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The Lancet
Journal Prestige (SJR): 14.934
Citation Impact (citeScore): 9
Number of Followers: 2749  
 
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ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
Published by Elsevier Homepage  [3183 journals]
  • The importance of randomised vs non-randomised trials
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Andreas Rieckmann, Christine S Benn
       
  • Pharmacological lipid-modification therapies for prevention of ischaemic
           heart disease: current and future options
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Kausik K Ray, Pablo Corral, Enrique Morales, Stephen J NichollsSummaryAtherosclerosis and its clinical manifestation as ischaemic heart disease remains a considerable health burden. Given that many factors contribute to ischaemic heart disease, a multifactorial approach to prevention is recommended, starting with lifestyle advice, smoking cessation, and control of known cardiovascular risk factors, such as blood pressure and lipids. Within the lipid profile, the principal target is lowering LDL cholesterol, firstly with lifestyle interventions and subsequently with pharmacological therapy. Statins are the recommended first-line pharmacological treatment. Some individuals might require further lowering of LDL cholesterol or be unable to tolerate statins. Additional therapies targeting different pathways in cholesterol metabolism are now available, ranging from small molecules taken orally, to injectable therapies. Examples include ezetimibe, which targets Niemann-Pick C1-like protein, and monoclonal antibodies that target PCSK9. Phase 3 trials have also been completed for bempedoic acid (targeting ATP-citrate lyase) and inclisiran (an interference RNA-based therapeutic targeting hepatic PCSK9 synthesis). In addition to LDL cholesterol, mendelian randomisation studies support a causal role for lipoprotein(a) and triglycerides in ischaemic heart disease. In this Series paper, we appraise currently available and emerging therapies for lowering LDL cholesterol, lipoprotein(a), and triglycerides for prevention of ischaemic heart disease.
       
  • Effectiveness of polypill for primary and secondary prevention of
           
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Gholamreza Roshandel, Masoud Khoshnia, Hossein Poustchi, Karla Hemming, Farin Kamangar, Abdolsamad Gharavi, Mohammad Reza Ostovaneh, Alireza Nateghi, Masoud Majed, Behrooz Navabakhsh, Shahin Merat, Akram Pourshams, Mahdi Nalini, Fatemeh Malekzadeh, Masoumeh Sadeghi, Noushin Mohammadifard, Nizal Sarrafzadegan, Mohammad Naemi-Tabiei, Abdolreza Fazel, Paul BrennanSummaryBackgroundA fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either enalapril or valsartan for primary and secondary prevention of cardiovascular disease.MethodsThe PolyIran study was a two-group, pragmatic, cluster-randomised trial nested within the Golestan Cohort Study (GCS), a cohort study with 50 045 participants aged 40–75 years from the Golestan province in Iran. Clusters (villages) were randomly allocated (1:1) to either a package of non-pharmacological preventive interventions alone (minimal care group) or together with a once-daily polypill tablet (polypill group). Randomisation was stratified by three districts (Gonbad, Aq-Qala, and Kalaleh), with the village as the unit of randomisation. We used a balanced randomisation algorithm, considering block sizes of 20 and balancing for cluster size or natural log of the cluster size (depending on the skewness within strata). Randomisation was done at a fixed point in time (Jan 18, 2011) by statisticians at the University of Birmingham (Birmingham, UK), independent of the local study team. The non-pharmacological preventive interventions (including educational training about healthy lifestyle—eg, healthy diet with low salt, sugar, and fat content, exercise, weight control, and abstinence from smoking and opium) were delivered by the PolyIran field visit team at months 3 and 6, and then every 6 months thereafter. Two formulations of polypill tablet were used in this study. Participants were first prescribed polypill one (hydrochlorothiazide 12·5 mg, aspirin 81 mg, atorvastatin 20 mg, and enalapril 5 mg). Participants who developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome—occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)—was centrally assessed by the GCS follow-up team, who were masked to allocation status. We did intention-to-treat analyses by including all participants who met eligibility criteria in the two study groups. The trial was registered with ClinicalTrials.gov, number NCT01271985.FindingsBetween Feb 22, 2011, and April 15, 2013, we enrolled 6838 individuals into the study—3417 (in 116 clusters) in the minimal care group and 3421 (in 120 clusters) in the polypill group. 1761 (51·5%) of 3421 participants in the polypill group were women, as were 1679 (49·1%) of 3417 participants in the minimal care group. Median adherence to polypill tablets was 80·5% (IQR 48·5–92·2). During follow-up, 301 (8·8%) of 3417 participants in the minimal care group had major cardiovascular events compared with 202 (5·9%) of 3421 participants in the polypill group (adjusted hazard ratio [HR] 0·66, 95% CI 0·55–0·80). We found no statistically significant interaction with the presence (HR 0·61, 95% CI 0·49–0·75) or absence of pre-existing cardiovascular disease (0·80; 0·51–1·12; pinteraction=0·19). When restricted to participants in the polypill group with high adherence, the reduction in the risk of major cardiovascular events was even greater compared with the minimal care group (adjusted HR 0·43, 95% CI 0·33–0·55). The frequency of adverse events was similar between the two study groups. 21 intracranial haemorrhages were reported during the 5 years of follow-up—ten participants in the polypill group and 11 participants in the minimal care group. There were 13 physician-confirmed diagnoses of upper gastrointestinal bleeding in the polypill group and nine in the minimal care group.InterpretationUse of polypill was effective in preventing major cardiovascular events. Medication adherence was high and adverse event numbers were low. The polypill strategy could be considered as an additional effective component in controlling cardiovascular diseases, especially in LMICs.FundingTehran University of Medical Sciences, Barakat Foundation, and Alborz Darou.
       
