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Doody's Review ServiceReviewer: John F. Moran, MD (Loyola University Stritch School of Medicine)
Description: This is a book about coronary risk factors with an almost exclusive emphasis on lipids and lipoprotein management. The book is divided into sections, the first on lipoprotein metabolism and epidemiology, the second concerns diagnosis, the third covers intervention, and the fourth is special areas such as the economic aspects of lipid management.
Purpose: The purpose is to help physicians in patient management and especially the relationship of lipids to coronary heart disease. The authors see an insight into lipid management as important as the interpretation of electrocardiograms, x-rays, and blood counts.
Audience: The authors have directed this book at practitioners; but cardiology fellows, medical residents, and endocrinologists would find much interesting material here.
Features: The first chapter is an excellent review of lipoprotein metabolism with all due emphasis on cholesterol and LDL cholesterol metabolism. They review the Seven Countries Study as well as MRFIT and the British Heart Study. Although lipids are emphasized here, there is an attempt to relate these to other coronary risk factors. Rare and very rare hyperlipidemias are covered, such as Tangier's Disease and Fish Eye Disease. The authors are from the United Kingdom and make some interesting comments about the economics of risk factors. The sale of cigarettes to children younger than 16 years old generates a tax revenue of £108 million pounds ($170.6 million) and a total tax revenue of £8,463 million ($13.37 billion). Other risk factors are reviewed: exercise, obesity, homocysteine fibrinogen. and other inflammatory markers such as C reactive protein. The Framingham Coronary Risk Factor is compared to the British Regional Heart Study. They would treat all patients with a greater than 30 percent, 10-year CHD risk. Blood pressure reduction is emphasized. The book is up-to-date with reference to the recent Heart Protection Study. There is a detailed section on cholesterol lowering medications and a good review on lipid lowering trials with special emphasis on the cholesterol controversy of the 1990s. There are many pertinent tables that are color coded for emphasis. There are six pages of abbreviations to help conserve text space, which include abbreviations for clinical trials as well as some that are not so commonly used, such as COC (combined oral contraceptive) and HAART (high active and retroviral therapy).
Assessment: Although the book has a definite British slant, there is good information here. The book finishes up with 20 cases, all with accompanying smiling patient pictures and comments by the authors. One interesting comment is Dr. Morrell's finding that hypothyroidism in patients given statins seems more likely to generate muscular aches and pains. One positive aspect about this is that the authors use milligrams percent for measurements in addition to millimoles per liter. There are tables contrasting the National Cholesterol Education Program and Adult Treatment Panel III Guidelines with the European Atherosclerosis Guidelines. Overall, this is a welcome addition to the medical literature.