The most effective means of reducing the risk of complications associated with type 2 diabetes is to ensure that each patient achieves and maintains their individualised glycaemic target. New guidance from the National Institute for Health and Clinical Excellence (NICE) providesrecommendations on using liraglutide (Victoza), a new option for patients who do not achieve target HbA1c using currently available therapies.
“Time is brain” – thrombolysis in acute stroke
“Time is brain” – thrombolysis in acute stroke – Mark Garside, Christopher PriceStroke is a common condition with long-term consequences. If symptoms are recognised early enough and patients are transported rapidly to hospital then there is the opportunity to administer treatments which may reduce long-term disability. We summarise the role of intravenous thrombolysis in the treatment of acute ischaemic stroke, including supporting evidence, how it is used in clinical practice, and possible future developments.
Heart rate control in heart failure and angina, and its benefits
In heart failure, heart rate control may improve mortality and the need for hospitalisation. In angina, heart rate control improves symptoms and reduces the need for PCI
Once-weekly exenatide: a new therapeutic option for glucose lowering
The evidence for, and usefulness of, once-weekly exenatide (Bydureon) are discussed in this review. It may be initiated in primary care since it has effects on glucose lowering and global cardiometabolic risk
Validating heart failure registers in primary care: a way to higher QOF payments and better outcomes
We hypothesised that practice heart failure registers may not be complete or robust due to patients not always being allocated the correct READ codes. We set up a project which improved practice heart failure registers. Ensuring practices have robust registers, by improving clinical coding in general practice, means more accurate prevalence levels can inform planning and commissioning of heart failure services.
Thrombolysis for the treatment of acute ischaemic stroke
Vitamin D and cardiovascular health
Vitamin D deficiency is a prevalent and important health issue that warrants vigilant systematic screening and appropriate treatment and follow-up on the part of physicians, especially those in the primary care and cardiovascular fields. Although vitamin D deficiency has traditionally been associated primarily with bone disease, it is now clear that this is a multi-organ system disease. Epidemiological studies consistently show strong associations between vitamin D deficiency and bone disease, cancer and diabetes. Additionally, epidemiological evidence links vitamin D deficiency with cardiovascular risk factors, cardiovascular disease and mortality. Conclusive evidence to show that vitamin D supplementation improves cardiovascular prognosis is currently lacking, although randomised trials are under way to address this issue. In this article we review the sources and metabolism of vitamin D, the epidemiology of vitamin D deficiency, and the available evidence linking vitamin D deficiency to cardiovascular disease; and we suggest an approach to systematic screening and to treatment of vitamin D deficiency.
Understanding the impact of statin titration: a modelling approach
Introduction: Clinical guidelines specifying target cholesterol levels may require dose titration strategies for patients who do not reach target. We describe a model that simulates cholesterol and cardiovascular risk reductions for different populations, therapies, titration steps and targets.
Looking back, looking forward: reflecting on the winter season and the demise of the PCCS
The message regarding eating less has come across loud and clear this year, but there has been plenty to worry about over the last twelve months. The demise of the Primary Care Cardiovascular Society (PCCS) has been on my mind. I was saddened to attend an Extraordinary General Meeting in January 2012, when it was decided to wind up the Society with honour due to declining funds and concern that this situation was likely to deteriorate for the foreseeable future. The closure of the PCCS is a great blow to all of us interested in promoting and improving the prevention and management of cardiovascular disease in our communities.
Atrial fibrillation and stroke: Optimising prevention and treatment
Uniquely, AF is an eminently preventable cause of stroke with a simple and highly effective treatment. AF is common and affects over 600,000 patients in England (1.2%). It is a major predisposing factor for stroke, and strokes caused by AF can be particularly severe and disabling. The annual risk of stroke is five to six times greater in AF patients, but […]
Effective management of atrial fibrillation
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia, and has a significant impact on morbidity and mortality. Treatment is tailored to the individual. This article will review the rhythm-management strategies for patients with atrial fibrillation, and discuss the roles of secondary and tertiary care.
Management and early treatment of transient ischaemic attack (TIA)
The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010;1 recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s.2 This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