  • Patient–doctor engagement in cardiovascular prevention –
           Authors' reply
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Ulf Näslund, Nawi Ng, Patrik Wennberg, Margareta Norberg
       
  • Patient–doctor engagement in cardiovascular prevention
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Panagiota Anyfanti, Eugenia Gkaliagkousi, Stella Douma
       
  • Blood pressure reduction and intravenous thrombolysis – Authors'
           reply
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Craig S Anderson, Philip M Bath
       
  • Blood pressure reduction and intravenous thrombolysis
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Nyika D Kruyt, Yvo B Roos, Paul J Nederkoorn
       
  • Surgery for intracerebral haemorrhage – Authors' reply
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Daniel F Hanley, Wendy C Ziai, Mario Zuccarello, Issam A Awad
       
  • Surgery for intracerebral haemorrhage
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Angelos G Kolias, Hani J Marcus, Marike L Broekman, Peter J Hutchinson, Peter McCulloch
       
  • Surgery for intracerebral haemorrhage
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Nicolas Engrand, Mikael Mazighi, Caroline Le Guerinel, Matthieu Dorison, Vera Dinkelacker
       
  • Department of Error
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s):
       
  • Fixed-dose combination antihypertensive medications
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Ivor J Benjamin, Reinhold Kreutz, Michael H Olsen, Aletta E Schutte, Patricio Lopez-Jaramillo, Thomas R Frieden, Karen Sliwa, Daniel T Lackland, Michael Brainin
       
  • Management of rheumatic mitral stenosis
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Hourmazd Haghbayan, Brian G Ballios, Eric A Coomes
       
  • Management of rheumatic mitral stenosis
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Eamon P McCarron, Monica Monaghan, Shiva Sreenivasan
       
  • Trial re-investment to build better research for better impact
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Thomas A Fox, Gillian A Horne, Charles Craddock, Gordon Cook, Stephen O'Brien, Sonia Fox, Anna Hockaday, Graham Silk, Peter Hillmen
       
  • The importance of randomised vs non-randomised trials –
           Authors' reply
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Hertzel C Gerstein, John McMurray, Rury R Holman
       
