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Hyperlipidaemia and monoclonal antibodies – paying for outcome

July 2014 Br J Cardiol 2014;21:94–5 doi:10.5837/bjc.2014.022 Editorial

Hyperlipidaemia and monoclonal antibodies – paying for outcome

Gilbert Wagener

Abstract

The introduction of high-dose statin therapy, more potent statins and the corresponding clinical trial results have led to new treatment targets in secondary prevention of cardiovascular disease (CVD).1 Most guidelines recommend that for secondary prevention patients require a treatment goal of less than 1.8 mmol/L low-density lipoprotein (LDL)-cholesterol (LDL-C).2 While the use of high-dose atorvastatin therapy is expected to become more widespread now that atorvastatin is available as a generic drug,3 in practice, poor compliance seriously impacts effective treatment.4 Only 1.9% of patients in the Treating to New Targets (TNT) study reduced the randomised treatment of 80 mg atorvastatin to 40 mg,1 whereas, in practice, the mean dose prescribed is 32 mg per day.5 For statins, there appears to be a road-block to implementing the results of large randomised-controlled trials (RCTs), similar to the issue of treating hypertension, another ‘silent’ disease. 

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Targeting residual risk: a new approach to treating CVD?

July 2014 Br J Cardiol 2014;21:108–12 doi:10.5837/bjc.2014.023 Clinical article

Targeting residual risk: a new approach to treating CVD?

Alan Begg, Iain Findlay

Abstract

Lipoproteins play a pivotal role in the development of atherosclerosis, where apolipoprotein B-containing lipoproteins are considered pro-atherogenic and high-density lipoprotein anti-atherogenic. The retention and accumulation of modified low-density lipoprotein in foam cells within the intima of the arterial vessel wall is characteristic of the atherosclerotic process. Conversely, high-density lipoprotein plays an important role in the efflux of excess free cholesterol from the arterial wall through the process of reverse cholesterol transport. High-density lipoprotein also has antioxidant and anti-inflammatory properties that may also confer a protective effect on the vasculature. Statins are the first-line treatment for lowering low-density lipoprotein, but the residual risk of disease remains high. Novel therapies are under investigation that may offer a new therapeutic approach to treating atherosclerosis and additional protection against cardiovascular disease.

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A walk around the right heart

April 2014 Br J Cardiol 2014;21:(2) Online First

A walk around the right heart

What is cardiac rehabilitation achieving for patients with CHD? The ASPIRE-2-PREVENT results

December 2013 Br J Cardiol 2013;20(suppl 3):S1–S19 doi:10.5837/bjc.2013.s04 Supplement

What is cardiac rehabilitation achieving for patients with CHD? The ASPIRE-2-PREVENT results

Kornelia Kotseva, Elizabeth L Turner, Catriona Jennings, David A Wood, on behalf of ASPIRE-2-PREVENT Study Group

Abstract

Insights from the world of cardiology

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What’s hot in cardiorenal medicine

December 2013 Br J Cardiol 2013;20:133-5 Meeting reportNews and views

What’s hot in cardiorenal medicine

Optimising hypertension treatment: NICE/BHS guideline implementation and audit for best practice

March 2013 Br J Cardiol 2013;20(suppl 1): S1–S16 doi:10.5837/bjc.2013.s01 Supplement

Optimising hypertension treatment: NICE/BHS guideline implementation and audit for best practice

Dr Terry McCormack, Dr Chris Arden, Dr Alan Begg, Professor Mark Caulfield, Dr Kathryn Griffith, Ms Helen Williams

Abstract

Insights from the world of cardiology

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Massive inferior venacavo-atrial thrombus following neoadjuvant chemotherapy

November 2012 Br J Cardiol 2012;19:184 doi:10.5837/bjc.2012.034 Clinical article

Massive inferior venacavo-atrial thrombus following neoadjuvant chemotherapy

Pankaj Kaul, Robert George, Rodolfo Paniagua, Subbarayulu Balaji, Mohan Sivananthan, Rob Sapsford

Abstract

A 26-year-old man presented with T4 adenocarcinoma of sigmoid colon, which was initially treated with a covering ileostomy and neoadjuvant chemotherapy with oxaliplatin and infusional 5-fluorouracil delivered through a right subclavian Hickman line. While receiving chemotherapy, he developed a massive right atrial thrombus, adherent to the inferior venacaval opening and the adjoining right atrial wall, mimicking a metastatic deposit, which was removed surgically on cardiopulmonary bypass. The patient subsequently underwent successful high anterior resection of the sigmoid cancer followed by adjuvant chemotherapy with oxaliplatin and capecitabine. The unusual features of this patient’s presentation include the extremely rapid growth of thrombus despite aggressive anticoagulation, the unusual site of thrombus on the inferior vena caval opening rather than around the Hickman line, and possible facilitation of thrombus formation by chemotherapeutic agents. We also discuss the diagnostic and therapeutic dilemmas in a patient with a concurrent malignancy and a right atrial mass.

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In brief

August 2012 Br J Cardiol 2012;19:112–3 News and views

In brief

Left pleuropericardial agenesis and coronary artery disease

August 2012 Br J Cardiol 2012;19:124–5 doi:10.5837/bjc.2012.023 Clinical article

Left pleuropericardial agenesis and coronary artery disease

Pankaj Kaul

Abstract

We present a 37-year-old man who underwent coronary artery bypass grafting for severe left main stem stenosis and right coronary artery disease and was found to have left pleuropericardial agenesis with luxation of heart to the left in the left common pleuropericardial cavity. Although complete absence of pericardium is found in one out of 14,000 patients, agenesis of left pericardium as well as left pleura is extremely rare. Despite a number of related and unrelated pathologies having been described with this condition, there are only two or three reports of co-existence of coronary artery disease. We describe the technicalities of coronary artery surgery in this condition and also review the literature for clinical diagnosis, associated conditions and complications.

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News from the American College of Cardiology Scientific Session 2012

May 2012 Br J Cardiol 2012;19:59–61 News and views

News from the American College of Cardiology Scientific Session 2012

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