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Ischaemic heart disease

Multiple risk factor reduction in diabetes works ▸

One hundred and sixty patients with type 2 diabetes and microalbuminuria were randomly assigned to receive conventional care or intensive treatment. Patients in the intensive therapy group were treated with drugs to maintain glycosylated haemoglobin values below 6.5%, blood pressure below 130/80 mm Hg, cholesterol below 4.5 mmol/l, and triglyceride below 1.7 mmol/l. Recommended lifestyle interventions included reduced dietary fat, regular moderate exercise, and cessation of smoking. All participants in the intensive therapy group were also advised to take aspirin and a dietary supplement that included vitamins E and C, folic acid, and chrome picolinate. In addition, patients in the intensive therapy group were given an angiotensin converting enzyme (ACE) inhibitor (or, if contraindicated, an angiotensin II receptor antagonist), regardless of blood pressure, to slow the progression of renal disease. After a mean follow up of 7.8 years, one or more cardiovascular events (death from cardiovascular causes, non-fatal myocardial infarction or stroke, coronary or peripheral artery revascularisation, or amputation as a result of ischaemia) had occurred in 44% of patients in the conventional treatment group but in only 24% of those in the intensive therapy group. The risk reduction was similar when revascularisation procedures were excluded. Rates of nephropathy, retinopathy, and autonomic neuropathy were also notably reduced in the intensive therapy group. Although the changes on the composite end point were striking there was no difference in cardiovascular death rates between the groups over the 7.8 years follow up.

Off-pump surgery is equivalent to on-pump CABG ▸

The trend to percutaneous intervention (PCI) for revascularisation rather than coronary bypass graft surgery (CABG) is based on the higher risks of acute stroke, myocardial infarction, and death with CABG. In addition there is a risk of neurocognitive disturbance. It was felt that the bypass machine may have been the problem, so off-pump techniques have been developed. In a trial of …

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