  • The importance of randomised vs non-randomised trials
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Benjamin Djulbegovic, Paul Glasziou, Iain Chalmers
       
  • Electric shocks and weakness of the right hand in a young man: Hirayama
           disease
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Christopher D Witiw, John E O'Toole
       
  • High-quality evidence to inform clinical practice
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Alexander C Fanaroff, Robert M Califf, Renato D Lopes
       
  • Marc Mitchell
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Adam Marcus
       
  • Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental
           Illness, Anne Harrington. W W Norton (2019), 384, US$ 27·95, ISBN:
           9780393071221
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Steven Rose
       
  • Paula Rego: personal and political
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Lesley Hoggart
       
  • Palliative care in Tajikistan
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Jacqui Thornton
       
  • Defining primary palliative care for universal health coverage
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Daniel Munday, Kirsty Boyd, Jenifer Jeba, Kellen Kimani, Sebastien Moine, Liz Grant, Scott Murray
       
  • From primary health care to universal health coverage—one step
           forward and two steps back
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): David Sanders, Sulakshana Nandi, Ronald Labonté, Carina Vance, Wim Van Damme
       
  • Progressing polypills beyond concepts to outcomes
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Anushka A Patel, Mark D Huffman
       
  • Proposal to screen all US adult patients for substance use
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): The Lancet
       
  • Better evidence needed for preventing paediatric migraine
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): The Lancet
       
  • Is the concept of hypertension as a disease unhelpful'
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): The Lancet
       
  • Primary prevention of ischaemic heart disease: populations, individuals,
           and health professionals
    • Abstract: Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Rajeev Gupta, David A WoodSummaryIschaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular health, and adequate health-care financing and universal health care are important for achieving these goals. Population-level interventions should focus on tobacco control, promotion of healthy foods (fruits, vegetables, legumes, and nuts), curbing unhealthy foods (saturated fats, trans fats, refined carbohydrates, excessive salt, and alcohol), promotion of physical activity in everyday living, and control of ambient and indoor pollution. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. Strategies to improve adherence to healthy lifestyles and drug therapies are essential and can be implemented at health system, health care, and patient levels with use of education, technology, and personalised approaches. Improving quality of medical education with a focus on ischaemic heart disease prevention for physicians, nurses, allied health workers, and the public is required.
       
  • Sex-based differences in medications for heart failure
    • Abstract: Publication date: Available online 22 August 2019Source: The LancetAuthor(s): Heather P Whitley, Warren D Smith
       
  • Identifying optimal doses of heart failure medications in men compared
           with women: a prospective, observational, cohort study
    • Abstract: Publication date: Available online 22 August 2019Source: The LancetAuthor(s): Bernadet T Santema, Wouter Ouwerkerk, Jasper Tromp, Iziah E Sama, Alice Ravera, Vera Regitz-Zagrosek, Hans Hillege, Nilesh J Samani, Faiez Zannad, Kenneth Dickstein, Chim C Lang, John G Cleland, Jozine M Ter Maaten, Marco Metra, Stefan D Anker, Pim van der Harst, Leong L Ng, Peter van der Meer, Dirk J van Veldhuisen, Sven MeyerSummaryBackgroundGuideline-recommended doses of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and β blockers are similar for men and women with heart failure with reduced ejection fraction (HFrEF), even though there are known sex differences in pharmacokinetics of these drugs. We hypothesised that there might be sex differences in the optimal dose of ACE inhibitors or ARBs and β blockers in patients with HFrEF.MethodsWe did a post-hoc analysis of BIOSTAT-CHF, a prospective study in 11 European countries of patients with heart failure in whom initiation and up-titration of ACE inhibitors or ARBs and β blockers was encouraged by protocol. We included only patients with left ventricular ejection fraction less than 40%, and excluded those who died within the first 3 months. Primary outcome was a composite of time to all-cause mortality or hospitalisation for heart failure. Findings were validated in ASIAN-HF, an independent cohort of 3539 men and 961 women with HFrEF.FindingsAmong 1308 men and 402 women with HFrEF from BIOSTAT-CHF, women were older (74 [12] years vs 70 [12] years, p
       
