Ischaemic heart disease

Statin treatment: the longer the better ▸ At what concentration of cholesterol should treatment be initiated? The answer from the heart protection study (HPS) seems to be anything above a total cholesterol of 3.5 mmol/l. The cost effectiveness seems to improve on long term treatment as more events are prevented. The LIPID study cohort was followed for two years beyond the initial six years of the trial, and allowed to take open label pravastatin (> 80% in each group). The group who had initially been assigned to placebo still appeared to have more events in this period than those initially on statin treatment, despite similar cholesterol concentrations, suggesting a long term effect with a 1–2 year lag time.

Nicorandil is effective at keeping angina patients out of hospital ▸ Nicorandil is used as a second line antianginal agent. It may also have a cardioprotective effect. This trial of > 5000 patients followed for 1.6 years suggests no reduction in coronary heart disease …