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6th October 2008 @ 2:53pm |
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Volume 15, Number 2, March-April 2008HOT Br J Cardiol 2008;15:63-64. HOT Br J Cardiol 2008;15:65-66. REVIEWFamilial hypercholesterolaemia:recognising the unrecognised Familial hypercholesterolaemia is a common genetic disorder that remains under-recognised. At present a simple genetic test is not available, although targeted genetic screening is being piloted in the UK. Recognition and treatment of this condition could help prevent many incidences of coronary heart disease. This article provides an overview of the pathophysiology, epidemiology, diagnosis and treatment of familial hypercholestrolaemia. Br J Cardiol 2008;15:79-81. REVIEWLow-density lipoprotein-apheresis: an update Low-density lipoprotein (LDL)-apheresis is the treatment of choice in homozygous familial hypercholesterolaemia as well as various other severe dyslipidaemic conditions. However, it appears to be under utilised in the UK. This article reviews the recent advances in (LDL)-apheresis techniques, as well as the beneficial effects and clinical outcomes of this therapeutic modality. Br J Cardiol 2008;15:83-85. HOT Anticoagulant therapy plays a key role in pharmacological reperfusion therapy for acute ST segment elevation myocardial infarction (STEMI). Until recently, the established role of unfractionated heparin (UFH) was unquestioned, but large trials with new agents including factor Xa inhibitors, direct thrombin inhibitors, and in particular, low molecular weight heparins (LMWHs), have shown potential advantages compared with UFH. This paper reviews the evidence base for the newer anticoagulants, with a focus on LMWH including the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment – Thrombolysis in Myocardial Infarction (ExTRACT TIMI)-25 study, which found that enoxaparin when appropriately adjusted for weight, age and renal function, provided superior net clinical benefit (balancing efficacy and safety) compared with UFH. In addition, new data from higher risk subgroups (the elderly, those with renal dysfunction or undergoing early coronary intervention) and the efficacy and safety of using concurrent clopidogrel are discussed to illustrate how these data may be integrated into contemporary practice Br J Cardiol 2008;15:87-94. HOT Data from 101 practices that had completed a survey of cholesterol target achievement using rosuvastatin in routine general practice were pooled to assess effectiveness at a national level. A total of 10,396 patients, who had total cholesterol (TC) measured prior to, and on, rosuvastatin 10 mg daily, were included in the analysis. Of these, 6,375 patients had not received a statin prior to rosuvastatin. The remainder had been switched from another statin. Significant reductions were observed in TC (28%) and low-density lipoprotein cholesterol (40%) when comparing prior to and on rosuvastatin 10 mg (p<0.001). A significantly greater proportion of patients achieved the General Medical Services (GMS) Quality and Outcomes Framework (QOF) target of TC ≤5 mmol/L with rosuvastatin 10 mg compared with prior to rosuvastatin (81% vs. 19%; p<0.0001). Of the 580 patients who had failed to reach target on atorvastatin 10 mg daily, 70% reached target on rosuvastatin 10 mg. Similarly, 68% of 246 patients who had failed to reach target on simvastatin 40 mg daily reached target on rosuvastatin 10 mg. General practitioners across the UK also substantially achieved other national and international cholesterol targets in patients treated with rosuvastatin 10 mg, including second line to simvastatin 40 mg and where higher doses of other statins had failed to reach target. Br J Cardiol 2008;15:95-100. HOT The total direct medical costs of heart failure in the UK each year are estimated to be approximately £716 million, with hospital in-patient care the biggest single healthcare cost, accounting for approximately 70% of the total cost of heart failure.1 Budget impact analyses are increasingly being used to complement economic evaluations as they enable healthcare purchasers to examine the relationship between maximised efficiency and affordability.2 This paper describes a budget impact model that estimates the incremental costs and benefits of adding eplerenone to standard care for heart failure resulting from myocardial infarction (MI) over a three-year period, from the perspective of National Health Service (NHS) healthcare decision makers. The model allows the impact of the drug to be measured appropriately with opportunities to quantify both costs and benefits on the total cost of healthcare for heart failure within the UK. Br J Cardiol 2008;15:101-105. HOT An elevated heart rate may be a primary determinant of myocardial ischaemia by altering the balance of oxygen demand and coronary perfusion. Given that there is considerable evidence showing survival is inversely related to heart rate, lowering heart rate would be expected to be an important tool in the management of angina.1-3 Theoretically it may also be beneficial in the prevention of myocardial infarction as the haemodynamic stresses placed upon the myocardium by a high heart rate are associated with coronary plaque rupture Br J Cardiol 2008;15:106-109. CASE REPORTSurgery for palpitations? Br J Cardiol 2008;15:110. CASE REPORTPercutaneous coronary intervention in dextrocardia Dextrocardia is a rare anomaly with an estimated prevalence of about one in 10,000. The incidence of coronary artery disease is the same as in the general population. We report two cases of successful percutaneous treatment of coronary stenoses and aim to highlight some of the additional technical challenges that such patients present to the Interventional Cardiologist. Br J Cardiol 2008;15:111-112. NEWS & VIEWSNews Br J Cardiol 2008;15:67,69,71. NEWS & VIEWSCorrespondence/book review Br J Cardiol 2008;15:73-74. NEWS & VIEWSBook review Br J Cardiol 2008;15:75. NEWS & VIEWSTune in and turn off We continue our series in which Consultant Interventionist Dr Michael Norell takes a sideways look at life in the cath lab… and beyond. In this column, he considers ‘non-expert’ opinion. Br J Cardiol 2008;15:76-77. |
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