Editorial articles

Within the last year we have witnessed the advent of public scrutiny of the results of surgical coronary revascularisation. The methodology em-ployed in order to achieve this scrutiny was flawed, as was the way the inadequate and incomplete results were presented to the general public. Data were presented without careful critical appraisal of what the figures actually meant. Little or no account was taken of context, risk assessment or case mix. This was either because of ignorance upon the part of those involved in publication or because of an inadequate level of concern for accuracy. In either case it was irresponsible. Inevitably, to make matters worse, any attempt to explain the fallibility of the presented figures and the flaws in their interpretation has lead to the charge of having something to hide.

Tryfonidis, Prendergast and Curzen present their findings of work designed to answer the very pertinent question “Are waiting times for coronary artery bypass grafting (CABG) longer than they should be?”. This question requires some reflection before we review the authors’ work and comments.

This report describes a 48-year-old woman with Parkinson”s disease who developed coronary artery dissection. We believe that dissection in this patient was probably caused by treatment with the anti-Parkinsonian drug pergolide.

The Impact of Nicorandil in Angina (IONA) study A report from a British Cardiac Society Satellite Symposium, 2002 Angina pectoris is not a benign disease: it is associated with significant morbidity and mortality and it affects more than 10% of men over the age of 60 years.

I am delighted that The British Journal of Cardiology is to become an official journal of the British Hypertension Society (BHS) information service. The BHS information service was developed to provide doctors and other health care professionals with information about hypertension. This includes details of current clinical management guidelines, recommended blood pressure monitoring devices and succinct summaries of management issues pertaining to specific clinical scenarios.

Concerning atherosclerosis imaging and coronary calcium concentrates predominantly on electron beam computed tomography (EBCT).1 Non-invasive coronary artery imaging can take the form of coronary artery calcium assessment or coronary angiography. Imaging can be performed with EBCT, or since 2001, with the latest generation of helical (‘spiral’) CT scanners (known as ‘multislice’ CT scanners in view of simultaneous acquisition of four image ‘slices’). There are major differences between EBCT and multi-slice helical CT. Whereas with helical CT the patient is continually advanced through a rapid mechanically rotating gantry (X-ray source and detector array), EBCT relies on X-rays produced with an electronically steered electron beam.

Taking vascular disease beyond convention Using the full lipid profile to identify and reduce the risk of coronary heart disease Lipid levels: risks and targets Prioritisation of high-risk coronary heart disease patients for statin intervention Key guideline cholesterol targets and full lipid profiling Scientific summary Introduction S1 Lipid levels: risks and targets S2 Prioritisation of high-risk coronary heart disease patients for statin intervention S3 Section 1: Key guideline cholesterol targets and full lipid profiling S4 Section 2: Scientific summary S5 Section 3: Patient identification S7 Section 4: Management strategies S9 Section 5: Practical use of clinical laboratories S10 Section 6: Tools for full lipid profiling and risk status calculation S11 Conclusion S11 Acknowledgements S12 Appendix 1: HDL, the metabolic syndrome and CHD risk S12 Appendix 2: Joint British societies coronary risk prediction charts S14 References S15 Patient identification Management strategies Practical use of clinical laboratories Tools for full lipid profiling and risk status calculation HDL, the metabolic syndrome and CHD risk.

Left ventricular hypertrophy (LVH) is more than just an adaptive response to the increase in left ventricular wall stress caused by hypertension. It has long been known that it is an indicator of a poor prognosis: the increased risk associated with LVH is independent of the blood pressure level.

Garlic has been used for its potential medicinal properties for centuries. It was cited 3,500 years ago by the Egyptians as useful in the treatment of heart disease, tumours, bites and worms. Interest in its use, particularly in reducing cardiovascular disease, has increased markedly over the past two decades with the rise in use of complementary and alternative medicines.

The prognosis for patients with non-ST elevation acute coronary syndromes (ACS) is not benign. Ongoing ischaemia is only one determinant of risk. The presence of ST-segment depression or elevated level of troponins is known to identify a group of patients at high risk of further events (death, MI, re-admission with ACS).The key management issue, however, is regarding which of these patients require early (i.e. in-hospital) revascularisation. Based upon current evidence from studies including FRISC II, TIMI-18, and the recent re-analysis of TIMI-III, our current strategy is to offer invasive investigation and revascularisation to all patients identified as ‘high risk’.