for the United Kingdom and to vali date its performance against the established Framingham cardiovascular disease algorithm and a newly developed Scottish score ( ASSIGN ) . Design Prospect i ve open cohort study using routinely collected data from general practice . Setting UK practice s contributing to the Q RESEARCH data base . Participants The derivation cohort consisted of 1.28 million patients , aged 35 - 74 years , registered at 318 practice s between 1 January 1995 and 1 April 2007 and who were free of diabetes and existing cardiovascular disease . The validation cohort consisted of 0.61 million patients from 160 practice s. Main outcome measures First recorded diagnosis of cardiovascular disease ( incident diagnosis between 1 January 1995 and 1 April 2007 ) : myocardial infa rct ion , coronary heart disease , stroke , and transient ischaemic attacks . Risk factors were age , sex , smoking status , systolic blood pressure , ratio of total serum cholesterol to high density lipoprotein , body mass index , family history of coronary heart disease in first degree relative aged less than 60 , area measure of deprivation , and existing treatment with antihypertensive agent . Results A cardiovascular disease risk algorithm ( QRISK ) was developed in the derivation cohort . In the validation cohort the observed 10 year risk of a cardiovascular event was 6.60 % ( 95 % confidence interval 6.48 % to 6.72 % ) in women and 9.28 % ( 9.14 % to 9.43 % ) in men . Overall the Framingham algorithm over-predicted cardiovascular disease risk at 10 years by 35 % , ASSIGN by 36 % , and QRISK by 0.4 % . Measures of discrimination tended to be higher for QRISK than for the Framingham algorithm and it was better calibrated to the UK population than either the Framingham or ASSIGN models . Using QRISK 8.5 % of patients aged 35 - 74 are at high risk ( 20 % risk or higher over 10 years ) compared with 13 % when using the Framingham algorithm and 14 % when using ASSIGN . Using QRISK 34 % of women and 73 % of men aged 64 - 75 would be at high risk compared with 24 % and 86 % according to the Framingham algorithm . UK estimates for 2005 based on QRISK give 3.2 million patients aged 35 - 74 at high risk , with the Framingham algorithm predicting 4.7 million and ASSIGN 5.1 million . Overall , 53 668 patients in the validation data set ( 9 % of the total ) would be reclassified from high to low risk or vice versa using QRISK compared with the Framingham algorithm . Conclusion QRISK performed at least as well as the Framingham model for discrimination and was better calibrated to the UK population than either the Framingham model or ASSIGN . QRISK is likely to provide more appropriate risk estimates to help identify high risk patients on the basis of age , sex , and social deprivation . It is therefore likely to be a more equitable tool to inform management decisions and help ensure treatments are directed towards those most likely to benefit . It includes additional variables which improve risk estimates for patients with a positive family history or those on antihypertensive treatment . However , since the validation was performed in a similar population to the population from which the algorithm was derived , it potentially has a “ home advantage . ” Further validation in other population s is therefore required Objectives Hypertension is common among patients with dyslipidemia but is often poorly treated . The objective of this analysis was to evaluate how a decision aid , used by primary care physicians to improve lipid therapy , impacted on the treatment of hypertension . Study Design Data were analyzed from patients enrolled in a r and omized trial focusing primarily on the treatment of dyslipidemia . Patients received usual care or a coronary risk profile every three months to monitor the risk reduction following lifestyle changes and /or pharmacotherapy to treat dyslipidemia . Hypertension management was assessed based on a post hoc analysis of individuals whose blood pressure exceeded current national hypertension guidelines . Results There were 2,631 subjects who completed the study . Among 1,352 patients without diagnosed hypertension , 30 % were above target on at least three consecutive visits . Among 1,279 individuals with known hypertension , 69 % were above target on at least two consecutive visits . Overall , patients receiving risk profiles were more likely to receive appropriate antihypertensive therapy  ( OR = 1.40 , 95 % CI 1.11 – 1.78 ) compared to those receiving usual care . After adjustment for inter-physician variability and potential confounders , the use of the risk profile was associated with an increased likelihood of starting therapy ( OR = 1.78 , 95 % CI 1.06 – 3.00 ) or modifying therapy ( OR = 1.40 , 95 % CI 1.03 – 1.91 ) . Conclusions In this clinical trial of dyslipidemia management , inadequately controlled hypertension was common , occurring in nearly 50 % of individuals . Ongoing coronary risk assessment was associated with more appropriate blood pressure management . Cardiovascular risk assessment decision aids should be further evaluated in a r and omized trial of hypertension therapy Cardiovascular disease causes the death of around 80 % of patients with type 2 diabetes.1 However , risk factors for cardiovascular disease in such patients are often untreated2 despite the proved benefits of intervention . 3 4 One way to help clinicians identify patients at high risk of cardiovascular disease is to use cardiovascular primary prevention risk tables . These tables integrate the multiple risk factors into a single score . We did a pilot study to test the hypothesis that documentation of a  cardiovascular risk score in the case notes would improve the management of cardiovascular risk factors . We recruited patients with type 2 diabetes who had no history of cardiovascular disease or renal disease . All patients were aged 35–75 years and attending a hospital OBJECTIVES Based on the data of the Prospect i ve Cardiovascular Münster ( PROCAM ) study , a prospect i ve study of men and women at work in the north-west of Germany , we aim ed ( i ) to develop a refined scoring scheme for calculating the risk of acute coronary events among adult and elderly men and women ; and ( ii ) to generate a new scoring scheme for calculating the risk of ischaemic stroke or transient ischaemic attack ( TIA ) . METHODS The coronary risk score was derived from a Weibull function using data from 18 460 men and 8515 