176 e-Letters

published between 2013 and 2016

  • Cholesterol as a statin indication
    Paul Durrington

    This article contains some valuable information, but is misleading in at least one important respect. The Joint British Societies did not recommend statin treatment when cholesterol levels are higher than 6mmol/l. Rather, they recommended that a ratio of total serum cholesterol to HDL cholesterol exceeding 6 should be an indcation. This is actually the most conservative use of lipid values as arbiters of who should recei...

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  • The significant association between apnoea-hypopnoea index and flow-mediated dilation of brachial artery: statistical consideration on its validity
    Tomoyuki Kawada

    I read with interest the cross-sectional study by Namtvedt et al. (1) for 77 adults, who were sampled from 30,000 individuals aged 30-65 years. They concluded that there was a significant positive association between obstructive sleep apnoea (OSA) and endothelial dysfunction by using indicators of apnoea-hypopnoea index (AHI), flow-mediated dilatation (FMD), sex and some cardiovascular risk factors. Atkinson made a query...

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  • Hormone Associated Spontaneus Coronary Artery Dissection
    Gonenc Kocabay

    To the Editor, We read with interest Plonczak et al's article depicting the two-vessel spontaneous coronary artery dissection(SCAD) as a cause of acute coronary syndrome(ACS)(1). SCAD is uncommon,accounting for 0.1-0.28% of all patients with ACS or sudden cardiac death.It is more common in young female patients with the average of initial presentation is 35-44 years old. Conventional coronary risk factors, such as smok...

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  • Clopidogrel Loading Dose in Patients Undergoing Elective Percutaneous Coronary Intervention
    Gen-Min Lin

    To the Editor: We read with interest the meta-analysis by Siller-Matula et al which reported that intensified clopidogrel loading with 600mg reduces the rate of major cardiovascular events without increase in major bleeding compared to 300mg in patients undergoing percutaneous coronary intervention (PCI) during one month follow-up.1 A large body of evidence have suggested the effectiveness and safety of 600-mg loading dos...

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  • Atrial reverse remodeling in super-responders to cardiac resynchronization therapy
    Gaetano Santulli

    In a recent issue of Heart1 Steffel et al. show in an elegant retrospective study that patients with an exceptionally good echocardiographic response to cardiac resynchronization therapy (CRT) are highly likely to experience a favorable outcome after CRT. We feel that this paper is worthy of comment. The study is well designed and represent an outstanding 'real world' experience. However, we do have several issues. The...

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  • Carotid plaque typization: a novel risk marker?
    Marijan Bosevski

    Toutouzas and co-authors demonstrated that carotid plaque vulnerability coincided with neovascularisation and inflammation, as measured by CEUS and MR.1 Carotid IMT and detection of stenosis have been previously established as predictor of prognosis of patients with cardiovascular disease. Carotid non-invasive measurements have been recommended in vulnerable patients, because of tight correlation between parameters: pl...

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  • Cilostazol in NICE guideline
    Sergi Bellmunt

    To the Editor,

    Shalhoub and Davies (1) commented in their summary of NICE guidance on cilostazol, naftidrofyryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication (NICE technology appraisal guidance 223; available at: www.nice.org.uk/guidance/TA223) that the cost-effectiveness analysis was based on appropriate assumptions, however, this analysis was based on a meta-anal...

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  • Access site selection for primary PCI - the evidence for transradial access is strong
    Karim Ratib

    We were interested to read the editorial written by Meier et al(1) relating to our recent meta-analysis of randomised trials evaluating access site selection in STEMI PCI(2). We agree with their comment that our meta-analysis adds to the body of evidence in support of radial access, and that our analysis has to be considered in the light of a number of interrelated issues. We do not however agree with the interpretation...

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  • Cardiac rehabilitation supports a heterogeneous population of patients
    W. Robert Williams

    In a recent publication reporting the outcome of a trial, West et al conclude that comprehensive cardiac rehabilitation (CR) following MI has no important effect on mortality, morbidity, risk factors or health related quality of life (HRQL).1 Trial results provided evidence, consistent with that from meta-analysis of post 1983 data, for a decline in the need for CR resulting from advances in patient management.


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  • Allometric scaling is useful for reliable comparisons of flow-mediated dilation
    Greg Atkinson

    One of the most consistent findings in research on percentage flow- mediated dilation (FMD%) is the negative correlation between baseline arterial diameter (Dbase) and FMD% itself. The study by Namtvedt et al.(1) is no exception in this respect. FMD% is obviously already an attempt to "normalise" the measured change in arterial diameter (in mm) for variability in Dbase, but seems to do this job poorly (2,3).

    In a...

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