ISCHAEMIC HEART DISEASE

A paclitaxel eluting stent for the prevention of coronary restenosis ▸Restenosis occurs in 20–40% of cases after coronary stent implantation, and remains the major drawback of percutaneous coronary intervention. However, the sirolimus eluting stent (Cypher) released last year suggested dramatic reductions in this problem. Now similar data has arrived for the Taxus stent (eluting paclitaxel). These data showed that > 50% restenosis occurred in 4% of the Taxus group versus 27% in the placebo bare stent group (p < 0.001). Although expensive, these stents may represent a cost saving if recurrent procedures are dramatically reduced in real clinical practice.

Give atorvastatin 80 mg if there is no revascularisation possible ▸The AVERT trial suggested that atorvastatin 80 mg/day produced a greater reduction in coronary heart disease (CHD) events than did angioplasty with a lower level of statin. It comes as no surprise that in 60 patients in whom revascularisation was not possible, after 12 weeks of treatment, patients in the aggressive lipid lowering treatment group had a significantly greater decrease in mean (SD) low density lipoprotein (LDL) cholesterol concentration than those in the usual care group (29 (38) mg/dl v 7 (24) mg/dl, p = 0.03). Patients in the aggressive treatment group also had a reduction in the number of ischaemic wall segments on stress echocardiography (mean between group difference of 1.3, 95% confidence interval (CI) 0.1 to 2.0; p = 0.04) and angina score after 12 weeks. There were no significant changes in atherosclerotic burden in either group.

Irbesartan does not reduce CVS end points compared to placebo or amlodipine ▸The primary outcomes of the irbesartan diabetic nephropathy trial were doubling of serum creatinine values, end stage renal disease, and death from any cause. The trial recruited 1715 adults with type 2 diabetic nephropathy and hypertension, serum …