Editorial articles

The National GPSI Cardiology Forum was established in 2005 and, despite the demise of the Primary Care Cardiovascular Society (PCCS) to which it was affiliated, it has remained active in the national cardiovascular arena. At a recent meeting at Warwick University, a decision was made to change our name to CVGP (CardioVascular General Practitioners: the Society for GPs with an interest in Cardiovascular Medicine). This name change does not alter our stated aims or direction of travel, but acknowledges the need to embrace all GPs involved in cardiovascular care rather than just GPs with a special interest (GPSIs) in cardiology. We believe this is essential in the evolving NHS clinical commissioning environment. 

When reference is made to sleep-disordered breathing (SDB), obstructive sleep apnoea (OSA) often springs to mind. Indeed, much research has been centred on identifying individuals at risk of OSA, determining the most effective form of therapy and unearthing the manner by which OSA increases cardiovascular disease (CVD) risk. As a result, factors such as central adiposity, neck circumference and age have been identified as OSA risk factors, and continuous positive airway pressure (CPAP) has become a well-recognised treatment for OSA. Studies also indicate that OSA may increase CVD risk via mechanisms involving tissue hypoxia and increased sympathetic nervous system activity, and that CPAP therapy counteracts these mechanisms.¹ The case for the OSA–CVD link has been further strengthened by additional research showing that CPAP can reduce elevated blood pressure and reduce the risk of cardiovascular events, such as heart attack and stroke.^2,3

The Cardiology Curriculum¹ describes the specialty of cardiology as a subspecialisation for physicians who were predominantly concerned with the care of patients with cardiovascular disorders. It goes on to state that care of such patients embraces a wide range of clinical activities and cardiologists need a broad view of the cardiovascular needs of individual patients and the communities in which they live, including an understanding of any prevailing health inequalities. This requires knowledge of not only the diagnostic and therapeutic modalities available, but also an appreciation of the importance of the epidemiology and potential for prevention of cardiovascular disease. Although cardiology is generally stereotyped as a highly practical skill-based medical specialty, with invasive and interventional skills as high-profile components of the workload, competence in other areas of practice such as cardiovascular clinical pharmacology and non-invasive imaging are equally important.

Twenty years ago, when we launched the British Journal of Cardiology (BJC) our intention was to produce a peer-reviewed journal, which linked cardiologists and general practitioners (GPs) with an interest in cardiovascular medicine. We have not waivered and, indeed, have grown to be a unique publication widely read across both primary and secondary care, leading opinion for 20 years.

Cardiovascular disease is one of the leading causes of morbidity and mortality among the elderly,^1,2 and interventional cardiologists are well aware that they are treating an increasing number of very elderly patients. It is clearly good news that life-expectancy is increasing and that more patients remain alive and active well into their eighties and nineties. While there is no obvious pathophysiological rationale for elderly patients to have a different therapeutic response to cardiovascular treatments there are important issues to consider. 

Angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) and beta blockers improve outcomes in patients with chronic heart failure secondary to left ventricular systolic dysfunction. 

The 2012 British Junior Cardiologists Association (BJCA) survey of cardiology trainees gives an important insight into what is happening in cardiology training in the UK.^1,2 Conducted six times since 2004, it was most recently performed in 2009. The authors should be congratulated on the effort that has clearly been involved. Several important issues emerge from these data, which, if the survey is truly representative of all UK trainees, necessitate some radical thinking. The issues that I shall discuss are: working hours and the role of general medicine, imaging training, and the percentage of female trainees. 

The British Hypertension Society (BHS) was established in 1980 by a group of physicians interested primarily in research. Over the years it has broadened its remit to encompass teaching and the development of best practice in hypertension management and cardiovascular risk prevention. Originally membership was restricted to people actively involved in research, but recently we have opened our doors to welcome other healthcare professionals (resident in the UK and Ireland) who are interested in the wider field. The majority of hypertension management in the UK is carried out by primary care physicians and nurses with increasing input from pharmacists. Many referrals to secondary care involve cardiologists. These practitioners are not sufficiently represented in the Society and, hence, we are keen for primary care health workers and cardiologists to apply for membership.

The hearts of the medical, sporting and lay communities were captured by the public cardiac arrest of 24-year-old midfielder Fabrice Muamba, during a football match in March 2012. His case was exceptional in that he survived because expert help was at hand immediately but, sadly, most young victims of sudden cardiac arrest do not live to hospitalisation. There are approximately 60,000 cases of sudden cardiac death in the UK each year,¹ the majority of which occur in older adults and are predominantly attributed to ischaemic heart disease or heart failure. In contrast, there are around 600 sudden deaths per annum in young people affected by inherited structural and electrical disorders of the heart, notably the cardiomyopathies and ion channelopathies.² 

In this issue (see pages 126–33), Paul Durrington has written an excellent review of one of the most interesting conundrums in current clinical lipidology – the putative role of cholesteryl ester transfer protein (CETP) inhibitors.