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  1. Iqbal Malik, Editor

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Ischaemic heart disease

Off-pump CABG after carotid surgery is safe ▸

Patients with combined coronary and carotid artery disease are at high risk of perioperative stroke and myocardial infarction. Of 2556 patients scheduled for off-pump bypass surgery (CABG), 82 patients with > 70% carotid stenosis were found by screening with duplex scanning (3% of the group). The mean age of the patients was 63 years. Carotid endarterectomy was immediately followed by off-pump CABG. There was no hospital mortality. One patient had perioperative myocardial infarction and another a transient ischaemic attack. It seems that, in the correct hands, combined procedures can be safe.

β Blockers as anti-inflammatory agents? ▸

Aspirin and pravastatin lower C reactive protein (CRP) concentrations and reduce vascular risk, underlining the importance of inflammation in destabilising coronary plaques. β Blockers are thought to work by reducing arrhythmia related deaths in patients with heart failure and ischaemic heart disease (IHD). Even excluding patients with contraindications to β blockers, a survey of 333 consecutive patients with IHD showed CRP concentrations 40% lower in those on β blocker treatment. How they lower CRP is not clear.

Statins improve bone density ▸

As well being good for your heart, statins were found to increase bone density and reduce fracture risk by 40%. This effect was independent of height, weight, lifestyle, and other medication. Coupled with the fact that coronary heart disease (CHD) risk is lowered on a statin even if your initial cholesterol is normal, perhaps all patients over 65 should be on one.

Difficult treatment of MI in the > 75 age group ▸

In a cohort of over 2000 patients > 75 years old who had a myocardial infarction (MI), only 63% of eligible patients got thrombolysis while 27% of thrombolysis recipients had what are regarded as absolute contraindications to the treatment. The …

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