Evidence-based Cardiovascular Medicine RSS feed: Current Issue. For all editorial correspondence contact the Managing Editor, Dr. Debbie Singh, at: debbie.singh@arachna.co.nz or write to Evidence-based Cardiovascular Medicine at 126 Central Avenue, London TW3 2RJ, United Kingdom. Evidence-based Cardiovascular Medicine provides the highest quality and most up to date evidence to help clinicians make the best treatment decisions. Every year, the editorial team read and appraise more than 10,000 articles published throughout the world. Summaries of the best quality and most useful research are included in the journal, alongside an expert commentary about what the findings mean in practice. The concise and easy to read format helps clinicians, health service managers and librarians to: • Convert their information needs into answerable questions • Track down the best evidence to answer the question • Appraise the evidence • Apply the results in your clinical practice • Evaluate treatment and performance Hundreds of issues of the most authoritative and respected journals in the field are systematically scanned for each issue of Evidence-based Cardiovascular Medicine , including the American Heart Journal, American Journal of Medicine, British Medical Journal, Circulation, European Heart Journal, Heart, JAMA, Lancet, New England Journal of Medicine, and hundreds more (please click here for a list of the numerous journal titles screened) . Evidence-based Cardiovascular Medicine appraises all this material to save busy clinicians time. Let the journal keep you up to date with developments in cardiovascular medicine in a timely, concise and critical manner.http://www.journals.elsevierhealth.com/periodicals/yebcm/?rss=yesElsevier Inc.en © 2006 Published by Elsevier Inc. All rights reserved. Evidence-based Cardiovascular Medicine1361-2611102June 2006 © 2006 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001217/abstract?rss=yesEditorial Board10.1016/S1361-2611(06)00121-7Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3CO2CO2http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000789/abstract?rss=yesEvidence-based Cardiovascular Medicine was launched in 1997, and since then we have strived to provide you with up to date summaries of research to help inform your clinical practice.Celebrating ten years of Evidence-based Cardiovascular MedicineDebbie Singh, Michael Kilborn, Mathew Noonan10.1016/j.ebcm.2006.04.011Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Editorial6970http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000820/abstract?rss=yesThe prevalence of overweight children and adolescents has been rising worldwide, and has exceeded epidemic proportions.1 The roots of the epidemic are complex and multifactorial, including increased access to and consumption of calorie-dense processed foods and sugary drinks and a proliferation of sedentary pursuits.2,3 This toxic environment is marketed directly to youth and busy parents. There is an imperative for action. Just as the problem is multidimensional and complex, so too must be the solution.4Will childhood obesity lead to an epidemic of premature cardiovascular disease?Brian W McCrindle10.1016/j.ebcm.2006.04.015Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Guest Editorials7174http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000790/abstract?rss=yesEvaluating professional performance is commonplace in society, but not to the same extent in the medical profession. An important reason may be the lack of generally accepted performance measures. This editorial outlines how this is changing and summarises some of the key cardiovascular performance indicator systems in the United States.Evaluating professional performance in cardiovascular medicineRobert D Furberg, Curt D Furberg10.1016/j.ebcm.2006.04.012Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Guest Editorials7578http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000819/abstract?rss=yesPercutaneous coronary intervention (PCI) with or without stenting alleviates symptoms and ischaemia among people with coronary artery disease and improves clinical outcomes after a myocardial infarction, but it does not mitigate the systemic atherosclerotic process. Indeed, PCI alone has not been found to lower long-term mortality or the rate of myocardial infarction (MI) in people with chronic stable angina.1 This editorial describes the importance of evidence-based medical treatment following PCI.Evidence-based medical therapy after percutaneous coronary interventionWissan A. Jaber, Charanjit S. Rihal10.1016/j.ebcm.2006.04.013Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Guest Editorials7980http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000807/abstract?rss=yesACE inhibitors and beta-blockers have significantly decreased clinical events in people with heart failure, however, event rates remain unacceptable.1−6 Novel therapies therefore need to be investigated.Growth hormone therapy as a treatment for heart failureRobert S McKelvie10.1016/j.ebcm.2006.04.014Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Guest