Volume 2, Number 4, October-November-December 2009

POPULAR
TOPICEDITORIALPromoting research that optimises primary care management of CVD
Professor Michael Kirby

ORIGINAL RESEARCHIs general practice the optimal setting for the recognition of statin-induced myotoxicity?
David Sciberras, Victor Robinson, Neville Calleja

Background: Previous research has shown that routine monitoring appears to add little to the prognostication of incipient statininduced myotoxicity (SIM) in the primary care setting. In view of this, and the fact that there are now millions of patients on statins, it seems of practical value to delve deeper into the symptomatology of SIM.
Aims: To estimate the prevalence of SIM in statin users as compared to non-users, and whether family practice is the ideal setting to identify SIM.
Method: The first phase of the research was a retrospective, case-controlled study based on existing records of a single practice (n=7,608). This was followed by a second stage, prospective, exploratory study using a semi-structured survey on a random subsample (n=220).
Results and discussion: Highly significant results were obtained in comparisons of data gathered from the first part of the study (ie, data from practice database) and the second stage (ie, data from the probing validated questionnaire), together with results showing a difference just below the threshold for significance between statin users compared to non-users in relation to upper limb weakness.
Conclusions: Probing seems to be of utmost importance in detecting SIM. The results are in line with previous studies on the same topic conducted in settings other than primary care.

POPULAR
TOPICJOURNAL REVIEWJournal Review

POPULAR
TOPICHOT TOPIC REVIEWHow to estimate cardiovascular risk in practice
Paul Durrington

The assessment of cardiovascular disease (CVD) risk is important in clinical practice in order to deploy statins, antihypertensive agents and aspirin most effectively and with the greatest likelihood that such treatment will confer benefit rather than harm.

POPULAR
TOPICDRUG REVIEWTredaptive: treating raised LDL-cholesterol and beyond
George Kassianos

Significant reductions in cardiovascular risk have been achieved over the past 20 years using statins to reduce levels of low-density lipoprotein (LDL) cholesterol and total cholesterol. However, there is growing evidence that managing only this lipid fraction may not optimally reduce patients’ CVD risk, particularly in those with type 2 diabetes or the metabolic syndrome. Low levels of high-density lipoprotein (HDL) cholesterol and raised triglycerides are important, but often overlooked, elements of the dyslipidaemic profile that commonly occur in these patients. Tredaptive offers the potential for reaching optimal nicotinic acid dosage and thereby a convenient option for achieving significant improvements on all three fronts of lipid modification – LDL cholesterol, HDL cholesterol and triglycerides, primarily because of significant reduction in the most troublesome sideeffect of nicotinic acid, facial flushing.

CONSULTATIONAssessing cardiovascular risk in the 10-minute consultation
Safia Debar, Simon de Lusignan, Juan Carlos Kaski

Cardiovascular disease is a major cause of mortality and morbidity which can be managed successfully in primary care. However, despite the quality of the evidence base and the universal use of practice-based information systems that can flag suboptimally managed patients and calculate risk for individuals opportunistically, there remains a gap in the primary care management of cardiovascular disease.

PREVENTIONSexual activity and erectile dysfunction in men with cardiovascular disease: assessing and managing risk
Professor Michael Kirby

This article reviews latest recommendations on how to assess the risk of sexual activity in men with cardiovascular disease (CVD), and how to safely manage erectile dysfunction (ED) in these patients.

NEWSNews stories in this issue...