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Doody's Review ServiceReviewer: John F. Moran, MD (Loyola University Stritch School of Medicine)
Description: This multiauthored text (58), intended to be a supplement to Braunwald's Heart Disease, 5th edition (W. B. Saunders, 1999), focuses on therapies for treatment and prevention of heart disease. It is divided into sections of methodology, treatments and prevention trials.
Purpose: The purpose is to provide information and knowledge in clinical trials in cardiology that are of value to patients.
Audience: The book is obviously intended for practitioners, but it is an excellent source for good reviews of many cardiovascular trials in recent years. Cardiology trainees as well as cardiologists would find it worthwhile.
Features: The first part of six chapters is devoted to the methodology of clinical trials, e.g. randomization, meta-analysis, population, data monitoring, etc. Various drug trials comprise the treatment section. There is a good review of the heparin and aspirin controversy which now may be out of date because of new information on low molecular weight heparin. The section on thrombolytic therapy is important, but now it is overshadowed by recent data on angioplasty in the treatment of acute myocardial infarctions if cath labs are available. The book is full of concise tables listing trials on the use of beta blockers, ace inhibitors, antiplatelet drugs for the treatment and management of myocardial infarctions. The chapters on the use of nitroglycerine and magnesium are interesting in that they fail to reduce mortality in acute myocardial infarctions. The importance of angioplasty in acute myocardial infarction and its use in combination with thrombolytic therapy and rescue angioplasty is discussed. The decision on whether to use angioplasty or thrombolytic therapy in the setting of an acute myocardial infarction now hinges on the availability of a cath lab and skilled personnel. There are trials of risk factors in the prevention section including smoking cessation, hypertension control, weight control, and exercise as well as the use of hormone replacement therapy, but written before the HERS trial. Each chapter is well referenced with these trials. There are many worthwhile tables complementing the text, especially the tables that list the clinical trials.
Assessment: This is a good source of material on drug trials that are well reviewed and listed in tables by diseases such as myocardial infarction, hypertension, and congestive heart failure. There is a particularly well detailed listing of the lipid trials and the effects of progression and regression of atherosclerosis lesions as well as a section on prevention. This book is valuable, but at this point suffers from the lack of the most recent data.