Editorials8184http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001163/abstract?rss=yesOver the past two decades we have become increasingly aware that cardiovascular disease is not restricted to developed countries. The problem affects all countries. In absolute numbers there are more people affected by cardiovascular disease in low and middle income countries than in higher income countries. In fact, while there has been a decline in mortality due to ischaemic heart disease in developed countries, the disease is increasing in the developing world. In 1990 cardiovascular disease accounted for 22% of deaths in developing countries. By 2020 it is predicted that cardiovascular disease will cause 34% of all deaths in these countries.1 By 2020 India alone may account for 2.6 million deaths from cardiovascular disease compared to 2.3 million in developed countries.2 Thus there is an urgent need for action.Preventing ishaemic heart disease in developing countriesPrem Pais10.1016/j.ebcm.2006.04.050Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Guest Editorials8588http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000716/abstract?rss=yesAngiotensin receptor blockers have a recognised role for people with heart failure and nephropathy. Evidence is emerging about their effects in people with hypertension. Cheung and colleagues assessed the effect of angiotensin receptor blockers in people with high blood pressure.Angiotension receptor blockers may be similarly effective to other antihypertensive drugs for primary prevention in the short termM Mohsen Ibrahim, Priscilla Igho-Pemu, Debbie Singh, René R Wenzel10.1016/j.ebcm.2006.04.005Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Hypertension8993http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000728/abstract?rss=yesAngiotensin-receptor-blockers (ARBs) are gaining popularity in the management of people with hypertension.1 Besides lowering blood pressure, ARBs have excellent tolerability with minimal adverse effects. Furthermore, they have the potential advantage over ACE inhibitors of achieving a better blockade of the rennin-angiotensin-system (RAS). Angiotensin-II (A-II) can be generated through enzymatic pathways other than ACE, both directly from angiotensinogen and from A–I.Commentary 110.1016/j.ebcm.2006.04.006Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Hypertension9093http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001011/abstract?rss=yesPeople with hypertension and left ventricular hypertrophy have a high risk of stroke. The Losartan Intervention for Endpoint reduction in hypertension (LIFE) study found that losartan reduced the risk of stroke in this population compared to an atenolol-based regimen.Losartan appears cost-effective for reducing stroke in people with hypertension and left ventricular hypertrophyIndres Moodley, Brian Rayner, Debbie Singh10.1016/j.ebcm.2006.04.035Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Hypertension9495http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001023/abstract?rss=yesThe LIFE study found that losartan-based therapy was associated with 25% less risk of stroke compared to atenolol-based therapy in people with hypertension and left ventricular hypertrophy determined by ECG criteria.1 Little is known about the pharmacoeconomic implications of the LIFE study, although losartan-based therapy is likely to prevent approximately 125,000 strokes in the European Union.2Commentary10.1016/j.ebcm.2006.04.036Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Hypertension9595http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000832/abstract?rss=yesLittle is known about the lipid-modifying effects of statins for African-Americans with hypercholesterolemia. Ferdinand and colleagues compared the efficacy and safety of rosuvastatin and atorvastatin in hypercholesterolemic African-Americans.Rosuvastatin may be more effective than atorvastatin in African-Americans with hypercholesterolemiaFrancisco A. Fonseca, Maria Cristina O Izar, Matthew A Silva, Angeliki Karapanos, Herbert Schuster, Debbie Singh10.1016/j.ebcm.2006.04.017Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Cholesterol96100http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000844/abstract?rss=yesIn spite of a high prevalence of coronary heart disease among African-Americans, there are limited data about the safety and efficacy of statins in this population. When interpreting the findings of this study there are several factors to bear in mind. This was a randomised open-label clinical trial with blinded laboratory analysis to assign treatments, but 52 people discontinued treatment (6.7%). This is a relatively high rate given the short duration of the study. Average reported discontinuation rates are usually 2% to 3% for these statins.1Commentary 110.1016/j.ebcm.2006.04.018Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Cholesterol97100http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001084/abstract?rss=yesAlthough recent studies suggest that 80mg atorvastatin is safe for long-term lipid lowering, physicians may be reluctant to