Tag Archives: cardiovascular disease

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Introduction Drugs that block the renin–angiotensin–aldosterone system, the angiotensin-converting enzyme inhibitors (ACEIs) and the angiotensin-receptor blockers (ARBs), have been shown to be effective in the management of hypertension, heart failure and several forms of renal disease including diabetic nephropathy. For this reason, the use of these agents is likely to increase steadily in the coming years. It is also clear from many of the randomised controlled trials that there is a dose-response curve for these agents, with higher doses being more effective.1-6 In the course of our clinical practice in acute general medicine, we obser

More than just a postcode The keynote session, ‘Cardiovascular disease and deprivation; more than a postcode’, heard from public figures and leading clinicians defining deprivation as it relates to cardiovascular disease from various perspectives. Professor Roger Boyle (National Director, Coronary Heart Disease and Stroke) said that, despite the “considerable progress” seen across all age groups and genders in cardiovascular disesase (CVD) reduction, there remains a gap between deprived and non-deprived areas, and between different social classes. “Deprivation and social class are key risks for mortality in CVD, yet, the map of spen

Momentous achievements The changes made in the diagnosis and management of cardiovascular disease over the past 10 years, led by primary care, were described as “momentous” by Primary Care Cardiovascular Society (PCCS) past chairman and board member Professor Richard Hobbs (Department of General Practice and Primary Care, University of Birmingham). Presenting the opening address ‘A decade of advances in cardiovascular disease’ at the two-day annual scientific meeting, he said: “Primary care teams have led advances in the treatment of cardiovascular disease and cardiovascular risk factors. They should feel very proud of the contribut

The need for new guidelines The aim of the first guidelines from the Joint British Societies (JBS 1) was to promote a more effective multi-disciplinary approach to cardiovascular disease (CVD) prevention.4 The guidelines addressed the needs of both individuals with established disease and apparently healthy subjects at high risk of developing disease. The National Service Framework for Coronary Heart Disease (CHD) for England and Wales endorsed the lifestyle and risk factor targets in JBS 1.5 It also established national audit standards, which were subsequently reinforced and expanded by the General Medical Services contract for primary care.

A total of 2,511 switch patients and 9,009 controls were identified. The risk of death or first major cardiovascular event was significantly associated with switching therapy (hazard ratio = 1.30, 95% confidence interval: 1.02–1.64) compared with patients who did not switch. Major cardiovascular events and stroke were also significantly associated with switching. There was no significant difference in all-cause mortality.  While recognising the observational nature of database research, this study has highlighted the potential for poorer cardiovascular outcomes in patients switching statin therapy, compared with patients maintained on thei

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