Volume 3, Number 2, April-May-June 2010

EDITORIALLooking at evidence with detached objectivity
Professor Mike Kirby

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TOPICJOURNAL REVIEWJournal Review

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TOPICHOT TOPIC REVIEWBariatric surgery: an effective quick fix to prevent the complications of morbid obesity or prelude to long-term problems?
Professor David Haslam

Bariatric surgery is becoming increasingly common as the obesity epidemic continues to flourish, and more secondary care centres are accepting increasing numbers of referrals backed by positive NICE guidelines.The Royal College of Surgeons warned earlier this year that some primary care trusts (PCTs) were rationing access to weight loss surgery. Is this a pragmatic response to concerns that a ‘quick fix’ solution to obesity is not viable in the longer term, or a refusal to recognise the need to take urgent action to prevent the complications of morbid obesity? In this article, we review the procedures used in bariatric surgery, the impact on cardiovascular risk and type 2 diabetes, what the guidelines recommend and the long-term management of patients who have undergone this type of surgery.

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TOPICGUIDELINESAn international perspective on cardiovascular risk management: recommendations for high-risk patients
D Duhot, E McGregor, Diana Gorog, C Packard

For people identified as being at risk of cardiovascular disease (CVD), the degree or intensity of intervention is dictated by the predicted likelihood of a future coronary event. Assessment of cardiovascular risk factors is therefore essential so that individuals can be stratified as accurately as possible into ‘very high’, ‘high’ or ‘moderate-to-low’ risk categories.

THERAPEUTICS REVIEWPrasugrel: the evidence supporting NICE’s recommendation for the treatment of acute coronary syndromes (ACS)
Professor Mike Kirby

The National Institute for Health and Clinical Excellence (NICE) recently recommended prasugrel in combination with aspirin as an option in the treatment of acute coronary syndromes (ACS). This article examines the evidence behind the decision and reviews the guidance. Haemostasis is the process by which bleeding from an injured blood vessel is stopped or reduced. When blood vessels are damaged, the three basic mechanisms that prevent blood loss include vascular spasm, platelet plug formation and blood coagulation (clotting). Platelets are produced in the bone marrow. There are between 250,000 and 400,000 platelets in every cubic millimetre (mm3) of blood. The lifespan of a platelet is about 5-10 days. In the first phase of platelet plug formation, platelets adhere to the damaged parts of a blood vessel. As a result of their adhesion, the platelets are activated and their characteristics change dramatically. They extend many projections that allow them to contact each other and begin the platelet release reaction. Liberated thromboxane A2 reinforces local vasoconstriction, while adenosine diphosphate (ADP) and thromboxane A2 activate nearby platelets, causing them to become sticky and clump together (platelet aggregation).

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TOPICNEWSNews stories in this issue...