prescribe high doses of statins. Newman and colleages compared the safety of 10mg versus 80mg atorvastatin and placebo for people at varying risk of cardiovascular disease.80mg atorvastatin appears as safe as lower dosesAnai ES Durazzo, Debbie Singh10.1016/j.ebcm.2006.04.041Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Cholesterol101102http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001096/abstract?rss=yesSince 1994, when the landmark 4S trial was published,1 statins have changed the way cardiovascular disease is treated. Early statin trials suggested that statins reduced morbidity and mortality compared to placebo. Later trials suggested that statins had benefits for high risk groups. More recent trials have analysed the intensity of statin treatment. Most of these trials strengthened the hypothesis that aggressively treating LDL cholesterol levels to lower targets further reduces adverse cardiovascular events.Commentary10.1016/j.ebcm.2006.04.042Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Cholesterol102102http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001138/abstract?rss=yesIntensive lipid-lowering therapy may be more beneficial than standard lipid lowering therapy for people at high risk. Schmermund and colleagues compared standard versus intensive lipid-lowering therapy with atorvastatin for people with moderate calcified coronary atherosclerosis. The primary endpoint was percentage change in total coronary artery calcification volume score, measured by electron-beam computed tomography, after one year.It is uncertain whether intensive lipid-lowering is more effective than standard atorvastatin therapyWolfgang Bocksch, Debbie Singh10.1016/j.ebcm.2006.04.046Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Cholesterol103105http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001175/abstract?rss=yesCoronary atherosclerosis is a frequent, slowly progressive disease of the coronary arterial wall. It is associated with early coronary plaque formation detected by intravascular ultrasound imaging in 21% of people in their 20s, 66% in their 30s, 75% in their 40s, 85% in their 50s, and 91% in their 60s.1 There is a large delay between early plaque formation and manifestation of coronary artery disease in men, giving a long time interval for primary prevention of major cardiac events.Commentary10.1016/j.ebcm.2006.04.047Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Cholesterol104105http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000662/abstract?rss=yesIt has been suggested that ACE inhibitors may improve symptoms and exercise tolerance in people with left ventricular systolic dysfunction. Abdulla and colleagues analysed the effect of ACE inhibitors on New York Heart Association (NYHA) class in people with left ventricular systolic dysfunction or heart failure.ACE inhibitors improve NYHA class in people with chronic heart failureKathy Hebert, Debbie Singh10.1016/j.ebcm.2006.04.001Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Heart Failure106107http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000674/abstract?rss=yesThe New York Heart Association functional classification is the most widely used scale to quantify the degree of functional limitation imposed by heart failure. This subjective tool is insensitive to change in exercise capacity and liable to significant interobserver variability.Commentary10.1016/j.ebcm.2006.04.002Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Heart Failure107107http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000911/abstract?rss=yesRecent studies in people with heart failure have increasingly used health-related quality of life as a complementary endpoint to mortality and morbidity. Johansson and colleagues examined factors influencing health-related quality of life in people with heart failure and interventions that may improve quality of life.A range of factors influence health-related quality of life in people with heart failureMary Riedinger, Debbie Singh10.1016/j.ebcm.2006.04.025Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Heart Failure108109http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000923/abstract?rss=yesHeart failure is a complex clinical syndrome with a wide range of symptoms, aetiologies, and pathophysiology.1 This syndrome is a major public health concern in the United States where approximately five million people have heart failure, with almost 500,000 newly diagnosed cases annually. These numbers are expected to increase due to the aging population and improvements in cardiac therapies. Health-related quality of life (HRQoL) varies between people with heart failure, but the overall burden of disease appears to be comparable to or worse than other chronic conditions.1−3 Research has suggested that HRQoL predicts morbidity and mortality in people with heart failure.4−6Commentary10.1016/j.ebcm.2006.04.026Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Heart Failure109109http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000959/abstract?rss=yesPeople with atrial fibrillation are conventionally treated with