BMJ 14 Nov 2009 Vol 339
1125 Most group analyses of cardiovascular risk conclude that nearly all differences can be explained by known risk factors such as lipids and blood pressure and smoking, but this area–stratified Glasgow study is an exception. However, it did not measure event rates but a popular surrogate measure of atherosclerosis – the common carotid intima-media thickness. Glaswegians in deprived areas develop plaque in their carotids out of all proportion to known cardiovascular risk factors, including “emerging” ones like von Willebrand factor, tissue plasminogen activator antigen and all the rest.
http://www.bmj.com/cgi/content/full/339/oct27_4/b4170
NEJM 5 Nov 2009 Vol 361
1827 Coronary artery bypass grafting has become the commonest surgical operation in the world, we keep being informed, though I bet that isn’t counting circumcision. Still, everyone who isn’t Jewish, Muslim, American or male can still have CABG so it obviously wins on some higher criterion of ubiquity. Eighty percent of it is still performed using a cardiopulmonary bypass pump to help the surgeon by keeping the heart still. These pumps are known to generate debris and causing microemboli, which have been held responsible for the cognitive impairment often seen after open heart procedures. Innovative cardiothoracic surgeons have argued for off-pump CABG and here they show willingness to put their assertions to the test of a randomised trial. As the accompanying editorial (p.1897) notes, this in itself should be seen as an enormous success. As for the result: sorry innovators, off-pump patients fare slightly worse by criteria of graft completion and late patency, and no better in neuropsychological assessments. http://content.nejm.org/cgi/content/abstract/361/19/1827
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