Volume 10, Number 6, November-December 2003

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TOPICEDITORIALThe British Journal of Cardiology celebrates its first 10 years
Kim Fox, Henry Purcell, Philip Poole-Wilson

Br J Cardiol 2003;10:411.

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TOPICEDITORIALDepartment of Health reports NSF key targets are being delivered ahead of schedule
Roger Boyle

Br J Cardiol 2003;10:412-413.

EDITORIALPCCS: critical thinking for times ahead
Fran Sivers

Br J Cardiol 2003;10:414-415.

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TOPICEDITORIALH.E.A.R.T UK: hyperlipidaemia and the challenges ahead
Julie Foxton, Anthony Wierzbicki, John Reckless

Br J Cardiol 2003;10:416-417.

EDITORIALProspects for hypertension in the next decade
Neil R Poulter

Br J Cardiol 2003;10:418-420.

EDITORIALNHA: the evolving role of the nurse in hypertension
Susan Kennedy

Br J Cardiol 2003;10:421-423.

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TOPICEDITORIALRehabilitation: quantity and quality will count
J Malcolm Walker

Br J Cardiol 2003;10:424-425.

EDITORIALBANCC: the changing role of the cardiac nurse
Debbie Hughes

Br J Cardiol 2003;10:426-427.

EDITORIALTraining in cardiology – the next decade
John Greenwood

Br J Cardiol 2003;10:428-430.

PRIMARY CAREComputer-enhanced assessment of cardiovascular risk
Peter Tyerman, Gill V Tyerman, Trefor Roscoe, Mike Campbell, Jenny Freemen

This study investigated the impact of the use of a computer programme to collect data on cardiovascular risk factors, which could also provide patient education. A retrospective analysis was carried out of data recorded over three years in a general practice in Barnsley, an area with the second highest prevalence of ischaemic heart disease in England.
The study found that use of a simple computer-based system by the primary care team led to 55% of the population being assessed within three years. Consequent patient education and lifestyle changes led to a reduction of risk factors in those at high risk who were re-screened. A possible reduction on admissions to hospital for cardiovascular disease was also noted.

Br J Cardiol 2003;10:472-476.

PRIMARY CAREDiabetes and coronary heart disease: combining the National Service Frameworks
Mike Mead

The two National Service Frameworks for coronary heart disease, and for diabetes, share some common themes. This article discusses where they overlap with each other and with national targets for stroke outlined in the National Service Framework for Older People. It then details a simple 10-point plan on how Primary Care Trusts can develop strategies to implement NSF targets so they achieve national standards.

Br J Cardiol 2003;10:478-481.

PRIMARY CAREWhat’s new in cardiovascular disease: report from the PCCS Annual Meeting and AGM
‘New’ was the operative word at this year’s Primary Care Cardiovascular Society annual meeting, held in Dublin from 3rd–4th October 2003. Delegates heard about the ‘new’ GP contract, the ‘new’ science of pharmacogenetics, the ‘new’ breed of healthcare professionals (with special interests) and a ‘new’ diploma in cardiovascular disease. Medical writer Dr Ola Soyinka reports.

Br J Cardiol 2003;10:484-488.

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TOPICREVIEWThe angina journey: a major challenge in cardiology
Coronary Heart Disease Collaborative

Br J Cardiol 2003;10:446-449.

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TOPICREVIEWNon-surgical aortic valve replacement
Miles Dalby, Helene Eltchaninoff, Alain Cribier

This article discusses percutaneous aortic valve replacement, a new technique developed to overcome the problem of restenosis of the native valve in patients treated with balloon aortic valvuloplasty. It describes the first four cases which have been undertaken using this new technique that show the potential for its development for more widespread use in the future.

Br J Cardiol 2003;10:450-452.

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TOPICREVIEWThe surgical management of aortic valve disease
Joanna Chikwe, Axel Walther, John Pepper

We summarise the natural history and pathophysiology of aortic stenosis and regurgitation, the indications for surgery, the advantages and disadvantages of tissue, mechanical, homograft and autograft aortic valve replacement, and the prediction of operative mortality for individual patients.

Br J Cardiol 2003;10:453-461.

REVIEWModified-release nicotinic acid for dyslipidaemia: novel formulation improves tolerability and optimises efficacy
Michael Schachter

Data from epidemiological and intervention studies have conclusively shown that a low level of high-density lipoprotein cholesterol (HDL-C) is an important risk factor for cardiovascular disease. Increasing low HDL-C levels produces risk reduction comparable with that observed with decreasing low-density lipoprotein cholesterol (LDL-C) in the major statin trials. The latter have shown that, even with effective statin therapy, there is still an unacceptably high residual risk of major coronary events. A substantial proportion of patients with coronary heart disease (CHD) with acceptable levels of LDL-C will have low levels of HDL-C and increased serum triglycerides. Of the available lipid-modifying treatments, nicotinic acid is the most potent agent for increasing HDL-C (by about 30% from baseline). In addition, it effectively decreases triglycerides and has a relatively modest effect in decreasing LDL-C. Modified-release nicotinic acid has been developed to overcome the poor tolerability associated with earlier formulations while maintaining the efficacy of immediate-release nicotinic acid. Modified-release nicotinic acid is effective and safe for the treatment of dyslipidaemia, including the atherogenic dyslipidaemia associated with type 2 diabetes and the metabolic syndrome. Combination therapy with modified-release nicotinic acid and a statin offers complementary therapeutic benefits, as well as reducing the progression of, or even regressing, atherosclerosis. This strategy can represent an important advance for clinical management of at-risk patients with dyslipidaemia.

Br J Cardiol 2003;10:462-468.

CASE REPORTAcute, reversible type II (Wenkebach) heart block due to combined chloroquine and diltiazem treatment
Neil Swanson, Nilesh J Samani

International travel to malarial areas is increasingly common. Chemoprophylaxis using chloroquine is common, but can cause cardiac problems. We describe a new problem, of reversible heart block, in a patient on both chloroquine and the frequently-used calcium channel blocker, diltiazem.

Br J Cardiol 2003;10:470-471.