Editorial articles

Our understanding of the pathophysiology of acute coronary syndromes and, in particular, the interplay of a number of complex parallel processes, continues to develop.1 These processes include inflammation, thrombosis and matrix turnover with potential gene and environmental influences. Vitamin D, known primarily as a hormone of bone metabolism, can affect the transcription of a number of genes which play a pivotal role in both the development of acute coronary syndromes and the pathogenesis of coronary artery disease (CAD). The purpose of this review is to examine the mechanisms by which vitamin D and the vitamin D receptor (VDR) might influence the development of acute coronary syndromes.

We continue our series where Consultant Interventionist Dr Michael Norell takes a sideways look at life in the
cath lab ….. and beyond. In this column, he looks at the unreal and riveting world of TV medicine.

Submissions are in and now the real lobbying can begin.
Scarcely a year after the implementation of the Quality
and Outcomes Framework (QOF) of the new General
Medical Services (GMS) contract,1 the first review is already
well underway and due to come into effect on 1st April 2006.

As an organisation we are delighted that, as from this
issue, The British Journal of Cardiology will become
the official journal of the Scottish Heart and Arterial
Risk Prevention group (SHARP). SHARP, a registered charity
launched in Scotland in 1988, now attracts members from
across the UK bringing together a wide range of healthcare
professionals interested in the prevention and management
of cardiovascular disease (CVD).

The Anglo-Scandinavian Cardiac Outcomes Trial
(ASCOT) reported the final results of its blood pressure
lowering arm at the European Society of Cardiology
(ESC) Annual meeting amidst much publicity.

Heart failure affects over 750,000 people in the UK and
65,000 new cases are diagnosed every year. It carries a
poor prognosis with a population-based study finding
a 40% one-year mortality in all new diagnosed cases1 with
those in New York Heart Association (NYHA) class IV having a
60% one-year mortality.

Drug-eluting stents (DES) have been available commercially in the UK for over three years. The National Institute for Clinical Excellence (NICE) produced a technology appraisal in October 2003 and that initial review is about to be updated. Well, has this technology delivered on its promise? Have we embraced it too quickly or is 100% DES usage around the corner?

The association between mitral valve disease, atrial
fibrillation (AF) and the incidence of embolic stroke is well
known. The incidence of systemic embolism (including
embolic stroke) is seven times greater in patients with mitral
valve disease and AF.

Health risk is not synonymous with obesity and
obesity is not synonymous with visceral fat.
Obesity is now recognised by governments, and
importantly in medical training, as a chronic disease
leading to multiple organ-specific pathologies
(including metabolic syndrome and coronary heart disease).

Major advances have been made in the management
of heart failure (HF) over recent years. Modern day
pharmacotherapy and device-based therapy have
brought about significant improvements in prognosis
and a reduction in morbidity.