1 / 24

Understanding the Challenges of Disease Prevention: A Clinical Perspective

This article explores the complexities of disease prevention from a clinical standpoint, emphasizing the differences between risk factors and disease. The work discusses the fluid nature of risk assessment, highlighting how arbitrary cut-off numbers can suddenly redefine millions as patients. It critically analyzes the paradox of prevention, the role of public awareness campaigns, and the importance of early detection methods in cardiovascular health. By focusing on a patient-centered approach, the piece argues for better strategies in addressing hidden cardiovascular disease and enhancing overall well-being.

elliott
Télécharger la présentation

Understanding the Challenges of Disease Prevention: A Clinical Perspective

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Problems with Prevention:A Clinical Perspective Michel Accad, MD October 17, 2011 GABA Panel Discussion

  2.  Prevention is bound to be difficult

  3. Ann Intern Med 1961

  4. Commonly Identified RFs

  5. Disease Risk Factor Compatible with well-being over a wide range of values Continuum of risk Risk is target for therapy (risk reduction) Statistical • Symptoms • Sharp demarcation from normal • Disease is target for therapy • Deterministic (present or not)

  6. Risk Factor ≠ Disease

  7. T H ED I S T I N C T I O NB E T W E E NR I S K F A C T O RA ND D I S E A S EH A SB E E NB L U R R E D

  8. Risk Assessment:A Fluid Concept • Imperfect Quantitative Models • Doctor’s perspective • Patient’s perspective • Patient’s means

  9. Treating Populations:The Paradox of Prevention

  10. Risk Factors:Disease by fiat • Cut-off numbers “define” disease • Numbers selected by super-committees • Changing cut-off numbers creates millions of patients overnight

  11. Risk factors as disease… …doctors as weathermen?

  12. 118 CVD Risk Factors And counting…

  13. Risk factor as disease • The problem of the J-curve Bad outcome Risk factor

  14. Public Awareness Campaigns… (the answer is most certainly yes…)

  15. “It is not the healthy who need a doctor, but the sick.” Matthew 9:12

  16. A better approach? Dr. is everything OK? DO I HAVE LATENT CVD?

  17. Focus on the early detection • Atherosclerosis • Hypertensive Cardiovascular Disease

  18. Vascular elasticity • Endothelial function • Digital retinal scan • CIMT • Microalbumin • Cardiac stress markers (eg. BNP) • Vascular calcium • Others

  19. Early detection approach PROS CONS Does not avoid problem of prediction Must distinguish disease patterns from age-related changes in the vasculature More expensive Not “validated” • Focused on the individual • Not a statistical assessment • Can be monitored in response to intervention • May identify patients without risk factors who have CVD • Facilitates dialogue regarding future risk

  20. The conundrum for early detection technologies A role for the private sector?

  21. The good news for the people

  22. Thank you

More Related