therapeutic anticoagulation for three weeks before and four weeks after cardioversion to reduce the risk of thromboembolism. Using transesophageal echocardiography to guide short-term anticoagulation has been proposed as an alternative.TEE-guided cardioversion with short-term anticoagulation may be effective for people with atrial fibrillation undergoing electrical cardioversionMarcia Maiumi Fukujima, Debbie Singh10.1016/j.ebcm.2006.04.029Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Atrial Fibrillation110112http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000960/abstract?rss=yesAtrial fibrillation is a significant cause of cardioembolic stroke, which is one of the most mentally and physically incapacitating conditions.1,2 Klein and colleagues previously suggested that at eight weeks follow up, TEE-guided cardioversion was associated with fewer haemorrhagic events compared to traditional treatment. There was no difference between groups regarding embolic events or death.3 The authors also found that a TEE-guided strategy was economically feasible compared to a conventional approach.Commentary10.1016/j.ebcm.2006.04.030Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Atrial Fibrillation111112http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000856/abstract?rss=yesThe INTERACT trial found that in people with high-risk non ST-segment elevation acute coronary syndromes receiving aspirin and eptifibatide, enoxaparin was associated with less bleeding, less myocardial ischaemia, and improved 30-day outcomes compared with unfractionated heparin.Enoxaprin may be more effective than unfractionated heparin for people with high-risk non ST-segment elevation acute coronary syndromesBlair J O’Neill, Debbie Singh10.1016/j.ebcm.2006.04.019Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Acute Coronary Syndromes113115http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000868/abstract?rss=yesPeople with high-risk acute coronary syndromes are at increased risk for early death, myocardial infarction or recurrent ischaemia. Early and routine investigation with cardiac catheterisation and revascularisation is now the mainstay of therapy to optimise outcomes.1 The best combination of antiplatelet and antithrombin therapy remains uncertain. Meta-analysis suggests that enoxaparin should be the antithrombin therapy of choice over unfractionated heparin.2 However, the SYNERGY trial found that enoxaparin did not improve outcomes over unfractionated heparin in the setting of percutaneous coronary intervention.3 In fact, enoxaparin was associated with increased bleeding complications, although post hoc analysis suggested that the increased bleeding was a result of crossing over from unfractionated heparin.Commentary10.1016/j.ebcm.2006.04.020Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Acute Coronary Syndromes114115http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000996/abstract?rss=yesPrevious studies suggest that adding clopidogrel to aspirin is more effective than aspirin alone for up to one year in people undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes without ST-segment elevation. The cost effectiveness of this approach remains uncertain.Clopidogrel for up to one year after PCI is cost-effective for people with acute coronary syndromesDominick J Angiolillo, Debbie Singh10.1016/j.ebcm.2006.04.033Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Acute Coronary Syndromes116118http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS136126110600100X/abstract?rss=yesPlatelet activation is a key event in the pathophysiology of acute coronary syndromes (ACS) and PCI.1 Enhanced platelet reactivity has a large impact on short and long-term clinical outcomes. Although aspirin significantly decreases adverse cardiovascular events, such as death, myocardial infarction, stroke, and repeat revascularisation, many people continue to have a significant risk of recurrent events. The advent of novel antiplatelet agents, in particular clopidogrel, a second generation thienopyridine, has led to a new era of dual oral antiplatelet blockade.2Commentary10.1016/j.ebcm.2006.04.034Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Acute Coronary Syndromes117118http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000765/abstract?rss=yesDebate continues about whether direct stenting is as safe and effective as stenting following balloon predilatation. Dawkins and colleagues assessed the safety, efficacy, and cost-effectiveness of a no-predilatation (direct) stenting strategy for people with de novo native coronary artery lesions. The primary endpoint was major adverse cardiac events at 30 days. Secondary endpoints included resource use, major adverse cardiac events, and angiographic binary restenosis at 180 days.Direct stenting appears as effective as stenting following predilatationTim Süselbeck, Debbie Singh10.1016/j.ebcm.2006.04.009Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Percutaneous Coronary Intervention119120http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000777/abstract?rss=yesCoronary stenting reduces