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November 2008 Br J Cardiol 2008;15:302–5 Clinical article

10 steps before you refer for atrial fibrillation

Rosie Heath, Gregory Y H Lip

Abstract

Atrial fibrillation (AF) is a relatively common condition. The national prevalence for England on the latest quality and outcomes framework data is 1.3% and as many as 10% of patients aged over 75 may be in AF. On average, all of us have a 20–25% lifetime risk of developing AF.

An average GP will have 16–20 cases on their personal list and can expect to diagnose three new cases per annum. However, it is recognised that many cases of AF go undiagnosed and opportunistic screening for AF has been recommended. Of note, AF is responsible for 45% of embolic strokes. With the increasing emphasis on AF from Chapter 8 of the National Service Framework for Coronary Heart Disease (NSF-CHD), the National Stroke Strategy1 and inclusion of AF in the Quality and Outcomes Framework – as well as publication of the National Institute for Health and Clinical Excellence (NICE) guidelines for AF management – it is important for GPs to diagnose, treat and refer AF patients correctly.

There are three main areas to consider in AF patients: first, the diagnosis and treatment of any underlying co-morbid condition; second, symptom control by either a rate- or rhythm-control strategy; and third, the reduction of the accompanying risk of stroke and thromboembolism by appropriate prescription of antithrombotic therapy. Many straightforward cases of AF can be satisfactorily managed entirely in primary care, using the following structured approach.

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September 2008 Br J Cardiol 2008;15:231-36 News and views

News from the 2008 Congress of the European Society of Cardiology

September 2008 Br J Cardiol 2008;15:271–2 Clinical article

Microscopic polyangiitis presenting as a pericardial effusion

Sajid Siddiqi, Sarah Rae, John Cooper

Abstract

Microscopic polyangiitis is a systematic necrotising vasculitis that affects small vessels without granulomata. Typically the most common manifestation is renal involvement. We report an unusual presentation of microscopic polyangiitis in a young male.

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July 2008 Br J Cardiol 2008;15:189 News and views

Controversies in cardiovascular care

July 2008 Br J Cardiol 2008;15:205–9 Clinical article

Efficacy of ezetimibe and future role in the management of refractory hyperlipidaemia in high-risk patients

Rizwan Sarwar, Clare Neuwirth, Shahenaz Walji, Yvonne Tan, Mary Seed, Gilbert R Thompson, Rossi P Naoumova

Abstract

A clinical audit of ezetimibe in the treatment of refractory hyperlipidaemia was conducted in 100 high-risk patients who failed to achieve desirable levels of total and low-density lipoprotein (LDL)-cholesterol on statins. Of these, 59 had familial hypercholesterolaemia (FH), the remainder had other aetiologies (non-FH). The percentage of patients achieving the total and LDL-cholesterol targets of the International Panel on the Management of FH or the Second Joint British Societies’ guidelines in non-FH patients was determined.

Ezetimibe significantly decreased mean LDL-cholesterol when used as an adjunct to statins or as monotherapy, from 3.9 to 3.1 mmol/L in FH, from 3.4 to 2.4 mmol/L in non-FH and from 6.0 to 4.4 mmol/L in statin-intolerant patients. The decrease in LDL-cholesterol on statins was inversely correlated with the decrement after adding ezetimibe (r= -0.67, p<0.0001) but 15% of patients showed no further decrease. The percentage of patients achieving target levels of LDL-cholesterol was 27% on statins and 63% on statins plus ezetimibe (p<0.007). None of the non-FH patients achieved target levels on statins but 33% did so when ezetimibe was added (p<0.001).

Ezetimibe is an effective adjunct to statins for lowering LDL-cholesterol in refractory hyperlipidaemia, except in a minority of patients, and is a useful substitute in statin-intolerant subjects.

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November 2007 Br J Cardiol 2007;14:251-2 Editorial

Switching statins: do it, but do it properly

Terry McCormack, Rubin Minhas

Abstract

Switching statins from on-patent to off-patent generic simvastatin is currently the focus of a major policy initiative by the Department of Health. In this context, an observational study of statin switching conducted by the manufacturer of an on-patent statin has already attracted considerable widespread media attention even before its publication within this issue of the British Journal of Cardiology (see pages 280-5). It is likely to stimulate considerable controversy and debate in the months ahead.

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September 2007 Br J Cardiol 2007;14:190 Editorial

REACHing for new heights in disease management

Deepak L Bhatt, P Gabriel Steg

Abstract

Atherothrombosis is the underlying pathology for most ischaemic events, including myocardial infarction, many forms of stroke, peripheral arterial insufficiency, and cardiovascular death, together with sudden cardiac death. As such, atherothrombosis represents a major healthcare concern throughout the world. Due to the increase in sedentary lifestyle and overeating, obesity, metabolic syndrome, and diabetes are all increasing in parallel, fuelling the atherothrombosis epidemic. It is likely, as the population ages and as urbanisation and industrialisation continue, that atherothrombosis will grow in prominence as a major public health problem.

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September 2007 Br J Cardiol 2007;14:203-04 Meeting reportNews and views

Women and heart disease

November 2005 Br J Cardiol 2005;12:409-10 Editorial

Combating vascular disease in Scotland

Alan G Begg

Abstract

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).

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May 2005 Br J Cardiol 2005;12(Suppl 1):S2-S7 Supplement

This House believes that the UK healthcare system may be failing as many as 50% of patients with hyperlipidaemia by not reducing their cholesterol to effective levels: a debate

Dr Clive Weston, Dr Nigel Capps, Dr Stewart Findlay, Ms Julie Foxton, Professor Richard Hobbs, Dr Terry McCormack, Dr Jim McMorran, Dr John Pittard, Ms Jan Procter-King

Abstract

A panel of experts, sponsored by Merck Sharp & Dohme Ltd and Schering-Plough Ltd and
made up of cardiologists, lipidologists, general practitioners and nurses with a special interest in coronary heart disease and lipid management, met recently to debate whether individuals with hyperlipidaemia are being treated to effective levels and, if not, how current and future treatment options could be better employed to reduce cardiovascular risk.

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