  • Is it time to include cancer in cardiovascular risk prediction tools'
    • Abstract: Publication date: Available online 20 August 2019Source: The LancetAuthor(s): Anne H Blaes, Chetan Shenoy
       
  • Gambling harm: a global problem requiring global solutions
    • Abstract: Publication date: Available online 20 August 2019Source: The LancetAuthor(s): Gerda Reith, Heather Wardle, Ian Gilmore
       
  • SGLT-2 inhibitors for people with type 2 diabetes – Authors' reply
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Thomas A Zelniker, Stephen D Wiviott, Itamar Raz, Marc S Sabatine
       
  • Intrahepatic cholestasis: suggested future investigations – Authors'
           reply
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Caroline Ovadia, Lucy C Chappell, Catherine Williamson
       
  • Intrahepatic cholestasis: suggested future investigations
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Alexandre J Vivanti, Cosmin Voican, Daniele De Luca, Alexandra Benachi
       
  • Pain relief during labour – Authors' reply
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Matthew J A Wilson, Christine MacArthur, Jane Daniels
       
  • Pain relief during labour
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Lei Wang, Lingxin Wei, Xiaoming Deng
       
  • Pain relief during labour
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Edward T C Miles, Julian P Stone
       
  • Pain relief during labour
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Sabine Logtenberg, Ben Willem Mol, Corine Verhoeven
       
  • Pain relief during labour
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): M James Lozada, Carolyn F Weiniger, Brendan Carvalho, Jeanette R Bauchat
       
  • Zhang's guidelines vs WHO guidelines for diagnosing labour
           dystocia – Authors' reply
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Stine Bernitz, Rebecka Dalbye, Inge Christoffer Olsen, Ellen Blix, Pål Øian, Torjørn Moe Eggebø
       
  • Zhang's guidelines vs WHO guidelines for diagnosing labour
           dystocia
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Miwako Shimazaki, Yuto Maeda, Kohei Ogawa, Tetsuya Tanimoto, Haruhiko Sago
       
  • Zhang's guidelines vs WHO guidelines for diagnosing labour
           dystocia
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Annie Kroushev, Daniel L Rolnik, Ben W Mol
       
  • Prepregnancy calcium supplementation and pre-eclampsia – Author's
           reply
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Theresa Anne Lawrie, Calcium and Pre-eclampsia Study Group
       
  • Prepregnancy calcium supplementation and pre-eclampsia
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Yuto Maeda, Yosuke Suzuki, Kana Yamamoto, Tetsuya Tanimoto
       
  • Prepregnancy calcium supplementation and pre-eclampsia
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Antonio Ponzetto, Natale Figura, Piero Riva
       
  • Coroners' investigations of stillbirths
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Andrew Haigh, Kathryn Haigh
       
  • Enhancing the National Family Health Survey-5 for policy making
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Rakhi Dandona, G Anil Kumar
       
  • Scientific leadership: the Italian Government's perspective
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Salvatore Sciacchitano, Armando Bartolazzi, Giulia Grillo
       
  • Health worker gap in Italy: the untold truth
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Luca La Colla
       
  • Getting to the heart of the matter in a multisystem disorder:
           Erdheim–Chester disease
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Andrea Buono, Ilaria Bassi, Caterina Santolamazza, Antonella Moreo, Patrizia Pedrotti, Alice Sacco, Nuccia Morici, Cristina Giannattasio, Fabrizio Oliva, Enrico Ammirati
       
  • SGLT-2 inhibitors for people with type 2 diabetes
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Timo E Strandberg, Mirko Petrovic, Athanase Benetos
       
  • SGLT-2 inhibitors for people with type 2 diabetes
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): German Malaga, Eloy F Ruiz
       
  • Marshall Leonard Marinker
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Geoff Watts
       
  • People with albinism in Africa: contending with skin cancer
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Esther Nakkazi
       