recurrent ischaemia and subsequent target vessel revascularisation.1,2 The standard technique for implanting stents requires routine predilatation with a balloon catheter to give the stent an easy passage and to enhance complete expansion of all stent modules. Recently, the technique of direct stenting without predilatation has been proposed in selected populations and lesions.3,4,5Commentary10.1016/j.ebcm.2006.04.010Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Percutaneous Coronary Intervention120120http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001060/abstract?rss=yesLow molecular weight heparin was developed to address some of the limitations of unfractionated heparin. Few studies have directly compared the low molecular weight heparin, dalteparin, versus unfractionated heparin during percutaneous coronary intervention.Dalteparin may be as safe as unfractionated heparin during PCIAnjli Maroo, Debbie Singh10.1016/j.ebcm.2006.04.039Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Percutaneous Coronary Intervention121123http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001072/abstract?rss=yesRecent trials evaluating the use of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) have predominantly used enoxaparin.1–3 Contemporary comparative data about dalteparin versus UFH during PCI are limited.4,5Commentary10.1016/j.ebcm.2006.04.040Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Percutaneous Coronary Intervention122123http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS136126110600087X/abstract?rss=yesSelf-monitoring of anticoagulation with warfarin is feasible, and several trials have suggested that self-monitoring might be equally effective to standard clinical monitoring.Self-monitoring and self-dosing of oral anticoagulation improves survivalJames D Douketis, Debbie Singh10.1016/j.ebcm.2006.04.021Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Care Management124126http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000881/abstract?rss=yesIn people who require treatment with an oral anticoagulant such as warfarin, self-monitoring of anticoagulation with a point-of-care coagulometer can obviate the need for laboratory or clinic visits for INR testing. Self-monitoring can consist of self-testing alone or can be combined with self-adjustment of warfarin dose, similar to a person with diabetes who monitors glycaemic control and adjusts their insulin dose. Although self-monitoring usually achieves comparable or better anticoagulation control than laboratory-based monitoring, there is limited evidence that self-monitoring reduces thromboembolic adverse events and anticoagulant-related bleeding.1Commentary10.1016/j.ebcm.2006.04.022Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Care Management125126http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000972/abstract?rss=yesPeople with coronary artery disease often have suboptimally managed hyperlipidemia. A range of different patient and clinician directed initiatives have been trialled to improve prescribing and compliance.A single email to clinicians may improve short-term prescribing for people with coronary artery disease and raised LDL cholesterolTroy McMullin, Debbie Singh10.1016/j.ebcm.2006.04.031Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Care Management127129http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000984/abstract?rss=yesEvidence-based guidelines consistently recommend a goal LDL cholesterol level less than 100mg/dL for most people at high risk, such as those with coronary heart disease, diabetes, cerebrovascular disease, or peripheral arterial disease. Despite these recommendations, a recent nationwide audit in the United States found that 50% to 70% of high-risk patients had LDL levels that exceeded this goal.1 With newer data supporting even lower LDL goals for certain high-risk groups, it is likely that the overall proportion of people not achieving their target lipid levels will significantly increase in future unless new methods are developed to help physicians close the gap between everyday practice and established treatment goals.Commentary10.1016/j.ebcm.2006.04.032Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Care Management128129http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001187/abstract?rss=yesFormal cardiac rehabilitation programmes help in the secondary prevention of coronary artery disease.1,2 However, not all eligible people are referred for rehabilitation. Cortes and Arthur examined the determinants of referral for cardiac rehabilitation.Personal factors, rather than health status, may predict referral for cardiac rehabilitationHeidi Mochari, Debbie Singh10.1016/j.ebcm.2006.04.051Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Care Management130131http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001199/abstract?rss=yesDespite the efficacy of cardiac rehabilitation for reducing mortality and its inclusion as a class 1 recommendation in national secondary prevention guidelines, there are consistently low participation rates. The magnitude of the impact on referral rates