Volume 2, Number 3, July-August-September 2009

EDITORIALWhen to use aspirin in the primary and secondary prevention of cardiovascular disease: acting on the latest evidence
Professor Roger Boyle, Jan Procter-King

EDITORIALThe art of knowing when to take action and when to let well alone
Professor Michael Kirby

“From inability to let well alone: from too much zeal for the new and contempt for what is old: from putting knowledge before wisdom, science before art, and cleverness before common sense, from treating patients as cases, and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.”

POPULAR
TOPICORIGINAL RESEARCHChronic kidney disease, estimated glomerular filtration rate and the Quality and Outcomes Framework: a survey of GPs in the UK
Ian John, Natasha McIntrye, Nicola Thomas on behalf of the CKD Forum

Objective: To determine the impact of recent initiatives in chronic kidney disease (CKD) management and GPs’ attitudes to the changes.
Participants: 1,000 randomly selected general practices in each of the ten Strategic Health Authorities in England.
Method: A one-shot, postal questionnaire was sent to each practice.
Results: The median prevalence of CKD in individual practices was 3.3%. The majority of GPs recognised CKD as an important health problem and considered that using eGFR provides a good measure of kidney function and that eGFR reporting has led to an improvement in patient care. Most GPs felt that testing for proteinuria should be included in the QOF, however some found the terminology confusing, particularly the distinction between albumin-creatinine ratios and protein-creatinine ratios. More than 80% of survey respondents said they use CKD guidelines in their practice. Only 50% of GPs responding to the survey felt that they had received sufficient education about CKD.
Conclusions: The survey shows general support by GPs for the recent changes in CKD diagnosis and management. However, it revealed a need for more primary care focussed educational initiatives in this area.
Keywords: chronic kidney disease; primary care; guideline

JOURNAL REVIEWJournal Review

TOPICAL REVIEWMaking sense of triglycerides
Jonathan Morrell

The importance of reducing total and LDL-cholesterol (LDL-C) in the prevention of cardiovascular disease (CVD) is so firmly established that it has, in only a short time, become part of everyday practice for all primary care health professionals. However, lipids come in multiple forms, which include fatty acids, the different forms of cholesterol and triglycerides. Most practitioners have only a sketchy idea of what triglycerides are, what they do and how important they are. Few understand the intricacies of measurement, diagnosis and interpretation and when and how to manage them. The story is complex and involves difficult biochemical and metabolic concepts so we should begin at the beginning!

POPULAR
TOPICPRIMARY CARE VIEWWhat can cardiac CT imaging add to our understanding in primary care?
Kathryn Griffith

POPULAR
TOPICGUIDELINESA commentary on the NICE guideline on identification and management of familial hypercholesterolaemia
Mary Seed, Steve E Humphries, Margaret Thorogood

Background: Familial hypercholesterolaemia (FH) is a genetic disorder with high serum cholesterol levels, early atherosclerosis and a high risk of premature coronary heart disease. It is both under-diagnosed and inadequately treated in some people, although the statin class of drugs is effective in reducing both morbidity and mortality.
Recommendations: The basis for a diagnosis of FH is an LDL cholesterol (LDL-C) level of greater than 4.9 mmol/L in an adult or 4.0 mmol/L in a child under 16, combined with either, or both, a family history or clinical signs (xanthomata). Diagnosis can also be made by a genetic test.
Because of the high risk of coronary heart disease, adults over 18 years should be treated with a high-potency statin. Patients should be reviewed at least annually, including a review of cardiovascular symptoms or risk factors. Primary care physicians should have a low threshold of suspicion for referral to a specialist in cardiology.Women of childbearing age need particular advice regarding contraception and specialist care in pregnancy. Children should be referred to a specialist centre for treatment.
Key words: Familial hyperlipidaemia, familial hypercholesterolaemia, coronary disease, women, children.

POPULAR
TOPICEVIDENCE REVIEWAntibiotic prophylaxis against infective endocarditis
Dr Peter Savill

It is very difficult to challenge dogma and accepted practice. I think that at virtually every stage of my medical career I have had it drummed into me that antibiotic prophylaxis should be given to patients with valvular heart disease before dental work and other potentially bacteraemic procedures in order to prevent infective endocarditis.

DIAGNOSTICS REVIEWAdvances in cardiac computed tomography: an update for primary care physicians
Shreenidhi Venuraju, Ajay Yerramasu, Avijit Lahiri

Coronary artery disease (CAD) remains the leading cause of mortality in the United Kingdom, causing a total of 120,000 deaths in 2003. The lifetime risk of developing coronary heart disease (CHD) in the UK by the age of 40 has been estimated at 50% in men and 33% in women. In addition to imposing a great burden, both economically and on the already stretched resources of the NHS, it is also the most important factor contributing to the number of years of life lost before the age of 65.

NEWSNews stories in this issue...