  • Political violence in Sudan: the need for a coordinated, locally led
           humanitarian health response
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Maysoon Dahab, Nada Abdelmagid, Tasnime Osama, Nazik Nurelhuda, Zafir Abutalib, Paul Spiegel, Francesco Checchi, Sara Abdelgalil
       
  • Testing the waters: a new test for hypotonic polyuria
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Ewout J Hoorn
       
  • Interleukin-23 blockade: another breakthrough in the treatment of
           psoriasis
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Mark Lebwohl
       
  • Nerve transfers to restore upper limb function in tetraplegia
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): Elspeth J R Hill, Ida K Fox
       
  • The gender plight of humanitarian aid
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): The Lancet
       
  • Fear and uncertainty around Kashmir's future
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): The Lancet
       
  • Reaching critical mass on mass shootings
    • Abstract: Publication date: 17–23 August 2019Source: The Lancet, Volume 394, Issue 10198Author(s): The Lancet
       
  • Is targeting CGRP the right pathway to prevent migraine'
    • Abstract: Publication date: Available online 16 August 2019Source: The LancetAuthor(s): Alessandro Tessitore, Antonio Russo
       
  • Uncovering covert stroke in surgical patients
    • Abstract: Publication date: Available online 15 August 2019Source: The LancetAuthor(s): Phillip E Vlisides, Michael S Avidan, George A Mashour
       
  • Department of Error
    • Abstract: Publication date: Available online 13 August 2019Source: The LancetAuthor(s):
       
  • Mandatory reporting and vaccination in North America
    • Abstract: Publication date: Available online 13 August 2019Source: The LancetAuthor(s): Lawrence C Loh
       
  • A tuberculosis-free world: is it a delusion'
    • Abstract: Publication date: Available online 12 August 2019Source: The LancetAuthor(s): Sachin Atre
       
  • A tuberculosis-free world: is it a delusion' – Authors' reply
    • Abstract: Publication date: Available online 12 August 2019Source: The LancetAuthor(s): Michael J A Reid, Eric Goosby
       
  • Is preoperative bowel preparation needed before elective colectomy'
    • Abstract: Publication date: Available online 8 August 2019Source: The LancetAuthor(s): Steven D Wexner, Shlomo Yellinek
       
  • Psoriasis biologics: a new era of choice
    • Abstract: Publication date: Available online 8 August 2019Source: The LancetAuthor(s): Satveer K Mahil, Catherine H Smith
       
  • Building evidence and measuring clinical outcomes for genomic medicine
    • Abstract: Publication date: Available online 5 August 2019Source: The LancetAuthor(s): Josh F Peterson, Dan M Roden, Lori A Orlando, Andrea H Ramirez, George A Mensah, Marc S WilliamsSummaryHuman genomic sequencing has potential diagnostic, prognostic, and therapeutic value across a wide breadth of clinical disciplines. One barrier to widespread adoption is the paucity of evidence for improved outcomes in patients who do not already have an indication for more focused testing. In this Series paper, we review clinical outcome studies in genomic medicine and discuss the important features and key challenges to building evidence for next generation sequencing in the context of routine patient care.
       
  • Family health history: underused for actionable risk assessment
    • Abstract: Publication date: Available online 5 August 2019Source: The LancetAuthor(s): Geoffrey S Ginsburg, R Ryanne Wu, Lori A OrlandoSummaryFamily health history (FHH) is the most useful means of assessing risk for common chronic diseases. The odds ratio for risk of developing disease with a positive FHH is frequently greater than 2, and actions can be taken to mitigate risk by adhering to screening guidelines, genetic counselling, genetic risk testing, and other screening methods. Challenges to the routine acquisition of FHH include constraints on provider time to collect data and the difficulty in accessing risk calculators. Disease-specific and broader risk assessment software platforms have been developed, many with clinical decision support and informatics interoperability, but few access patient information directly. Software that allows integration of FHH with the electronic medical record and clinical decision support capabilities has provided solutions to many of these challenges. Patient facing, electronic medical record, and web-enabled FHH platforms have been developed, and can provide greater identification of risk compared with conventional FHH ascertainment in primary care. FHH, along with cascade screening, can be an important component of population health management approaches to overall reduction of risk.
       