of the characteristics identified in this review may be underestimated given that some of the studies did not enrol non-English speaking people or people without health insurance. It was surprising that men were not more likely to be referred as this has been observed in prior studies. However, this may be due to the small number of women in the studies reviewed.Commentary10.1016/j.ebcm.2006.04.052Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Care Management131131http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS136126110600073X/abstract?rss=yesThere is evidence that statins reduce cholesterol and prevent cardiac events. Some retrospective analyses suggest that statins may also help to prevent cancer. Dale and colleagues assessed the effect of statin therapy on cancer incidence, death from cancer, and on specific cancers.Statins have no effect on cancer incidence or cancer deathSheng Kang, Debbie Singh10.1016/j.ebcm.2006.04.007Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers132134http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000741/abstract?rss=yesStatins can help to treat and prevent cardiovascular disease by reducing total cholesterol. Statins may also reduce the risk of several other conditions, such as osteoporosis1 and cognitive decline.2 However, there is conflicting evidence about the association between statins and risk of cancer. In experiments, statins have been found to increase the frequency of several cancers in rodents, at levels of exposure similar to those used therapeutically in humans.3 Recent in vitro studies suggest that statins can act as immunoregulators, and this mechanism may contribute to the development of malignant diseases.4,5 However, statins may be associated with half as much risk of colorectal cancer compared to treatment with fibrates.6 Others have found no link between statins and colorectal cancer incidence in large samples.7Commentary10.1016/j.ebcm.2006.04.008Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers133134http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS136126110600114X/abstract?rss=yesPeople with high blood pressure are at increased risk of cardiovascular events. Statins have been found to reduce risks, but the relative efficacy of different statins remains uncertain.Pravastatin, simvastatin, and atorvastatin appear equally effective for preventing cardiovascular eventsAfshin Farzaneh-Far, Peter Libby, Debbie Singh10.1016/j.ebcm.2006.04.048Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers135137http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001151/abstract?rss=yesThere is good evidence that statins lower cardiovascular mortality and morbidity in both primary and secondary prevention and across a wide range of LDL cholesterol levels and risk profiles at treatment initiation. Most trials compare statins with placebo. Until recently, no data permitted comparison of these drugs with each other in terms of cardiovascular mortality and morbidity.Commentary10.1016/j.ebcm.2006.04.049Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers136137http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000698/abstract?rss=yesIt remains uncertain whether surgical or percutaneous revascularisation is the optimal treatment for people with isolated left anterior descending artery disease. Boodhwani and colleagues assessed early and mid-term outcomes following percutaneous versus surgical treatment of isolated left anterior descending artery disease.Surgical treatment may have better mid-term outcomes than percutaneous therapy in people with isolated LAD diseaseDuminda N Wijeysundera, Debbie Singh10.1016/j.ebcm.2006.04.003Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers138140http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000704/abstract?rss=yesWith ten-year patency rates exceeding 90%, surgical revascularisation using the left-internal-mammary artery (LIMA) is the gold standard for treating stenoses of the left anterior descending artery.1 Percutaneous revascularisation is a less invasive treatment that has previously been limited by higher restenosis rates. Given their improved patency rates, drug-eluting stents may allow percutaneous intervention to become a reasonable alternative to surgical therapy.2Commentary10.1016/j.ebcm.2006.04.004Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers139140http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001035/abstract?rss=yesThere is some evidence that amiodarone may reduce atrial tachyarrhythmias after cardiac surgery, but previous studies have been small. Mitchell and colleagues examined whether oral amiodarone before and after surgery is safe and effective for reducing atrial tachyarrhythmias after cardiac surgery. The primary endpoint was incidence, up to 6 days after surgery, of atrial tachyarrhythmias lasting five minutes or more that required treatment.Oral amiodarone prophylaxis reduces atrial tachyarrhythmia following cardiac surgeryAnne B Curtis, Debbie Singh10.1016/j.ebcm.2006.04.037Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers141143http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001047/abstract?rss=yesAtrial