Since the first description of a beta-blocking agent in 1962, this class of drug has become among the most widely used in the management of cardiovascular disease (CVD). Betablockers are now used routinely after a myocardial infarction, in patients with angina pectoris and as an additional therapy in the management of high blood pressure. However, they have traditionally been avoided in heart failure because it was thought that they were potentially harmful. But some large, well-designed randomised controlled trials have provided an overwhelming body of evidence to dispel this myth once and for all
prevention in practise
The prevention of cardiovascular disease (CVD) is being moved up a gear with the ambitious and wide-reaching NHS Health Check programme. The agenda for this programme has been clearly laid out for us in the Putting Prevention First best practice guidance that was published in April 2009. The “Cog Man” on the cover highlights the close links between the heart, brain, kidneys and diabetes, explaining the comprehensive nature of vascular risk assessment, and this image is going to be seen regularly on national leaflets and posters promoting the programme. This article provides a practical guideline for the primary care team on implementing the Health Check programme, setting out who we should be checking, what we should be checking and how we should act on what we find.
monitoring
Glycated haemoglobin – HbA1C, or A1C as it is now being called – should be used to diagnose diabetes, according to a recent recommendation from an international expert committee appointed by the American Diabetes Association, the International Diabetes Federation and the European Association for the Study of Diabetes. We explore the basis for this recommendation, and look at why HbA1C would provide a more accurate measure for diagnosing diabetes than glucose tests and what the change would mean in clinical practice.
Editorial
Promoting research that optimises primary care management of CVDProfessor Michael Kirby
Promoting research that optimises primary care management of CVD
How to estimate cardiovascular risk in practice
Tredaptive: treating raised LDL-cholesterol and beyond
Beta-blockers in heart failure: are we doing the best we can for our patients?
Since the first description of a beta-blocking agent in 1962, this class of drug has become among the most widely used in the management of cardiovascular disease (CVD). Betablockers are now used routinely after a myocardial infarction, in patients with angina pectoris and as an additional therapy in the management of high blood pressure. However, they have traditionally been avoided in heart failure because it was thought that they were potentially harmful. But some large, well-designed randomised controlled trials have provided an overwhelming body of evidence to dispel this myth once and for all.
Selecting targets in cardiovascular risk reduction: guidelines or indicators?
There is a profusion of guidelines and recommendations setting out targets for managing the risk factors associated with cardiovascular disease to help us manage our patients. But which ones should we follow? In this article, we compare the treatment thresholds and targets in these different recommendations, consider the reasons for the variety of targets and look at how to rationalise the selection of the targets for an individual patient.
Sexual activity and erectile dysfunction in men with cardiovascular disease: assessing and managing risk
Editorial
Welcome to this issue of BJPCN. I find myself, rather like a modern-day Scrooge, worrying about how we will face the next financially challenging years in the NHS. The Government has recently announced a pay freeze for GPs, and Lawrence Buckman, chair of the BMA’s GP Committee, warns that this affects not just doctors but all of the members of the teams they work with. This will put pressure on primary care teams, which can spill into day-today interaction with each other and with patients. How can we ensure that the quality of patient care is maintained throughout these tough times?
Diagnosing diabetes: who to test and what test to use
Diabetes affects approximately 3-4% of the British population but is thought to be significantly under-diagnosed. How can we improve the number of patients who are diagnosed early and so improve their risk of long-term complications?