  • No-deal food planning in UK Brexit
    • Abstract: Publication date: Available online 4 August 2019Source: The LancetAuthor(s): Tim Lang
       
  • AI can now identify atrial fibrillation through sinus rhythm
    • Abstract: Publication date: Available online 1 August 2019Source: The LancetAuthor(s): Jeroen M L Hendriks, Larissa Fabritz
       
  • Non-communicable diseases and climate change: linked global emergencies
    • Abstract: Publication date: Available online 1 August 2019Source: The LancetAuthor(s): Rachel Nugent, Edward Fottrell
       
  • Ursodeoxycholic acid for intrahepatic cholestasis in pregnancy
    • Abstract: Publication date: Available online 1 August 2019Source: The LancetAuthor(s): Hanns-Ulrich Marschall
       
  • Oral regimen management of acute hypertension in pregnancy
    • Abstract: Publication date: Available online 1 August 2019Source: The LancetAuthor(s): Elizabeth R Lemoine, S Ananth Karumanchi
       
  • Bringing closure: towards achieving a better understanding of Israel
    • Abstract: Publication date: Available online 31 July 2019Source: The LancetAuthor(s): Julio Rosenstock, Paul Zimmet, Jay S Skyler, Mark Atkinson, Desmond Schatz, John B Buse, Steven Kahn, Irl B Hirsch, Derek Leroith, K George Alberti
       
  • Heat and health: a forthcoming Lancet Series
    • Abstract: Publication date: Available online 31 July 2019Source: The LancetAuthor(s): Anthony Capon, Ollie Jay, Kristie Ebi, Selina Lo
       
  • Department of Error
    • Abstract: Publication date: Available online 31 July 2019Source: The LancetAuthor(s):
       
  • Progress in beating the tobacco epidemic
    • Abstract: Publication date: Available online 29 July 2019Source: The LancetAuthor(s): Tedros Adhanom Ghebreyesus
       
  • Strategies to identify patients for antihypertensive treatment
    • Abstract: Publication date: Available online 25 July 2019Source: The LancetAuthor(s): Thomas Kahan
       
  • The state of hypertension care in 44 low-income and middle-income
           countries: a cross-sectional study of nationally representative
           individual-level data from 1·1 million adults
    • Abstract: Publication date: Available online 18 July 2019Source: The LancetAuthor(s): Pascal Geldsetzer, Jennifer Manne-Goehler, Maja-Emilia Marcus, Cara Ebert, Zhaxybay Zhumadilov, Chea S Wesseh, Lindiwe Tsabedze, Adil Supiyev, Lela Sturua, Silver K Bahendeka, Abla M Sibai, Sarah Quesnel-Crooks, Bolormaa Norov, Kibachio J Mwangi, Omar Mwalim, Roy Wong-McClure, Mary T Mayige, Joao S Martins, Nuno Lunet, Demetre LabadariosSummaryBackgroundEvidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs—and its variation between countries and population groups—by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage.MethodsIn this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval.FindingsOur pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9–74·3) had ever had their blood pressure measured, 39·2% of participants (38·2–40·3) had been diagnosed with hypertension, 29·9% of participants (28·6–31·3) received treatment, and 10·3% of participants (9·6–11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade.InterpretationOur study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage.FundingHarvard McLennan Family Fund, Alexander von Humboldt Foundation.
       
  • Blood pressure control: a challenge to global health systems
    • Abstract: Publication date: Available online 18 July 2019Source: The LancetAuthor(s): Clara K Chow, Rajeev Gupta
       
  • Department of Error
    • Abstract: Publication date: Available online 16 July 2019Source: The LancetAuthor(s):
       
 
 
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