This week in the BMJ

Volume 326, Number 7404, Issue of 28 Jun 2003

Pill could reduce cardiovascular disease considerably
Measure cholesterol in everyone over 50
Paperless records are better than traditional system
Scottish hospital consultants deprecate on-call workload
Genetic epidemiology can help control Chagas' disease in Latin America

Pill could reduce cardiovascular disease considerably

Taking a single combination pill daily could reduce the incidenceof cardiovascular disease by over 80%. In the first of threearticles in this issue, Wald and colleagues (p 1419) present the concept of combining six active components in one pill (thePolypill) taken every day from age 55, or sooner if peoplehave a diagnosis of cardiovascular disease or diabetes. Theyargue that the combination of a statin, a thiazide, a ${beta}$ blocker,an angiotensin converting enzyme inhibitor, folic acid, andaspirin simultaneously reduces four key cardiovascular riskfactors: low density lipoprotein cholesterol, blood pressure,serum homocysteine, and platelet function. The authors' systematic review and meta-analysis of over 200 studies (p 1423) showsthat the use of statins can lower low density lipoprotein cholesterolby 1.8 mmol/l, which could decrease the risk of ischaemic heartdisease by 60% and stroke by 17%. Their examination of 354randomised controlled trials (p 1427) found that giving drugsat half the standard dose can significantly lower blood pressure with minimal adverse effects, which in turn reduces the riskof stroke by 63% and ischaemic heart disease by 46%. In anaccompanying editorial, Rodgers (p 1407) says that the Polypillmay have enormous potential for preventing cardiovascular disease,including in developing countries.

CHRIS DRAPER/PHOTONICA

Measure cholesterol in everyone over 50

Current UK guidelines on who should have a cholesterol measurementfail to identify 20% of people who may benefit from treatmentto reduce their risk of heart disease or stroke. Wilson andcolleagues (p 1436) compared four different methods of selectingpeople for cholesterol measurement: the national service frameworkcriteria, Sheffield tables, age threshold of 50 years, andfixed cholesterol values. They found that targeting everyoneover 50 for cholesterol measurement and coronary risk assessmentis a simple and efficient way of identifying people in thegeneral population at increased risk of heart disease.

Paperless records are better than traditional system

Electronic medical records are more complete and understandablethan paper records. In a cross sectional study of 529 recordsin 25 general practices, Hippisley-Cox and colleagues (p 1439)found that 89% of paperless records and 70% of paper recordswere medically understandable. Almost 90% of paperless recordshad at least one diagnosis, compared with 32% of paper basedrecords. Drug dose reporting was far better in the electronicrecords than in the paper records (87% versus 33%). However, from interviews the authors found that the method of reportingdid not affect the doctors' recall of patients or consultations.

JOSH SHER/SPL

Scottish hospital consultants deprecate on-call workload

Scottish hospital consultants feel most strongly about highintensity on-call workload when trading off between incomeand other job characteristics. In a postal survey of 1650 NHSconsultants, Ubach and colleagues (p 1432) used a discretechoice experiment to test the strength of preferences for consultants'work. The aspect given highest preferences was limiting high intensity on-call work; consultants then most strongly preferreda job that included opportunities to do non-NHS work, goodrelationships with staff, adequate staff levels, and fewerhours at work. The relative value of these work features dependedon consultants' age, sex, family circumstances, specialty,income, and location. The authors contend that knowing which aspects of consultants' jobs matter to them and how much theymatter can be used as the basis for determining levels of remuneration,thus helping to improve recruitment, retention, and job satisfaction.

PAUL TOMKINS/SCOTTISH VIEWPOINT

Genetic epidemiology can help control Chagas' disease in Latin America

Chagas' disease (also known as American trypanosomiasis) isthe most costly parasitic infection in Latin America. In aclinical review, Miles and colleagues (p 1444) discuss thepublic health and economic implications of Trypanosoma cruzi,a complex zoonosis transmitted primarily by triatomine bugswhich infest poor quality housing. The parasite multiples insidecells, particularly those of the heart and smooth muscle, andcan cause severe abnormalities and cardiomyopathy in up to30% of infected people. The authors say that molecular epidemiologycan be used to guide disease control strategies by distinguishing the genetic diversity of T cruzi and clarifying transmissioncycles of different species.

CDC