Cardiovascular

Risk stratification for stroke in patients with non-valvular atrial fibrillation – can we improve decision-making for optimal treatment?

Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.

Atrial fibrillation: a significant risk factor for stroke

Atrial fibrillation (AF) is the commonest sustained arrhythmia, affecting 1.2% of the population, which equates to more than 600,000 people in England. The prevalence of AF increases with age, with 8.4% of the over-65 age-group affected and also it is increasing in incidence and prevalence.Each year there are 150,000 strokes in the UK. Nearly one in five (18%) of the people presenting with a stroke are in AF at the time of presentation, and one in six strokes are directly attributable to AF.

EDITORIAL | Keeping up with two professions: medicine and literature

Like Chekhov, doctors have to find time for both medicine and literature – in our case, the latest research literature. Finding time to read all that is necessary to keep up-to-date is a real challenge for most GPs, especially those with a special interest in cardiology or diabetes, but helps by summarising the most important developments.

EDITORIAL | A fit body leads to a fit heart and reduced risk of CVD

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)

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).

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?

Managing a patient with cardiovascular disease: where does chronic kidney disease fit in?

Previous coronary artery bypass graft (CABG) surgery

An innovative strategy for improving the management of chronic heart failure

Mandy Davies, Christine Thomson and their practice team from Elgin provide a ‘how to’ guide on setting up an innovative strategy for managing chronic heart failure, based on their programme that recently won an Innovation in Primary Care Award.

Look before you leap: do patient care plans improve the secondary prevention of heart disease in general practice?

Look before you leap: do patient care plans improve the secondary prevention of heart disease in general practice?Mark Davis

Mark Davis reviews a recent primary care study assessing the impact that tailored care and care plans can have on the secondary prevention of heart disease. Murphy AW, Cupples ME, Smith SM et al. Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice. BMJ 2009; 339: B4220.

“Heredity sets limits, environment decides the exact position within these limits” – Edwin Carleton MacDowell, 1887-1973

This quotation, although made more than one hundred years ago, remains very true today. New evidence from the INTERSTROKE study, published recently in The Lancet, shows that ten risk factors – many associated with lifestyle – account for 90% of the risk of stroke.1 Analysis of data from 6,000 people, half suffering strokes and the other half matched controls, from 22 countries worldwide between March 2007 and April 2010, revealed these risk factors are: high blood pressure, smoking, waist-to-hip ratio (abdominal obesity), physical inactivity, diet, lipids, diabetes, alcohol intake, stress and depression, and heart disorders.

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