Background: Although guidelines recommend similar evaluation and treatment for both sexes, differences in approach and outcomes have been reported.Design: Prospective, observational registry.Methods: Consecutive patients at high cardiovascular risk were assessed for risk factors and management at baseline, and followed-up for 2 years.Results: Twenty-two thousand and twenty-eight patients with documented arterial disease (symptomatic) or three or more atherothrombotic risk factors (asymptomatic) completed the 2-year follow-up of the REduction of Atherothrombosis for Continued Health Registry in Europe (women, 31.5%; men, 68.4%). Women patients were 3.3 years (mean) older than men. Few differences were observed between asymptomatic men and women in risk factor profile or management at baseline. Higher proportions of symptomatic women than men had diabetes (P < 0.001), hypertension (P < 0.0001), elevated total cholesterol levels (P < 0.0001) or elevated triglycerides (P < 0.01). A much lower proportion of women than men were current smokers (asymptomatic, 14.6 vs. 29.3%; symptomatic, 11.9 vs. 19.5%, both P < 0.0001). Within the symptomatic population, women received antithrombotic agents (91.8 vs. 94.9%, P < 0.0001) and lipid-lowering agents (68.2 vs. 73.1%, P < 0.0001) less frequently than men. After multivariate adjustment, fewer symptomatic women than men had undergone coronary revascularizations at 2 years (odds ratio, 0.72; 95% confidence interval, 0.61-0.85). There were no differences in primary outcomes, including cardiovascular death/myocardial infarction/stroke (odds ratio, 1.01, 95% confidence interval, 0.93-1.11, P = 0.78), between the sexes.Discussion: Although no differences were found in cardiovascular event rates at 2-year follow-up, secondary prevention could be improved in women, which might further reduce event rates.

BACKGROUND:Abdominal obesity is known to be a risk factor for cardiovascular and metabolic diseases. However, despite the importance of abdominal obesity as a risk factor for cardiovascular and metabolic disease, there are currently no UK-specific data on its prevalence in patients attending primary care.AIM:The aim of the International Day for the Evaluation of Abdominal obesity (IDEA)-UK observational study was to determine the distribution of waist circumference--a marker of abdominal obesity--and its relationship with cardiovascular risk markers in a UK-based primary care population.METHODS:Patients underwent measurements of height, weight and waist circumference and provided data on reported cardiovascular disease (CVD), diabetes, hypertension and dyslipidaemia.RESULTS:A total of 1731 patients were assessed within the study, of which 719 were male and 1012 were female. Of these 1731 patients, 1718 had complete datasets for the presence of reported cardiovascular risk factors. Median waist circumference in the male and female populations respectively was 99.0 cm [interquartile range (IQR) 91.0-108.0 cm] and 89.0 cm (IQR 79.0-100 cm). In all, 38.8% of men and 51.2% of women were abdominally obese (waist circumference > 102 cm and > 88 cm respectively) according to the US National Cholesterol Education Program (NCEP) guidelines. Within both male and female populations, the incidence of reported CVD, lipid disorders, hypertension and diabetes increased with increasing quartiles for waist circumference.CONCLUSION:Increased waist circumference is widespread in patients attending primary care in the UK and is associated with elevated levels of reported diabetes, hypertension, lipid disorders and CVD.

Peripheral arterial disease (PAD) is a reliable marker of future vascular disease and is a substantial public health issue. In Europe and North America, 27 million people are estimated to have PAD, and in the UK around 100,000 people are diagnosed every year. People with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD. Evidence suggests that aggressive risk factor management will prevent many premature deaths and associated morbidity. Therefore, it is vital to identify patients and initiate effective management strategies swiftly. However, whilst 40% of PAD patients have symptomatic disease ranging from intermittent claudication to critical limb ischaemia, around 60% are asymptomatic. As a result of the low rates of detection PAD is underdiagnosed and undertreated in the UK. The gravity of the problem has prompted the formation of professional bodies to address this situation through the development of national clinical guidelines. Indeed, with the focus of general practitioners' work covered by the quality and outcomes framework in the General Medical Services (GMS) contract, many consider that the inclusion of PAD in the GMS contract is critical to raising awareness and improving the management of PAD in primary care.

ABSTRACT. Diets enriched with fish oil may favorably affect the vascular perturbations underlying synthetic graft thrombosis. Therefore, these studies were designed to test the hypothesis that diets enriched with fish oil would decrease the incidence of thrombosis in newly constructed polytetrafluorethylene grafts. A double-blind, randomized trial was conducted. Twenty-four patients were randomized to receive 4000 mg of fish oil or 4000 mg of control oil. Both preparations were enriched with antioxidants and deodorized with peppermint. Patients began therapy within 2 wk after graft placement and were monitored for 12 mo or until thrombosis developed. With a permuted-block randomization schedule, 12 patients received fish oil and 12 patients received control oil. The primary patency rates at 365 d were 14.9% for the control group and 75.6% for the fish oil-treated group. Survival analysis revealed a significant difference between fish oil-treated and untreated patients (P < 0.03, Mantel-Cox test), with a power of 90%. Moreover, analysis of covariables, including age of ≥50 yr, gender, race, body weight, diabetes mellitus, bleeding times, and lipid profiles, indicated that this effect occurred principally as a result of fish oil administration. Importantly, fish oil treatment also decreased venous outflow resistance and systemic BP, compared with control values. Fish oils possess unique biologic properties that favorably affect the incidence of polytetrafluorethylene graft thrombosis, and they thus represent a potential treatment strategy for the prevention of access thrombosis.

Antiplatelet therapy has a role in the primary and secondary prevention of serious vascular events, especially in high-risk patients, including people with diabetes. This review considers the evidence and guideline recommendations for initiating antiplatelet therapy in people with diabetes with and without vascular disease. It concludes that, for diabetic patients with coronary heart disease, stroke or peripheral vascular disease, an antiplatelet agent (e.g. aspirin 75 mg per day or clopidogrel 75 mg per day) should be given routinely and continued in the long term. For diabetic patients with acute coronary syndromes, the addition of clopidogrel (75 mg daily) to usual therapy should be considered. For primary prevention, aspirin (75 mg) should be considered for all diabetic patients with well controlled hypertension and a ≥ 20% risk of developing coronary disease over 10 years.

Metabolic syndrome is thought to be present in nearly half of the adult population of the US and one-quarter of adults in the UK. It is associated with obesity and an atherogenic lipid profile, and is strongly implicated in coronary heart disease. Various bodies have provided diagnostic criteria for metabolic syndrome and guidelines for its treatment. The lack of a single, integrated, evidence-based guideline led a group of UK experts to propose a set of practical recommendations that can be used to guide clinical management of this important syndrome. Metabolic syndrome is a multifaceted condition with a significant role in the pathogenesis of coronary heart disease (CHD). The Expert Panel of the US National Cholesterol Education Program (NCEP) highlighted management of metabolic syndrome as imperative in the battle to reduce mor- tality from CHD 1 . According to the NCEP, targeting this syndrome is second in importance only to reduction of low- density-lipoprotein cholesterol (LDL-C) in lowering cardio- vascular risk. In 2004, a group of UK experts met to discuss current evidence and create a consensus guideline 2 .