Ischaemic heart disease

Spotting risk factors in diabetics ▸ Of 601 patients with type 2 diabetes mellitus, only 76% had cholesterol measured, compared to rates of 92% for HbA1c and 99% for blood pressure (p < 0.0001 for either comparison). When elevation was detected, Hba1c was more likely to be treated (92%) than raised blood pressure (BP) (78%) or raised low density lipoprotein (LDL) cholesterol (38%, p < 0.001 for comparison). Even in a tertiary centre, cardiovascular risk reduction in diabetics who are at very high cardiovascular risk is clearly not as aggressive as it should be.

How cost effective are BP lowering, glucose control and cholesterol control in diabetics? ▸ The UKPDS data suggest BP control is as important as glycaemic control in preventing cardiovascular complications in diabetes. Using a model, a US group has calculated that BP control using angiotensin converting enzyme (ACE) inhibitors and α blockers is cost saving (saving US$1959 per life-year gained), while glucose control was cost effective in the young ($9614 at age 25–34 years) but not in the elderly ($2.1 million at age 85–94 years). Cholesterol lowering was most effective in middle age. All models have assumptions built in, but at least the message that BP control is important is very strong.

Oral glycoprotein IIb/IIIa agents do more harm than good ▸ Oral glycoprotein IIb/IIIa agents were associated with 31% increased mortality (odds ratio (OR) 1.31, p = 0.0001) in a meta-analysis of 33 326 patients. Results were similar whether the agent was added to (OR 1.38, 95% confidence interval (CI) …