Ministry of Health Clinical Practice Guidelines: Lipids

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.

Cardiovascular Risk Calculators: Back to Basics

Cardiovascular disease (CVD) is a leading global cause of mortality and morbidity. Risk assessment of asymptomatic individuals plays an important role in the primary prevention of CVD and its complications by guiding management decisions, in particular the decision to use statins or antiplatelet agents, as well as more controversially, the target level for risk factors such as hypertension and cholesterol. Timely and regular risk assessments also identify the development of physiological disturbances such as pre-hypertension, pre-diabetes, dyslipidaemias, clinical obesity and metabolic syndrome, which can be asymptomatic in the early stages, but may lead to increased risk for many ageing-related degenerative diseases, including CVD. These physiological mal-adaptations are remarkably responsive to behavioural lifestyle interventions at an early stage, and may be stabilised or even reversed without medications. This article describes the why and how of assessing CVD risk and a suggested framework for management, including the appropriate use of behavioural lifestyle interventions as first-line treatment. It also describes the various risk scores available, their differences and limitations and how to best use them in clinical practice. More research is required regarding the use of non-traditional and emerging markers of CVD risk such as carotid intima-media thickness, coronary artery calcium scoring, hsCRP, ankle brachial index, Apo-B, albuminuria, and how they may be incorporated into existing risk models.

Trends in mortality from acute myocardial infarction in the coronary care unit

<p><b>INTRODUCTION</b>The treatment and outcome of acute myocardial infarction (AMI) has evolved greatly over the past few decades. We compared the mortality and complication rates of patients with AMI admitted to the Coronary Care Unit (CCU) in 2002 to previously reported data.</p><p><b>MATERIALS AND METHODS</b>All data for AMI patients admitted to National Heart Centre CCU in 2002 were collected through the Singapore Cardiac Data Bank, including demographics, in hospital complications and mortality. These were compared to previous reports from the same institution in 1988, 1975 and 1967.</p><p><b>RESULTS</b>A total of 516 cases with AMI were identified. A higher proportion of patients were aged >or=70 years in 2002 (31.8%) compared to 1988 (25%), 1975 (11%) and 1967 (5.6%). Acute percutaneous transluminal coronary angioplasty (PTCA) was performed in 250 of 516 (48%) patients in 2002. The overall in-patient and age-standardised mortality was 14.7% and 10% respectively, compared to 20.6% and 17% respectively in 1988 (P = 0.06). For the 250 patients who underwent acute PTCA, overall mortality was 5.2% compared to 24% in those who did not (P <0.001). Common in-hospital complications included heart failure (38%), non-sustained ventricular tachycardia (8%), atrial fibrillation (8%) and complete heart block (6%). Age, heart failure, bundle branch block and sustained ventricular tachycardia were associated with higher mortality by univariate analysis. On multivariate analysis, older age, heart failure and the absence of percutaneous intervention were independently associated with higher mortality.</p><p><b>CONCLUSION</b>In-hospital mortality for AMI patients admitted to the CCU declined from 1988 to 2002 despite a higher proportion of elderly patients. The introduction of new therapies including drugs and percutaneous intervention may have contributed to this decline.</p>