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  1. Iqbal Malik, Editor

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Ischaemic heart disease

Wouldn't you want primary angioplasty for your MI? ▸

The evidence for the benefits of primary angioplasty over thrombolysis is strengthened further by the latest meta-analysis. Primary angioplasty was better than thrombolytic treatment at reducing overall short term death (7% v 9%; p = 0.0002), non-fatal reinfarction (3% v 7%; p < 0.0001), stroke (1% v 2%; p = 0.0004), and the combined end point of death, non-fatal reinfarction, and stroke (8% v 14%; p < 0.0001). The results seen with primary angioplasty remained better than those seen with thrombolytic treatment during long term follow up, and were independent of both the type of thrombolytic agent used, and whether or not the patient was transferred for primary angioplasty.

Trial shows statins do not produce benefit ▸

After a host of trials suggesting statins lower coronary heart disease (CHD) risk in patients with normal cholesterol even if they have not had previous vascular events, the ALLHAT trial of 10 355 patients suggests that 40 mg of pravastatin in hypertensives with at least one additional risk factor gain no benefit. At year 4, total cholesterol concentrations were reduced by 17% with pravastatin versus 8% with usual care; among the random sample who had low density lipoprotein (LDL) cholesterol concentrations assessed, levels were reduced by 28% with pravastatin versus 11% with usual care. All cause mortality was similar for the two groups (relative risk (RR) 0.99, 95% confidence interval (CI) 0.89 to 1.11; p = 0.88), with six year mortality rates of 14.9% for pravastatin versus 15.3% with usual care. CHD event rates were not significantly different between the groups (RR 0.91, 95% CI 0.79 to 1.04; p = 0.16), with six year CHD event rates of 9.3% for pravastatin and 10.4% for usual care. Perhaps cholesterol concentrations were not lowered enough to detect a difference?

Shouldn't we be screening for insulin resistance? ▸

The metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal …

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    BMJ Publishing Group Ltd and British Cardiovascular Society