This week in the BMJ
Volume 326, Number 7404, Issue of 28 Jun 2003Pill could reduce cardiovascular disease considerably
Pill could reduce cardiovascular disease considerably
Taking a single combination pill daily could reduce the incidence of
cardiovascular disease by over 80%. In the first of three articles in this
issue, Wald and colleagues
(p 1419) present
the concept of combining six active components in one pill (the Polypill)
taken every day from age 55, or sooner if people have a diagnosis of
cardiovascular disease or diabetes. They argue that the combination of a
statin, a thiazide, a 
blocker, an angiotensin converting enzyme
inhibitor, folic acid, and aspirin simultaneously reduces four key
cardiovascular risk factors: low density lipoprotein cholesterol, blood
pressure, serum homocysteine, and platelet function. The authors' systematic
review and meta-analysis of over 200 studies
(p 1423) shows that
the use of statins can lower low density lipoprotein cholesterol by 1.8
mmol/l, which could decrease the risk of ischaemic heart disease by 60% and
stroke by 17%. Their examination of 354 randomised controlled trials
(p 1427) found that
giving drugs at half the standard dose can significantly lower blood pressure
with minimal adverse effects, which in turn reduces the risk of stroke by 63%
and ischaemic heart disease by 46%. In an accompanying editorial, Rodgers
(p 1407) says that
the Polypill may have enormous potential for preventing cardiovascular
disease, including in developing
countries.
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Measure cholesterol in everyone over 50
Current UK guidelines on who should have a cholesterol measurement fail to identify 20% of people who may benefit from treatment to reduce their risk of heart disease or stroke. Wilson and colleagues (p 1436) compared four different methods of selecting people for cholesterol measurement: the national service framework criteria, Sheffield tables, age threshold of 50 years, and fixed cholesterol values. They found that targeting everyone over 50 for cholesterol measurement and coronary risk assessment is a simple and efficient way of identifying people in the general population at increased risk of heart disease.
Paperless records are better than traditional system
Electronic medical records are more complete and understandable than paper records. In a cross sectional study of 529 records in 25 general practices, Hippisley-Cox and colleagues (p 1439) found that 89% of paperless records and 70% of paper records were medically understandable. Almost 90% of paperless records had at least one diagnosis, compared with 32% of paper based records. Drug dose reporting was far better in the electronic records than in the paper records (87% versus 33%). However, from interviews the authors found that the method of reporting did not affect the doctors' recall of patients or consultations.
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Scottish hospital consultants deprecate on-call workload
Scottish hospital consultants feel most strongly about high intensity on-call workload when trading off between income and other job characteristics. In a postal survey of 1650 NHS consultants, Ubach and colleagues (p 1432) used a discrete choice experiment to test the strength of preferences for consultants' work. The aspect given highest preferences was limiting high intensity on-call work; consultants then most strongly preferred a job that included opportunities to do non-NHS work, good relationships with staff, adequate staff levels, and fewer hours at work. The relative value of these work features depended on consultants' age, sex, family circumstances, specialty, income, and location. The authors contend that knowing which aspects of consultants' jobs matter to them and how much they matter can be used as the basis for determining levels of remuneration, thus helping to improve recruitment, retention, and job satisfaction.
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Genetic epidemiology can help control Chagas' disease in Latin America
Chagas' disease (also known as American trypanosomiasis) is the most costly parasitic infection in Latin America. In a clinical review, Miles and colleagues (p 1444) discuss the public health and economic implications of Trypanosoma cruzi, a complex zoonosis transmitted primarily by triatomine bugs which infest poor quality housing. The parasite multiples inside cells, particularly those of the heart and smooth muscle, and can cause severe abnormalities and cardiomyopathy in up to 30% of infected people. The authors say that molecular epidemiology can be used to guide disease control strategies by distinguishing the genetic diversity of T cruzi and clarifying transmission cycles of different species.
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