Cardiovascular diseases

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

Ambulatory monitoring is critical in accurately assessing blood pressure to calculate absolute cardiovascular risk. Recently, there has been debate about the need for ambulatory blood pressure monitoring (ABPM) in clinical decision making, promoting instead the use of an absolute cardiovascular disease (CVD) risk-based approach. While we fully endorse hypertension management based on absolute risk, inherent in this assessment is the accurate measurement of blood pressure (BP). ...

Geoffrey A Head BSc, PhD · Barry P McGrath MB BS, MD, FRACP · Mark R Nelson MB BS(Hons), PhD, FRACP · Michael Stowasser MB BS, MD, FRACP

About 80% of congenital heart disease (CHD) is multifactorial and arises through various combinations of genetic and environmental contributors. About 20% of cases can be attributed to chromosomal anomalies, Mendelian syndromes, non-syndromal single gene disorders or teratogens. Down syndrome and velocardiofacial syndrome are the most commonly seen syndromes in patients with CHD. To date, more than 30 genes have been linked to non-syndromal forms ...

Gillian M Blue MSc, GradDipGenCouns · Edwin P Kirk MB BS, PhD, FRACP · Gary F Sholler MB BS, FRACP · Richard P Harvey PhD · David S Winlaw MB BS, MD, FRACS

She was not told the meaning of absence why parents could not visit except on weekends — and then only for an hour. The 1906 Home Handbook of Domestic Hygiene and Rational Medicine outlines the treatment for rheumatic afflictions — hot blanket packs, repeated. She remembers those who wrapped her body in hairy blankets to preserve her rheumatic heart — remembers how the blankets electrified her body so ...

Jennifer Harrison

What is in our food should be on the labelTrans fatty acids (TFAs) are produced by the food industry during partial hydrogenation of edible vegetable oils, such as soybean oil, canola oil and cottonseed oil. This industrial process leads to oils that are more solid at room temperature and have better physical properties for food processing, including increased shelf life. Low levels of TFAs are ...

Gunveen Kaur PhD · David Cameron-Smith PhD · Andrew J Sinclair PhD

To the Editor: A 62-year-old woman was admitted on 10 January 2012 for cardiac monitoring after her implantable cardioverter–defibrillator (ICD) discharged four times over a few hours. She had a history of ventricular tachycardia due to ischaemic cardiomyopathy, and had had an ICD (D284DRG Maximo II DR, Medtronic, Minneapolis, Minn, USA) inserted 6 years earlier. Her ICD had ...

Bo Xu · Howard Connor · Robert Ziffer

A new drug with great promise, but be very aware of the risksDabigatran is the first new oral anticoagulant for the prevention of embolism in patients with non-valvular atrial fibrillation (AF) that has been recently ...

Ross I Baker BMedSc, FRACP, FRCPA · Paul Harper MD, FRCP, FRACP · Claire McLintock MB ChB, FRACP, FRCPA

Objective: To assess the use of Prothrombinex-VF powder for injection (PTX-VF) at Royal Perth Hospital and analyse the efficacy and safety profile of PTX-VF.Design, setting and patients: A prospective observational audit ...

Paul C Kruger MB BS · Annette S Le Viellez BSc(MedSci) · Richard P Herrmann MB BS, FRCPA, FRACP

To the Editor: Neal and Irwig1 argue that more precise measurement of blood pressure using ambulatory blood pressure monitoring is unlikely to deliver the clinical and economic benefits that could be achieved by switching to a risk-based strategy, such as that advocated by the National Vascular Disease Prevention Alliance.2 Moreover, they question: do you need to “know your numbers”? However, all risk-based strategies are based on numbers for blood pressure and various lipid parameters. Furthermore, despite a wealth of evidence that numbers-based approaches reduce cardiovascular events, I am not aware of any randomised controlled trial demonstrating the superiority, or even the equivalence, of a strategy based on 5-year absolute risk for cardiovascular prevention. Is a strategy based on 5-year absolute risk best for the individual patient? Clinicians treat lifetime risk,3 taking into account family history and, for women, the prospect of pregnancy. A low 5-year risk is not sufficient justification for withholding treatment of elevated lipids or blood pressure. Although the 44-year-old, male non-smoker without diabetes and with a systolic blood pressure of 170 mmHg may have a 5-year cardiovascular risk of 5%, clinicians will investigate and provide aggressive blood pressure treatment to reduce his lifetime risk. Treating according to the numbers will ensure that the choice of therapy offers the greatest risk reduction. Clinicians treat individuals, not populations. Management of the individual patient with cardiovascular risk is neither exclusively numbers-based nor exclusively risk-based, but a combination of the two approaches. We should use the approach that works best for the individual patient.

Duncan J Campbell

Despite the various functional tests and biomarkers available for evaluation of patients with coronary artery disease (CAD), we sometimes look for the reassurance of anatomical information by way of a coronary angiogram. However, as an invasive modality, it does carry some risks, and the proportion of patients with normal coronary angiograms has remained relatively stable at 15%. In recent years, the rapid development of computed ...

Gary Y H Liew MB BS, FRACP · Michael P Feneley MD, FRACP · Stephen G Worthley MD, PhD, FRACP