Table 3 Differences in practice patterns of family physicians and general internist respondents in managing CVD* risk
| Â | Family Physicians (N = 562) | General Internists (N = 326) | p-value |
|---|---|---|---|
Antiplatelet therapy for prevention of myocardial infarction in a 45-year-old asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose | |||
Aspirin 100 mg every other day | 0.9% | 0.9% | < 0.01 |
Aspirin 81 mg daily | 65.6% | 54.3% | Â |
Aspirin 325 mg daily | 4.8% | 5.8% | Â |
Clopidogrel 75 mg daily | 0.9% | 2.5% | Â |
No antiplatelet therapy** | 27.8% | 36.5% | Â |
Dyslipidemia pharmacotherapy recommendation for a 45-year-old asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose | |||
Atorvastatin 10 mg every evening | 42.4% | 41.0% | 0.84 |
Ezetimide 10 mg daily | 2.5% | 4.3% | Â |
Niacin 500 mg twice daily | 3.9% | 3.7% | Â |
No specific therapy for dyslipidemia** | 51.2% | 50.9% | Â |
Dietary recommendation (avoiding fat) for a 45-year-old asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose | |||
Trans fatty acids** | 62.5% | 61.8% | 0.91 |
Polyunsaturated fats | 9.6% | 9.2% | Â |
Mono-unsaturated fats | 3.2% | 5.8% | Â |
No specific fat as long as it does not exceed 30% of total intake | 24.6% | 23.1% | Â |
LDL Goal for a 50-year-old asymptomatic man, negative family history of premature CHD, BP 170/94 mm Hg, BMI 26 kg/m2, total cholesterol 210 mg/dL, LDL 130 mg/dL, HDL 36 mg/dL, TG 256 mg/dl, Fasting glucose 140 mg/dL, and normal exercise stress test | |||
LDL < 130 mg/dl | 11.8% | 12.3% | 0.36 |
LDL < 100 mg/dl** | 59.0% | 56.0% | Â |
LDL < 70 mg/dl | 29.2% | 31.7% | Â |
Hypertension and dyslipidemia management for a new asymptomatic 78-year- old female patient with questionable history of diabetes, BP 159/78 mm Hg, BMI 29 kg/m2, LDL 199 mg/dL, TG 479 mg/dL, and HbA1c of 6.0% | |||
Lifestyle and dietary modification | 6.8% | 8.0% | 0.11 |
Lifestyle and dietary modification and treatment with a thiazide diuretic | 6.6% | 5.2% | Â |
Lifestyle modification and treatment with a statin | 14.9% | 10.2% | Â |
Lifestyle and dietary modification and treatment with both a thiazide diuretic and a statin** | 71.7% | 76.5% | Â |
Approach to stress testing for a new asymptomatic 78-year-old female patient with questionable history of diabetes, BP 159/78 mm Hg, BMI 29 kg/m2, LDL 199 mg/dL, TG 479 mg/dL, and HbA1c of 6.0% | |||
I would order one as a follow up to today's visit | 39.6% | 33.0% | 0.88 |
I would order one today and yearly thereafter | 5.6% | 10.5% | Â |
I would order a test if she develops symptoms of chest pain, shortness of breath or atypical angina** | 48.1% | 48.8% | Â |
I would not order a stress test on this elderly woman | 6.7% | 7.7% | Â |