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Episode 109: More, questions, questions and more questions

In episode 109, Mike and James continue on with listener questions and start off trying to reduce the risk of using risk assessment tools and risk reduction information. They then delve into questions about tapering steroids, antidepressants, side effects from thiazides and sitagliptin and the amazing clarity of their answers is only outdone by the vagueness of their conclusions.

Show notes

1) Prediction with Framingham versus the real risk primary care patients

Heart 2009;95:125–9

2) Relative risk reduction with statins in primary prevention

BMJ 2009;338:b2376

ACP J Club 2009;151:14

Lancet 2005;366:1267–78

Diabetes – Lancet 2008;371:117–25

3) Issues with Framingham/UKPDS risk assessments

UK – overestimates mortality from CHD by 47% and non-fatal CHD by 57%

BMJ 2003;327:1-6

Germany, Italy, and Denmark – overestimates risk by 50%

China – overestimates CHD rates by 5 fold

JAMA 2004;291:2591-9

UKPDS and Framingham

Major CVD – risk overestimated by 170% (95% CI 146–195%) and 202% (176–231%) using the two Framingham equations

Major coronary heart disease – risk overestimated by 198% (162–238%) with the UKPDS, and by 146% (117–179%) and 289% (243– 341%)

with the two different Framingham equations

Stroke – risks over-estimated with the UKPDS and one of the Framingham equations

Diabetologia 2010;53:821–31

Heart 2006;92:1752-9

4) Tapering corticosteroids

Am J Med 2009;1222:977-91

5) Incomplete publication of antidepressant studies leading to bias (publication bias)

NEJM 2008;358:252-60

BMJ 2003;326:1171-3

6) Meta-analysis of antidepressants

Ann Intern Med 2005;143:415-26

Ann Intern Med 2008;149:734-50

Lancet 2009;373:746–58

Tools for Practice Website

http://www.acfp.ca/docs09/SecondGenerationAntidepressantsToolsforPracticefinal.pdf

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