We now recognise the brain as the seat of the psyche, but the functions of the mind are dependent on the whole body and the harmonious interaction of all its parts.” (Sir Frederick Walker Mott 1853-1926. British neurologist, psychiatrist and sociologist, quoted by W.S. Dawson in Aids to Psychiatry)
HDL cholesterol and cardiovascular risk: the case for intervention
Statin therapy, optimally applied, lowers LDL cholesterol and reduces cardiovascular risk by 30-50%. This leaves a residual risk that needs tobe addressed by other interventions. The well-documented strong, inverse relationship between cardiovascular risk and HDL cholesterolconcentration, at all levels of LDL cholesterol, suggests that there may be further benefits from raising HDL cholesterol – the HDL hypothesis.Definitive proof, however, awaits the results of ongoing major outcomes studies.
Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk
Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk – Richard Hobbs, Eleanor McGregor, John Betteridge
Diabetes mellitus, in particular type 2 diabetes but also type 1 diabetes after the age of 40, confers substantial cardiovascular risk. In people with diabetes, at least in those who have had the disease for a few years, and no history of coronary heart disease, the risk of myocardial infarction is similar to that in non-diabetic patients with manifest cardiovascular disease. Intensive management of cardiovascular risk factors is, therefore, widely recommended for individuals with diabetes.
Lipids and cardiovascular disease: is LDL cholesterol enough?
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality worldwide and its incidence is increasing as lifestyle habits from developed countries are adopted by the developing world. The incidence of diabetes is also increasing rapidly as an epidemic of obesity gathers pace.1 The epidemiology of CVD is uniform throughout the world as demonstrated in the INTERHEART study, which showed that 85-90% of population attributable risk is due to nine cardiovascular risk factors, of which 55% is associated with dyslipidaemia and 12% to previously diagnosed diabetes.2 The dyslipidaemia risk factor in INTERHEART was the ratio of the endogenous (expressed as apolipoprotein B or approximately as non–HDL cholesterol) to reverse cholesterol transport pathways (expressed as apolipoprotein A1 or approximately as HDL cholesterol levels).
Testosterone and type 2 diabetes: the forgotten link
The recommendation by the National Institute for Health and Clinical Excellence (NICE)1 that men with type 2 diabetes should be assessed annually for erectile dysfunction (ED) may have far-reaching implications. Unfortunately, this is the only significant piece of NICE guidance not yet introduced into the GP Quality and Outcomes Framework (QOF) for 2010.1,2 Although NICE incorrectly classified ED as a neuropathic complication of type 2 diabetes (T2D) rather than a macrovascular, microvascular, endocrine and neuropathic process, the implication of the suggested full assessment of these men is important.
EDITORIAL – “Vote for the man who promises least; he will be the least disappointing-
Since the general election, we have seen a remarkable focus on reform and reorganisation. The coalition government’s proposals are really going to change management, governance and accountability throughout the NHS. GP commissioning is the centrepiece of these reforms, which will see the disappearance of centrally managed processes and performance targets.
Cutting the risk of death after acute coronary syndromes
Approximately 110,000 patients are admitted to hospital each year in the UK with acute coronary syndromes. What is the pathophysiology and how should these patients be managed in primary care?
Multifactorial intervention in diabetes care: ‘At-A-Glance’ analysis of evidence
An understanding of evidence-based medicine and how to implement it in clinical practice is now crucial for all professionals involved in the delivery of healthcare. New evidence-based publications are constantly being developed to meet health professionals’ needs for clear, concise and up-to-date information.
In this issue we will review the United Kingdom Prospective Diabetes Study (UKPDS) 38 and the Collaborative Atorvastatin Diabetes Study (CARDS) using the ‘At-A-Glance’ format, as below:
A AcronymT Title and reference
A Aim and introduction
G GroupL Limb and endpointsA Absolute riskN Number needed to treat (NNT)C Clinical conclusionE Education for patient
What is the ‘real-life’ reduction in cholesterol with statins?
Daniel Rutherford looks at how much statins reduce cholesterol in day-to-day clinical practice by reviewing a key study exploring this issue.
Ten key questions on chronic kidney disease
Prescribing for patients with chronic kidney disease
Chronic kidney disease (CKD) affects renal drug elimination and other important processes involved in drug disposition, including absorption, drug distribution and non-renal clearance. As a result, the reduced renal excretion of a drug or its metabolites can cause toxicity and the sensitivity to some drugs is increased even if elimination is unimpaired.
