Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) Concept pill could cut heart disease by more than 80%
(2)
What do hospital consultants value most about their
jobs?
(3) Cholesterol
test at 50 spots those most at risk of heart
disease
(1) Concept pill could cut heart disease by more than 80%
(A strategy to reduce
cardiovascular disease by more
than 80%)
http://bmj.com/cgi/content/full/326/7404/1419
(Quantifying effect
of statins on low density lipoprotein
cholesterol, ischaemic
heart disease, and stroke:
systematic review
and meta-analysis)
http://bmj.com/cgi/content/full/326/7404/1423
(Value of low dose
combination treatment with blood
pressure lowering
drugs: analysis of 354 randomised
trials)
http://bmj.com/cgi/content/full/326/7404/1427
(Editorial: A cure
for cardiovascular disease?)
http://bmj.com/cgi/content/full/326/7404/1407
A single pill could reduce
heart attacks and strokes by
more than 80%, conclude
researchers in this week's
BMJ. Heart attacks, stroke,
and other preventable
cardiovascular diseases
currently kill or seriously affect
half the population of Britain.
Professors Nicholas Wald
and Malcolm Law propose
that a single pill containing
six active components -
aspirin, a cholesterol lowering
drug, three blood pressure
lowering drugs at half standard
dose, and folic acid -
taken daily by everyone
from age 55 would have a huge
impact on the prevention
of disease in the Western
world.
Their radical strategy is
based on evidence from over
750 trials involving 400,000
participants. Each
component of the "Polypill"
would reduce one of four
cardiovascular risk factors
(high blood cholesterol, blood
pressure, blood homocysteine
levels, and platelet
function).
The pill would be suitable
for people aged 55 and older
and many people with existing
high blood pressure, heart
disease or diabetes. It
need not be expensive and should
be safe with minimal side
effects.
Trials of the "Polypill"
are planned, to see if the
combination is safe and
effective, and may take several
years.
The authors suggest that
the pill would be taken without
a medical examination or
measurement of risk factors as
treatment would be effective
whatever the initial levels of
the risk factors.
It is time to discard the
view that risk factors need to be
measured and treated individually
if found to be
"abnormal," say the authors.
Instead it should be
recognised that in Western
society the risk factors are
high in all of us, so everyone
is at risk. There is much to
gain and little to lose
by the widespread use of these
drugs, they conclude.
So, is this bold conclusion
justified? Quite possibly, says
Dr Anthony Rodgers in an
accompanying editorial.
Despite widespread perceptions,
these medications are
extremely safe and well
tolerated ? new problems seem
unlikely since they have
been studied so extensively and
used so often together.
Realising their enormous potential
should be a major goal.
Professor Wald will be discussing
this research at a
press conference at 10:30am,
Wolfson Institute of
Preventive Medicine, Barts
and The London, Queen
Mary's School of Medicine
and Dentistry, Charterhouse
Square, London EC1.
Contacts:
Professor Nicholas Wald,
Wolfson Institute of
Preventive Medicine, Barts
and the London, Queen
Mary's School of Medicine
and Dentistry, University of
London, UK
Dr Anthony Rodgers, Clinical
Trials Research Unit, The
University of Auckland,
New Zealand
Email: a.rodgers@auckland.ac.nz
(2) What
do hospital consultants value most about their
jobs?
(What do hospital consultants
value about their jobs? A
discrete choice experiment)
http://bmj.com/cgi/content/full/326/7404/1432
Consultants feel most strongly
about on-call conditions,
freedom to do non-NHS work,
and developing good
relations with staff, according
to a survey of various
aspects of their work in
this week's BMJ.
As part of a survey of all
career grade doctors in NHS
Scotland about flexible
working, 1,650 hospital
consultants completed a
discrete choice experiment,
together with questions
about their workloads,
contractual status, income
and family circumstances. To
quantify their strength
of preference for various aspects
of their work, a monetary
value for each job
characteristic was calculated.
This reflects the income
consultants would be prepared
to give up or accept for a
change in the level of another
job characteristic.
The most important characteristic
was on-call.
Consultants would need to
be compensated up to
£18000 (30% of their
average net income) for a high
on-call workload, while
compensation of up to £9700
(16% of their net income)
would be required to forgo
opportunities to undertake
non-NHS work.
Consultants would be willing
to accept £7000 (12% of
net income) as compensation
for fair rather than good
working relationships with
staff, and £6500 (11% of net
income) to compensate them
for a shortage of staff.
The least important characteristic
was hours of work,
with £562 per year
(0.9% of net income) needed to
induce consultants to work
one extra hour per week,
although the importance
changed as the number of hours
increased.
Preferences (and prices)
differed depending on
consultants' own circumstances,
such as age, sex, age,
family circumstances, speciality,
income, and location.
The questionnaire was designed
before detailed
proposals for the new consultant
contract were
published. However, the
results still have important
implications for the remuneration
of consultants, and
should be used to help address
recruitment and retention
problems, conclude the authors.
Contacts:
Anthony Scott, Reader in
Health Economics, Institute of
Applied Health Sciences,
University of Aberdeen,
Scotland
Email: a.scott@abdn.ac.uk
Fiona French, Research and
Development Officer, NHS
Education for Scotland,
Aberdeen, Scotland
Email: fiona.french@nes.scot.nhs.uk
(3) Cholesterol
test at 50 spots those most at risk of heart
disease
(Comparison of methods
to identify individuals at
increased risk of
coronary heart disease from the general
population)
http://bmj.com/cgi/content/full/326/7404/1436
Measuring the cholesterol
of everyone aged 50 years
and over is a simple and
efficient way of identifying those
at high risk of heart disease
in the general population,
suggest researchers in this
week's BMJ.
Over 6,000 people aged between
30 and 74 years with
no history of heart attack,
stroke, or angina took part in
the study. Four common screening
tests were compared
to identify those at a 10
year coronary risk of 15% or
greater - national guidelines,
Sheffield tables, age
threshold of 50 years, and
risk assessment using fixed
cholesterol values.
Although the Sheffield tables
identified almost all
(99.91%) of people at 15%
or greater risk, this strategy
required measurement of
cholesterol in 73% of the study
population. In contrast,
the screening test based on age
required measurement of
cholesterol in only 46% of the
population and led to 93%
of those at 15% or greater
risk being identified.
The simplicity of this method
may also help to increase
the uptake in screening
and help to identify people with
other modifiable risk factors
(such as high blood
pressure, diabetes, and
smoking) and thus lead to an
integrated screening programme
for coronary heart
disease, say the authors.
This study contributes to
the debate on how limited
resources are targeted to
those people who are most
likely to benefit from treatment
to reduce their risk of
heart disease, they conclude.
Contact:
Sarah Wilson, Senior Research
Fellow, William Harvey
Research Institute, Barts
and the London, Queen Mary's
School of Medicine and Dentistry,
London, UK
Email: s.l.wilson@qmul.ac.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)