Cardiovascular diseases

The J-shaped relationship between alcohol consumption and cardiovascular risk has been studied and confirmed in multiple studies. Whether it should influence the formulation of public policy on alcohol consumption is another question.

Peter L Thompson MD, FRACP, FACC

The 2003 National Heart Foundation of Australia position statement on “stress” and coronary heart disease found depression to be an important risk factor. This consensus statement updates the evidence on depression in patients with coronary heart disease, and provides guidance for health professionals on screening and treatment.

David M Colquhoun MB BS, FRACP, FCSANZ · Stephen J Bunker RN, PhD · David M Clarke PhD, FRACGP, FRANZCP · Nick Glozier MB BS, FRANZCP, PhD · David L Hare DPM, FRACP, FCSANZ · Ian B Hickie MD, FRANZCP, FASSA · James Tatoulis MB BS, MD, FRACS · David R Thompson MA, PhD, FRCN · Geoffrey H Tofler MB BS, MD, FRACP · Alison Wilson MBA · Maree G Branagan MPH

We have a continued responsibility to ensure that the benefits of new drugs demonstrated in randomised controlled trials are translated into clinical practice.

John W Eikelboom MB BS, MSc · Graeme J Hankey MD, FRACP, FRCP

To the Editor: We would like to add a cautionary note to O’Neil’s support for the inclusion of “depression and other psychosocial factors” in the updated National Vascular Disease Prevention Alliance guidelines for assessing cardiovascular disease (CVD) risk. Her statement “it is now clear that depression is also an important risk factor for CVD” is premature.1 Different authors have challenged the suggested relationship and, given ...

Hans G Stampfer · Dana A Hince · Simon B Dimmitt

In reply: I thank Stampfer, Hince and Dimmitt for their response. While I acknowledge that there are aspects of the relationship between cardiovascular disease (CVD) and depression that remain undetermined, recent evidence clearly supports the role of depression as an independent risk factor for CVD and is indeed convincing.1-3 This is especially true in studies that assess depression using diagnostic criteria.4 We know that the ...

Adrienne E O’Neil

CorrectionAuthorship statement omitted: In “Secondary prevention of coronary heart disease in Australia: a blueprint for reform” in the 4 February 2013 issue of the Journal (Med J Aust 2013; 198: 70-71), a full statement of authorship was omitted. Julie Redfern and Clara Chow coauthored the editorial on behalf of the Executive Committee and all participants in the National Secondary Prevention of Coronary Disease Summit held in December ...

Julie Redfern* BSc, BAppSc(Physio), PhD · Clara K Chow* MB BS, PhD, FRACP

Early detection and management can slow the progression of atherosclerosis.

Ian R Hamilton-Craig PhD, FRACP, FCSANZ · Gerald F Watts DSc, MD, FRACP

To the Editor: Clozapine therapy is a recognised risk factor for myocarditis and cardiomyopathy; however, there are no national guidelines for cardiac monitoring. Similar to many centres in Australia, and consistent with the consensus view from major psychiatric facilities in Victoria,1 our institution’s policy is to monitor patients with a baseline echocardiogram before starting treatment with clozapine, at 6 months and 12 months after starting treatment, and ...

Stuart D Murch · David L Prior · David J Castle

To the Editor: Scott and colleagues address the vexed issue of using highly sensitive (hs) cardiac troponin (cTn) assays to detect myocardial infarction (MI) and likely increases in hospitalisations.1 Greater numbers of MIs detected by hs-cTn assays also confound population surveillance of MI trends and our understanding of disease prevention. The initial introduction of cTn assays resulted in predictions of marked increases in MI rates, based ...

Lee J Nedkoff · Michael S T Hobbs · Tom G Briffa

To the Editor: In their article, Head and colleagues stated that “white coat hypertension carries minimal actual CVD [cardiovascular disease] risk”.1 However, a failure to identify white coat hypertension, and to misdiagnose it as true hypertension, can lead to inappropriate prescription of antihypertensive medications, with associated financial costs and adverse effects such as falls and acute kidney injury, which are unrelated to CVD risk. Although the ...

Patrick Coleman

In reply: The cardiovascular risk associated with white coat hypertension itself is quite separate from the risk of treating white coat hypertension inappropriately. We agree that there are considerable issues associated with treating elderly patients for hypertension and possibly inappropriately treating white coat hypertensive patients. However, although white coat hypertension is more common among elderly patients, the condition needs to be considered in a broader context ...

Geoffrey A Head · Barry P McGrath · Mark R Nelson · Michael Stowasser

Primary catheter ablation is an increasingly used therapeutic strategy for the management of atrial fibrillation. In this consensus statement, the National Heart Foundation of Australia presents general recommendations to health care providers to assist them in the care of these patients.

Jonathan M Kalman MB BS, PhD, FRACP · Prashanthan Sanders MB BS, PhD, FRACP · David B Brieger MB BS, PhD, FRACP · Anu Aggarwal MB BS, FRACP, PhD · Nick A Zwar MB BS, PhD, FRACGP · James Tatoulis MB BS, MD, FRACS · Andre E Tay RN, CCDS, MN · Alison Wilson MBA · Maree G Branagan MPH

To the Editor: The latest guidelines for the management of absolute cardiovascular disease (CVD) risk released by the National Vascular Disease Prevention Alliance1 question the utility of conventional risk assessment methods to accurately estimate cardiovascular risk of individuals with depression. Subsequently, these guidelines advocate that individuals assessed for CVD risk be assessed for depression and other psychosocial factors. This appears to be a promising advance, ...

Adrienne E O’Neil

Good correlation with out-of-office readings, virtual elimination of white-coat effectAn accurate blood pressure (BP) reading can be obtained if measurement guidelines are followed properly. However, BP readings recorded in routine clinical practice are often inaccurate and much higher than mean awake ambulatory BP values and readings obtained by home measurement. In studies that have included data on office BP readings that were recorded manually in ...

Martin G Myers MD, FRCPC · Mark R Nelson MB BS(Hons), PhD, FRACGP · Geoffrey A Head BSc(Hons), PhD

Can we be optimistic?An 8-year-old Aboriginal girl presents with shortness of breath and severe mitral regurgitation, and requires urgent surgery; a young Torres Strait Islander mother has a disabling stroke related to mitral stenosis; and a middle-aged Aboriginal community leader dies from infective endocarditis associated with a mechanical valve. These are the realities of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australia. Globally, ...

Graeme P Maguire MB BS, FRACP, PhD · Jonathan R Carapetis MB BS, FRACP, PhD · Warren F Walsh MB BS, FRACP, FACC · Alex D H Brown BMed, MPH, PhD

A national registry for acute coronary syndromes will improve patient care and clinical resultsAcute coronary syndromes (ACS) represent a substantial burden of morbidity and mortality within Australia.1 Modern treatment of these syndromes requires efficient risk stratification, timely angiography and revascularisation, and use of proven secondary prevention therapies.2-4 With a robust evidence base, it is a reasonable societal expectation that care be applied as completely as ...

Derek Chew MB BS, MPH, FRACP · David Brieger MB BS, PhD, FRACP · Carolyn M Astley RN, BN(Hons) · Andrew Georgiou PhD, FACHI, FCHSM