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This paper explores the rationale for early, 'vitamin-like' use of statins to lower LDL levels in asymptomatic adults aged 35–50 years. The authors describe the features of a trial designed to determine whether this approach could dramatically reduce the burden of atherosclerosis and atherothrombotic events in the general population.
No worldwide consensus exists regarding the best way to manage patients with asymptomatic carotid artery stenosis (CAS). In this thought-provoking article, Professor A. Ross Naylor presents his argument against the use of a 'one size fits all' approach involving the costly widespread use of surgical or percutaneous interventions, a high percentage of which are unnecessary. Instead, he recommends that the medical community should increase efforts to identify those at particularly high risk for stroke, who are the only patients likely to really benefit from these interventions
Patients with atrial fibrillation are at substantial risk of thromboembolism and acute ischemic stroke. Professor Gregory Lip gives his perspective on the role of using the antiplatelet agent aspirin for stroke prevention in these patients, compared with warfarin and novel anticoagulant drugs, supported by data from randomized, clinical trials and guideline recommendations.
Obesity is known to have an adverse impact on health. However, the utility of BMI as a measure of obesity to predict total and cardiovascular mortality has been called into question. The authors of this article outline why BMI might not be the most appropriate measure of obesity, and they suggest other methods to determine body fat and its distribution that could be more accurate for assessing cardiovascular risk.
Comprehensive recommendations for surgical intervention exist for patients with degenerative aortic or mitral vale disease who experience symptoms or left ventricular dysfunction. However, for asymptomatic individuals with valve disease, the optimum management strategy is less clear. In this opinion article, Vaishnava and colleagues present the case for performing early valve surgery in this patients and argue against the more-conventional approach of watchful waiting.
