Volume 1, Number 3, October/November/December 2008

EDITORIALSixty years on, and it is the quality that counts
Professor Michael Kirby

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TOPICEDITORIALReview calls for greater effort to diagnose and treat peripheral arterial disease
Susan Mayor

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TOPICORIGINAL RESEARCHEarly indications of best practice in reducing the inequalities in vascular health in England
Robert Pears, Jan Procter-King, Jennie Carpenter

Objective: To identify current best practice in reducing health inequalities through the provision of vascular checks in the forthcoming Vascular Risk Programme (VRP).
Design: A qualitative study based on documentation from informal networks at the Department of Health, the National Screening Committee (NSC), NHS Alliance members and the charity sector describing 28 vascular initiatives, the views of ten interviewees, and the views of the authors.
Results: Service provision is diverse with a large variety of providers among the 28 initiatives (46.4% by GP practices, 25.0% by charities, 14.3% by private providers, 7.1% by pharmacies, and 7.1% by PCT nurses in the workplace).
The VRP will be a logistical challenge, notably minimising the non-attendance of the most high-risk subjects. Questions remain over target age range, choice of risk assessment tools, follow-up, funding, and the amount of quantitative data available on best practice. The NSC handbook will encourage standardisation in available vascular tests, and examples of best practice will be transferable to other areas.
Conclusions: The effectiveness of implementation at PCT level will determine whether the Vascular Risk Programme can reduce England’s vascular health gap. Service quality can improve in deprived areas more quickly than affluent areas, given the right incentives and an innovative approach. Future research and vascular learning networks will provide further support to PCTs trying to reduce their vascular health gap.

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TOPICJOURNAL REVIEWJournal review

TOPICAL REVIEWThe essentials of diet and supplements for improving cardiovascular health
James H O’Keefe

TOPICAL REVIEWC-reactive protein as a marker of cardiovascular risk. Chicken, egg or turkey?
Brian Karet

INTERVIEWHigh blood pressure: only one number matters for patients over 50
Professor Peter Sever

PRACTICE REVIEWImplementing the NICE guideline for secondary prevention of MI
Jane S Skinner

The NICE guideline for secondary prevention post-myocardial infarction (MI) was published in May 2007 and set out how to optimise secondary prevention in patients who have had an MI. This article provides a summary of the guideline.

PRACTICE REVIEWImproving patient adherence to prescribed medication for cholesterol management
Leif Erhardt

Atherosclerosis develops under the influence of a combination of several well-recognised risk factors, including smoking, lack of exercise, excess weight and obesity, hypertension and elevated cholesterol. The consequences of this process may develop from several sites and often the first event will be a fatal myocardial infarction (MI). As a result, healthcare professionals have been urged to place greater emphasis on preventing high-risk patients from developing the potentially life-threatening complications of coronary heart disease (CHD). Indeed, it has been claimed there is a ‘collective failure’ among doctors to reduce the risk of recurrent disease and unnecessary CHD-related deaths.

PRACTICE REVIEWCardiovascular disease and type 2 diabetes
Richard M Cubbon, Mark T Kearney

The risk of developing cardiovascular disease (CVD) is more than doubled in patients with type 2 diabetes (T2D). Projections of current epidemiological data suggest a continuing rise in the prevalence of T2D over the coming decades, and the majority of these people will die from cardiovascular events. However, in spite of advances in CVD prevention strategies, T2D continues to be associated with poor outcomes, so novel therapeutic strategies remain an important research focus. This brief review summarises the pathogenesis of CVD associated with T2D, and discusses risk reduction strategies in these patients.

DRUG REVIEWStatin therapy for secondary prevention of coronary heart disease: an update (part 3)
Kausik K Ray, Lesley A Everett

This narrative review continues the assessment of recent advances in statin therapy in patients with coronary heart disease (CHD).

TRIAL REVIEWThe BEAUTIFUL study: underlining the importance of heart rate
Sarah Jarvis

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TOPICNEWSNews stories in this issue...