women who were recruited before 1996 and had a mean follow-up period of 12+/-6 years . The stroke score was derived using a Cox proportional hazards model using data of 5905 men and 2225 women aged 35 - 65 years with at least 10 years of unbroken follow-up . RESULTS The coronary risk score was based on 511 major coronary events , 462 ( 168 fatal , 294 non-fatal ) in men and 49 ( 18 fatal , 31 non-fatal ) in women and included the risk factors LDL cholesterol , HDL cholesterol , systolic blood pressure , smoking status , triglycerides and diabetes mellitus status . It was accurate in both sexes over an age range from 20 to 75 years with an area under the receiver-operating characteristics ( ROC ) curve of 0.82 . The stroke score was based on 85 cerebral ischaemic events ( 21 TIAs , 64 ischaemic strokes ) and included the risk factors age , sex , diabetes mellitus status , smoking status and systolic blood pressure . It had an area under the ROC curve of 0.78 and identified a high-risk group comprising only 4 % of the study population that contained 31 % of all cerebral ischaemic events . CONCLUSION Both new PROCAM risk scores provide simple and effective ways to assess the risk of acute coronary events and ischaemic stroke in the general population and will improve the ability of physicians to target measures in an effort to prevent these potentially devastating conditions BACKGROUND The Coronary Health Assessment Study ( CHAS ) was developed to determine the feasibility of using patient-specific , multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD . METHODS Study participants included 253 community based physicians , r and omized into profile and control groups , and 958 of their patients . The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback . The control group received their profiles only if the patient was clinical ly reevaluated during a 3-month follow-up visit . Patients ' coronary risk factors were evaluated at baseline and at follow-up . RESULTS The profile group had a significantly higher ( P < 0.05 ) ratio of high-risk/low-risk patients who returned for a follow-up visit compared to the control group ( 1.23 vs 0.77 ) . The patients in the profile group also had significantly ( P < 0.05 ) greater mean reductions in total cholesterol ( -0.5 vs -0.1 mmol/L ) , LDL cholesterol ( -0.4 vs 0.0 mmol/L ) , the total cholesterol/ HDL ratio ( -0.6 vs -0.2 ) , and the predicted 8-year coronary risk ( -1.8 vs -0.3 % ) . CONCLUSIONS Computer-generated coronary risk profiles can be effective in assisting physicians to identify high-risk patients . Their use is also associated with significantly greater improvements in the serum lipid profiles and the overall coronary risk of these patients Objective : To improve equity in cardiovascular disease prevention by developing a cardiovascular risk score including social deprivation and family history . Design : The ASSIGN score was derived from cardiovascular outcomes in the Scottish Heart Health Extended Cohort ( SHHEC ) . It was tested against the Framingham cardiovascular risk score in the same data base . Setting : R and om- sample , risk-factor population surveys across Scotl and 1984–87 and North Glasgow 1989 , 1992 and 1995 . Participants : 6540 men and 6757 women aged 30–74 , initially free of cardiovascular disease , ranked for social deprivation by residence postcode using the Scottish Index of Multiple Deprivation ( SIMD ) and followed for cardiovascular mortality and morbidity through 2005 . Results : Classic risk factors , including cigarette dosage , plus deprivation and family history but not obesity , were significant factors in constructing ASSIGN scores for each sex . ASSIGN scores , lower on average , correlated closely with Framingham values for 10-year cardiovascular risk . Discrimination of risk in the SHHEC population was significantly , but marginally , improved overall by ASSIGN . However , the social gradient in cardiovascular event rates was inadequately reflected by the Framingham score , leaving a large social disparity in future victims not identified as high risk . ASSIGN classified more people with social deprivation and positive family history as high risk , anticipated more of their events , and abolished this gradient . Conclusion : Conventional cardiovascular scores fail to target social gradients in disease . By including unattributed risk from deprivation , ASSIGN shifts preventive treatment towards the socially deprived . Family history is valuable not least as an approach to ethnic susceptibility . ASSIGN merits further evaluation for clinical use AIMS To estimate the potential effectiveness of different " high-risk " and " population " approaches to the primary prevention of  cardiovascular disease ( CVD ) in middle-aged British men , after correction for regression dilution bias . METHODS AND RESULTS We used a combination of cohort and r and omised controlled trial evidence to estimate the effectiveness of high-risk strategies , based on the identification of high-risk factors or high absolute risk , and strategies based on population -wide reductions in cholesterol and blood pressure . High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population . Aggressive pharmacological treatment ( using statins , beta-blockers , ACE-inhibitors and aspirin ) in individuals with a 10-year Framingham event risk of > or=30 % ( 6 % of population ) would have reduced major CVD by at most 11 % . This figure increased to 34 % at a > or=20 % treatment threshold ( 26 % of population ) . In contrast , modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD . Taking regression dilution bias into account , 10 % reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45 % . CONCLUSIONS If high-risk strategies are to have a major impact on CVD in the population , they need to be more widely used than previously envisaged . Population -wide reduction of major risk factors is needed if CVD is to be substantially reduced CONTEXT Despite improved underst and ing of atherothrombosis , cardiovascular prediction algorithms for women have largely relied on traditional risk factors . OBJECTIVE To develop and vali date cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors . DESIGN , SETTING , AND PARTICIPANTS Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years ( through March 2004 ) for incident cardiovascular events ( an adjudicated composite of myocardial infa rct ion , ischemic stroke , coronary revas 
    Output:
    