tachyarrhythmias are common after cardiac surgery, occurring in 30% to 50% of people. They are a significant source of morbidity after surgery and lead to increased costs and hospital stay. One strategy to prevent these arrhythmias has been to administer antiarrhythmic drugs such as amiodarone. Previous studies in this field have been small and yielded somewhat conflicting results,1–4 although there appeared to be agreement that older people and those undergoing valve surgery would be most likely to benefit. Shorter durations of amiodarone therapy preoperatively have not been found to be effective.3–4Commentary10.1016/j.ebcm.2006.04.038Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers142143http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001102/abstract?rss=yesCardiopulmonary bypass is invasive so alternative strategies are often preferred. A new system of coronary artery bypass grafting known as the mini-extracorporeal circulation system has been developed, but little comparative data are available.Miniextracorporeal circulation system appears safe and effective in coronary artery bypass graftingYves Fromes, Debbie Singh10.1016/j.ebcm.2006.04.043Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers144146http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001114/abstract?rss=yesCardiopulmonary bypass (CPB) is a highly complex process. CPB machines are commonly used to temporarily replace blood circulation by the heart and the respiratory function of the lungs by passing blood through an extracorporeal circuit that both oxygenates and generates flow. The development of extracorporeal systems over the past 50 years has been integral to modern cardiac surgery. However, several adverse effects of cardiac surgery are blamed on conventional CPB systems. It is often difficult to identify which adverse effects are specifically related to CPB, to surgery, or to both.Commentary10.1016/j.ebcm.2006.04.044Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers145146http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000893/abstract?rss=yesSome studies suggest an association between chlamydia pneumoniae serological markers and cardiovascular events. Previous studies have found variable effects of antibiotics in people with acute or stable coronary heart disease.Clarithromycin may increase cardiovascular mortality in people with stable heart diseaseTorsten Bossert, Debbie Singh10.1016/j.ebcm.2006.04.023Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers147148http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS136126110600090X/abstract?rss=yesVarious studies suggest an association between infection and atherogenesis. Chlamydia pneumonia has been found within atherosclerotic plaques, suggesting that antibiotic treatment may be a possibility. If atherosclerosis is an inflammatory disease, this offers new opportunities for the prevention and treatment of coronary artery disease.1 However, recent study results are disappointing.2,3Commentary10.1016/j.ebcm.2006.04.024Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers148148http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000935/abstract?rss=yesEpsilon-aminocaproic acid is a plasmin inhibitor that may reduce bleeding when administered prophylactically to people undergoing cardiac surgery. Kikura and colleagues assessed the efficacy of epsilon-aminocaproic acid for reducing bleeding after cardiac surgery. The primary endpoint was reduction in postoperative thoracic-drainage volume and in donor-blood transfusion up to 12 days after surgery.Epsilon-aminocaproic acid does not reduce blood transfusions following cardiac surgeryRoman Kluger, Debbie Singh10.1016/j.ebcm.2006.04.027Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers149151http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106000947/abstract?rss=yesExcessive postoperative bleeding remains an important complication of cardiac surgery. It may result in haemodynamic instability, tamponade, hypothermia, dilutional coagulopathy, and increased risk of blood transfusion and surgical re-exploration.Commentary10.1016/j.ebcm.2006.04.028Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Other Papers150151http://www.journals.elsevierhealth.com/periodicals/yebcm/article/PIIS1361261106001126/abstract?rss=yesWith appropriate lifestyle changes and the right medicines in the right dosages, people with symptomatic coronary heart disease can significantly improve their mortality, morbidity, and quality of life. These improvements occur irrespective of age, sex, income, or geography.1 Yet, all too often these benefits do not materialise. Despite the development of effective support services,2 a minority of eligible people access cardiac rehabilitation and secondary prevention programmes.3 ‘Compliance’ with behavioural recommendations and prescribed treatments is often low.4 Alexander M Clark10.1016/j.ebcm.2006.04.045Evidence-based Cardiovascular Medicine 10, 2 (2006)2006-06-01Evidence-based Cardiovascular Medicine2006-06-01102S1361-2611(06)X0028-3Resource Review152153