Date of Award

Spring 5-1-2003

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Family and Consumer Sciences

First Advisor

Sarah T. Hawkins

Second Advisor

Frederica L. Kramer

Third Advisor

Rao Ivaturi

Abstract

Cardiovascular disease remains the major cause of morbidity and mortality in the United States claiming the lives of over 40% of the nearly 2.4 million Americans who die each year. Recent studies have shown that elevated homocysteine in the blood is related to a higher risk of coronary heart disease, peripheral vascular disease and stroke independent of other classical cardiovascular disease risk factors. The aim of this study is to determine the general awareness and acceptance of U.S. cardiovascular specialists of the homocysteine theory, the criteria used for ordering a homocysteine test, the frequency physicians refer patients to dietitians for consultation, and the kind of treatment prescribed for patients with elevated blood homocysteine levels. The study surveyed a random sample of 1000 physicians and surgeons specializing in cardiology and cardiovascular diseases in the United States. Results are based on the 13 7 surveys which were completed and returned. Statistical results included frequencies, Pearson Chi-Square, and multiple regressions. Results of the survey showed that ninety seven percent of responding physicians are aware of the homocysteine theory. Eighty-one percent think that obtaining a homocysteine blood level is helpful for assessing cardiovascular disease; yet thirty seven percent rarely/never order the homocysteine test. Forty-three percent consider evidence of patient's poor dietary intake before ordering the homocysteine test, and thirty four percent reported the absence of other common risk factors as their primary criterion lV for ordering the test. Approximately fifty percent of the physicians prescribe B-12, B-6 and folic acid supplements for patients with elevated homocystiene level, while thirtyfour percent prescribe only folic acid supplements. Pearson Chi-Square showed no correlation between the physicians' location of practice (large cities vs. other locations) or length of time in practice and the frequency of ordering the homocysteine test or frequency of ordering B-vitamin supplements (P< 0.05). Almost 60 percent of the physicians rarely/never recommend that patients with elevated homocysteine levels consult a dietitian. There was a negative correlation between physicians' length oftime in practice and dietary consultation with a dietitian, with physicians who had spent less than 20 years in practice referring to dietitians more frequently than did older physicians. This suggests that training of recent medical graduates has improved their perception about consulting a dietitian. In conclusion, more clinical studies are needed to provide information on the clinical effectiveness ofB-vitamin therapy for lowering the risk of cardiovascular diseases. At the same time, physicians need to have an effective, comprehensive communication with the clinical dietitians in order to improve the treatment of their patients.

Download

Share

COinS