(203) The Cochrane Test
1) Consider anything that works.
2) Make effective treatment available to all.
3) Minimise illtimed interventions.
4) Treat patients in the most cost effective place.
5) Prevent only what is preventable.
6) Diagnose only if treatable.
(205) "I have examined our records and also carried out on-line searches and have not found any case where the administration of Harmogen or indeed any oestrone or oestradiol analogues or derivatives have been linked with raised gamma-glutamyl-transpeptidase levels".
(206*) Review article - expressing the TAKEHEART philosophy.
Reckless' QUALYs. £535 for coronary heart disease preventive programme compared with £4764 for breast screening and £5294 for cervical screening. (Quality Adjusted Lifespan for one Year).
(210*) Report of meeting of National Forum for coronary heart disease Prevention.. Lack of data on women's cardiovascular health "No experimental data on women whatsoever. We don't know when or how to intervene..." (Prof David Wood, National Heart & Lung Institute).
Attempts to fine tune oestrogen, progestogen & androgen influences in hormone replacement therapy continue (balance between risks of breast/endometrial cancer and cardiovascular disease/osteoporosis, Dr John Stevenson of Wynn Institute for Metabolic Research). Women are "hormone deficient for a third of their lives" (JS).
QALYS again. 10 yrs hormone replacement therapy for 50yr old £6,200, for a heart transplant £7,200.
(211*) People with smoking related diseases cost the National Health Service £437 million/year. At any time they occupy 9000 beds. "Smoking is the largest single cause of preventable, premature death in this country (Health Education Authority, The Big Kill). 17 million smokers in the United Kingdom. 110,000 die each year from smoking related diseases (this excludes passive smoking). Highest deaths in Manchester, lowest Maidstone & Kent.
Smoking doubles the chance of men dying before 65. 70% more women who smoked would die before the age of 65 than those who never smoked (Dr Spencer Haggard, Chief Executive, Health Education Authority).
(213*) Short review article about the whole question of coronary risk factors
(214) While public health measures are central to controlling coronary heart disease, there is an imperative parallel need for the detection and treatment of individuals at high risk .
(216) The consistent demonstration that smoking is a strong, dose related, independent predictor of the incidence of coronary heart disease. Case against smoking is based upon convincing observational epidemiology.
(217) Clinical trials of blood pressure lowering offer convincing evidence of reduction in strokes and cardiac failure, but evidence of reduction in coronary heart disease is inconsistent and modest.
(218) Hypertension treatment in the elderly achieved reductions in coronary events as well as strokes. SHEP
(219) As 218
(220) The Gothenburg hypertension trial. Substantial fall in coronary heart disease confined to those in whom both blood pressure and cholesterol decreased.
(221) Association of blood pressure and lipid risk factors coexist in same individual more often than happens by chance.
(222) "Familial Dyslipidaemic hypertension" remarkably common
(223) Evidence for correction of hypercholesterolaemia in lowering risk of coronary heart disease is unique in its extent and in the concordance of data from epidemiology, and from several other disciplines.
(224) Shows clearly that the extent of benefit is related to the degree of cholesterol lowering.
(225) As 224
(226) As 224
(227) Cholesterol lowering has favourable effect on angiographically measured coronary or peripheral atherosclerosis.
(228) as 227
(229) Effective lipid lowering diet leads to reduced progression and increased regression of coronary heart disease, associated with reduction of cardiovascular events.
(230) Meta analysis of 8 trials confirms that recurrent coronary heart disease end points are substantially reduced by lowering cholesterol levels.
(231) No persuasive evidence that reducing cholesterol to 4.9 - 5.0 causes any untoward effect.
(232) Finnish trial which shows increased mortality - cholesterol was barely lowered ?untoward effects of drug combinations.
(243) "When all trials of prevention are considered, reduction of blood cholesterol concentrations by diet or drugs has led to a fall in both fatal and non-fatal coronary events."
(244) "Fit older people are prepared to heed advice on lifestyle."
(245) 54 general practice patients with cholesterol > 7 compared with 54 with normal levels. Only other significant difference found to be in STIN scores (Status Incongruence). "The results of this study clearly support the thesis that there is a socio-economic component in ischaemic heart disease risk"
(246) The risk of acute myocardial infarct declined rapidly after quitting and was no different from that experienced by 'never smokers' after three years.
(248) Discussion of the activities of Pulse UK, a firm selling franchises with a day's training to screen for cholesterol, blood pressure and glucose. Seems totally inadequate.
(250) "Lowering serum cholesterol concentrations does not reduce mortality and is unlikely to prevent coronary heart disease. Claims of the opposite are based on preferential citation of supportive trials."
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