CARDIO ARTICLES

Arch Intern Med 11 Jan 2010 Vol 170
27 Are you bored with guidelines? Fed up with arguments about cardiovascular risk assessment? Then brighten your day with this paper about 27 cardiovascular risk assessment guidelines. They are all different - grossly or subtly - proving that whenever you get a roomful of doctors discussing the same evidence, they will never arrive at the same answer. http://archinte.ama-assn.org/cgi/content/abstract/170/1/27

JAMA 6 Jan 2010 Vol 303
54 Many readers may not be cardiologists or hospital doctors, and I guess quite a few of you didn't know what NSTEMI stands for until about 8 years ago. Troponins only came in around then too, and they are vital to distinguish whether unstable angina is or is not associated with myocardial damage. Immediate angiography is also a relative novelty in the UK. Yet now every second hospital discharge summary now seems to read c/o chest pain NSTEMI troponin 2.1 PCI stents to LAD, Cx, please continue clopidogrel for 12 months. Here is a case study of a 43 year old American man which takes you through the modern management of NSTEMI in full wearisome detail.
http://jama.ama-assn.org/cgi/content/short/303/1/54?home

Lancet 9 Jan 2010 Vol 375
132 C-reactive protein was first described over 70 years ago, and we use it as a "something's wrong" test all the time, instead of or alongside ESR. It isn't actually all that much use, and patients often end up being told "Your blood test tells me you are ill, which I already knew, but it doesn't tell me what's wrong, so I want to repeat it." How many non-sequiturs can you squeeze into a sentence? And yet we all do it, taking obscure comfort later in the fact that 26 has fallen to 13. It's the same if you try to use it as a marker for cardiovascular risk. This immensely painstaking individual participant meta-analysis shows that even minor elevations of CRP are associated with increased risk for coronary heart disease; also for stroke; also for vascular death; also for non-vascular death; also for several cancers; also for lung disease. Elevated CRP is vaguely bad news: a Completely Random Predictor.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61717-7/abstract