Editorial articles

During the second half of the twentieth century our knowledge of the aetiology of and pathophysiological mechanisms underlying hypertension have advanced immeasurably. Furthermore, few, if any, areas of medicine have as many major morbidity and mortality trials to inform optimal management as does hypertension.

The merits of reducing cholesterol to help prevent coronary heart disease (CHD) were questioned 10 years ago. There were great debates about the utility of reducing low-density lipoprotein cholesterol (LDL-C) and it is now clear, following the publication of at least eight different clinical drug trials, that reducing cholesterol with statin drugs helps to reduce total mortality, cardiovascular mortality and morbidity and interventional procedures.

The Primary Care Cardiovascular Society (PCCS) has come a long way since a small group of us met in an inauspicious hotel in middle England in the mid 1990s, to discuss the formation of a group through which to develop a network of general practitioners (GPs) with a particular interest in cardiovascular disease and its management.

Ten years ago, England had one of the worst death rates from circulatory diseases in Europe. Today, thanks to the expertise and hard work of thousands of NHS staff, major progress has been made in implementing the National Service Framework (NSF) for Coronary Heart Disease (CHD), and deaths from circulatory diseases are set to be reduced by 40%, three years ahead of the 10-year target set when the NSF was published in March 2000. As a result, we estimate that around 100,000 lives are being saved each year.

This is the tenth anniversary issue of the British Journal of Cardiology(BJC) and, to mark the occasion, we have invited editorials from medical and nursing groups officially associated with the journal.

The ability to deliver increased cardiac services in line with the National Service Framework (NSF) is dependent on a skilled workforce being developed at an unprecedented rate. The numbers of trained staff are at present inadequate, and they will remain so using traditional models of training.

Thrombolytic therapy remains the predominant reperfusion strategy for ST segment elevation myocardial infarction (STEMI) in the UK, with government policy directed towards optimising thrombolytic delivery. However, the publication of the first Myocardial Infarction National Audit Project (MINAP) report last year informed us that only 28% of hospitals supplying data treated the target 75% of eligible patients inside 30 minutes.

The early, non-invasive detection of coronary artery disease is a major challenge confronting contemporary cardiology. In particular, the early identification of vulnerable plaques that may lead to acute coronary syndromes (ACS) poses a major dilemma.

The Coronary Artery Revascularisation in Diabetes (CARDia) trial is an investigator-initiated study and is the first prospective study designed specifically to address the hypothesis that optimal percutaneous coronary intervention (PCI) with stenting and abciximab is not inferior to up-to-date coronary artery bypass grafting (CABG) as a revascularisation strategy for diabetics with multivessel or complex single vessel coronary disease.

Physicians aiming to prevent vascular disease, either when managing an individual patient or when designing a clinical trial, usually think about reducing the risk of stroke or ischaemic heart disease, or their combination. And, yet, an explosion in numbers of another vascular-related condition is looming, namely in dementia. This first edition of Heart & Brain focuses on dementia in general, and vascular dementia more specifically.