Volume 13, Number 5, September-October 2006

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TOPICEDITORIALOptimal treatment for complex coronary artery disease and refractory angina
Christine Wright, Glyn Towlerton, Kim Fox

Br J Cardiol 2006;13:306-308.

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TOPICEDITORIALPFO: to close or not to close – a headache decision
Jessica Wilson, Paul Oldershaw

Br J Cardiol 2006;13:310-312.

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TOPICEDITORIALLate clinical events after drug-eluting stents: is there a problem?
Martyn Thomas

Br J Cardiol 2006;13:313-316.

PRIMARY CAREThe impact of the new GP contract on measurement of lipids and use of statins in the over 80s with coronary heart disease
Samira Siddiqui, Chris Isles, Ewan Bell, Alan Begg

The benefits of statins for both primary and secondary prevention of coronary heart disease (CHD) are limited mainly to patients under 80. We examined the impact of the new General Medical Services (GMS) contract on measurement of lipids and prescribing of statins in patients over 80 years of age with CHD. We found that there has been a significant increase in both, with little evidence supporting this and substantial financial implications. National guidance on the assessment and management of lipids in the over 80s in the new GMS contract is urgently required.

Br J Cardiol 2006;13:367-369.

PRIMARY CARERevised GMS2: a target too far?
Mike Mead

Br J Cardiol 2006;13:371-372.

REVIEWThe oblique view
Michael Norell

Br J Cardiol 2006;13:341-342.

REVIEWAn unappreciated pioneer in cardiology: Ernest Starling
John Henderson

Br J Cardiol 2006;13:344-345.

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TOPICREVIEWShould cardiologists be interested in albuminuria?
Clive Weston, Achanthodi Vasudev, Daniel Obaid, Saatehi Bandhopadhay, Jiten Vora

Excretion of excess urinary albumin is a marker of generalised endothelial dysfunction and both progressive renal disease and cardiovascular events in those with and without diabetes; its detection provides a simple way of identifying patients at particularly high risk. Effective management of cardiovascular risk factors and the use of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have been shown to retard or prevent progression of microalbuminuria to more profound albuminuria. Microalbuminuria can be reversed by such therapy and recently an ACE inhibitor has been shown to prevent the development of microalbuminuria in hypertensive patients with type 2 diabetes. Given the increasing prevalence of type 2 diabetes and the corresponding ascendancy of ensuing cardiovascular disease and renal failure, strict control of multiple risk factors, including microalbuminuria, is to be encouraged.

Br J Cardiol 2006;13:347-350.

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TOPICREVIEWUse of non-steroidal anti-inflammatory drugs does not modify the antihypertensive effect of lercanidipine in essential hypertension
Manuel Luque, Angel Navarro, Nieves Martell

The aim of this study was to assess whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affected blood pressure control in patients with essential hypertension who were being treated with lercanidipine, a vasoselective dihydropyridine calcium channel blocker. A total of 334 patients (mean [+ SD] age 61+10 years, 51% females) with mild-to-moderate essential hypertension and a history of osteoarthritis received lercanidipine (10 mg/day, up-titrated to 20 mg/day) for four to eight weeks until blood pressure control was achieved. At that point, treatment with NSAIDs (mostly diclofenac and naproxen) was started. Treatment with NSAIDs was maintained for four weeks.
At baseline, mean systolic blood pressure (SBP) was 157+10 mmHg, diastolic blood pressure (DBP) 92+6 mmHg, and heart rate 75+9 beats per minute. The administration of lercanidipine was associated with a significant decrease of SBP (to 139+9 mmHg) and DBP (to 82+7 mmHg) (p<0.001), without changes of heart rate.
SBP and DBP readings were not affected by the concomitant use of NSAIDs. Among 156 patients whose blood pressure was well controlled with lercanidipine, 128 (82%) continued to have well controlled SBP and DBP readings. The remaining 28 patients had SBP and DBP > 140 and/or 90 mmHg, but differences in blood pressure between the two groups were not significant. Eight patients (2.3%) had mild side effects and three were withdrawn due to ankle oedema.
We conclude that the use of NSAIDs did not significantly modify the antihypertensive effect of lercanidipine in essential hypertension. Therefore, lercanidipine is a useful drug for hypertensive patients with osteoarthritis who require treatment with NSAIDs.

Br J Cardiol 2006;13:353-359.

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TOPICCASE REPORTCase conferences from the Royal Brompton Hospital: a focus on myocardial ischaemia
Jessica Wilson, Paul Bhamra-Ariza

This is the first in a regular series of ‘Case Conferences’ dealing with ‘difficult’ angina, or patients who present with challenging myocardial ischaemia (even in the absence of symptoms). Decisions are not always either ‘right’ or ‘wrong’ in such cases and the purpose is to aim for consensus on an appropriate management strategy. These cases are designed to be interactive and we encourage comments from our readers. We hope that you find these cases interesting and informative and that you join in the debate.

Br J Cardiol 2006;13:364-366.

REPORTBig trouble in little Britain
Helen Rivas-Toro

Br J Cardiol 2006;13:329-331.

REPORTPatient satisfaction of the Angina Plan in a rapid access chest pain clinic
Catherine Marie Sykes, Sara Nelson, Kathy Marshall

The aim of this study was to understand patients’ satisfaction with the Angina Plan (AP). Comments from the satisfaction questionnaire help us to understand why patients were satisfied with the AP.

Br J Cardiol 2006;13:361-362.

NEWS & VIEWSNews from the 2006 Congress of the European Society of Cardiology and the XVth World Congress of Cardiology
The 2006 Congress of the European Society of Cardiology joined with the World Heart Federation’s XVth World Congress of Cardiology this year and was held in Barcelona, Spain, from 2nd–6th September 2006. The joint meeting was dominated by one subject – new concerns about increased mortality and myocardial infarction with drug-eluting stents. We report on this and other highlights from this year’s meeting.

Br J Cardiol 2006;13:317-325.

NEWS & VIEWSLifestyle management of blood pressure
Lifestyle modifications are an essential initial approach to the management of blood pressure. To review the current evidence in this area, The British Journal of Cardiology recently convened a round table meeting to look at the lifestyle management of raised blood pressure. It considered the role of dietary changes, exercise, alcohol and weight, and ways of changing patients’ behaviour, on blood pressure. The meeting, held at The Royal Society of Medicine, London, and supported by an unrestricted educational grant from Unilever, was attended by investigators involved in the EUROACTION study. EUROACTION is a European Society of Cardiology demonstration project in preventive cardiology which has just been completed in eight countries in both hospital and primary care. It is evaluating whether a nurse-led multidisciplinary team can help patients and families achieve recommended lifestyle and risk factor reduction targets for cardiovascular disease prevention.

Br J Cardiol 2006;13:332-337.