Angioplasty, bypass surgery or medical treatment: how should we decide?

Coronary revascularisation continues to be underused despite evidence that this results in poorer outcome

The Applicability of the Framingham coronary heart disease prediction function to black and minority ethnic groups in the UK

In the UK, coronary heart disease (CHD) morbidity and mortality is higher among the black and minority ethnic groups (BMEG). A number of clinical tools are available to calculate an individual’s absolute risk of developing CHD. These are based upon data derived from the Framingham heart study (FHS), the participants of which were white, middle class Americans. The prediction functions derived from the FHS data are multivariable mathematical weightings applied to major CHD risk factors to produce a probability estimate of developing CHD within a timeframe, and limitations are acknowledged when applying the Framingham data to other populations.\ud \ud Currently, data from UK cohort studies do not exist to test these functions among the BMEGs.\ud \ud The aim of this study is to assess the applicability of the Framingham prediction function to BMEGs, by comparing the summary CHD risk scores between BMEG and whites, generated after application of the Framingham prediction function to individual cardiovascular risk factor data, and then to compare the relative summary risk scores with previously published measures of CHD mortality

Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study

<b>OBJECTIVES</b> Though atrial fibrillation (AF) is an important cause of cardiovascular morbidity, there are few large epidemiological studies of its prevalence, incidence, and risk factors. The epidemiological features of AF are described in one of the largest population cohorts ever studied. <b>METHODS</b> The prevalence and incidence of AF were studied in the Renfrew/Paisley population cohort of 15 406 men and women aged 45-64 years living in the west of Scotland. This cohort was initially screened between 1972 and 1976 and again between 1977 and 1979. Incident hospitalisations with AF in the 20 year period following initial screening were also studied. <b>RESULTS</b> The population prevalence of AF in this cohort was 6.5 cases/1000 examinations. Prevalence was higher in men and older subjects. In those who were rescreened, the four year incidence of AF was 0.54 cases/1000 person years. Radiological cardiomegaly was the most powerful predictor of new AF (adjusted odds ratio 14.0). During 20 year follow up, 3.5% of this cohort was discharged from hospital with a diagnosis of AF; the rate of incident hospitalisation for AF was 1.9 cases/1000 person years. Radiological cardiomegaly (adjusted odds ratio 1.46) and systolic blood pressure (adjusted odds ratio 2.1 for ≥ 169 mm Hg) were independent predictors of this outcome. <b>CONCLUSIONS</b> Data from one of the largest epidemiological studies ever undertaken confirm that AF has a large population prevalence and incidence, even in middle aged people. More important, it was shown that the long term incidence of hospitalisation related to AF is high and that two simple clinical measurements are highly predictive of incident AF. These findings have important implications for the prevention of AF