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Objective: This study aims to establish the benefits of lowering cholesterol in diabetic patients with well-controlled hypertension and average/below-average cholesterol concentrations, but without established coronary disease.Research Design and Methods: In the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA), 10,305 hypertensive patients with no history of coronary heart disease (CHD) but at least three cardiovascular risk factors were randomly assigned to receive 10 mg atorvastatin or placebo. Effects on total cardiovascular outcomes in 2,532 patients who had type 2 diabetes at randomization were compared.Results: During a median follow-up of 3.3 years, concentrations of total and LDL cholesterol among diabetic participants included in ASCOT-LLA were approximately 1 mmol/l lower in those allocated atorvastatin compared with placebo. There were 116 (9.2%) major cardiovascular events or procedures in the atorvastatin group and 151 (11.9%) events in the placebo group (hazard ratio 0.77, 95% CI 0.61-0.98; P = 0.036). For the individual components of this composite end point, the number of events occurring in the diabetes subgroup was small. Therefore, although fewer coronary events (0.84, 0.55-1.29; P = 0.14) and strokes (0.67, 0.41-1.09; P = 0.66) were observed among the patients allocated atorvastatin, these reductions were not statistically significant.Conclusions: Atorvastatin significantly reduced the risk of major cardiovascular events and procedures among diabetic patients with well-controlled hypertension and without a history of CHD or markedly elevated cholesterol concentrations. The proportional reduction in risk was similar to that among participants who did not have diagnosed diabetes. Allocation to atorvastatin prevented approximately 9 diabetic participants from suffering a first major cardiovascular event or procedure for every 1,000 treated for 1 year. [ABSTRACT FROM AUTHOR]

Objectives: To study whether the wide differences in heart disease incidence amongst ethnic groups in the UK, with the higher mortality and morbidity in peoples of south Asian descent, may be attributed to differences in public health awareness and life-style. Design: Questionnaire-based survey of women from different ethnic groups attending an antenatal clinic in a city centre district general hospital. Results: We surveyed 232 housewives from 3 different ethnic groups: 84 white (mean age 24.3 years +/- standard deviation (SD) 5.84), 76 Afro-Caribbean (mean age 24.7 years +/- SD 4.46) and 72 Asians (defined as people of south Asian or Indian subcontinent descent; mean age 25.7 years +/- SD 5.5). The proportions of smokers amongst the whites, blacks and Asians were 38.1%, 27.6% and 2.8% respectively. Proportions consuming alcohol regularly were 31.0%, 10.5% and 4.2% respectively. A higher proportion of blacks reported a change in dietary fibre intake, whilst a higher proportion of whites reported a change in dietary fat intake and sugar intake as a result of public health campaigns, publicity or advertising. There was a significantly lower proportion of reported regular exercise activity amongst the Asian women and their husbands or partners. Conclusion: This study demonstrates that Asian families were the least likely to take regular exercise, and had a lower awareness of cholesterol or dietary content (fibre, sugar, salt) despite public health campaigns and publicity. They were however the least likely to smoke cigarettes. These ethnic differences may in part explain the higher prevalence of coronary heart disease amongst the Asian population in the UK. This ethnic group should be targeted for intense public health intervention, education and other preventative measures to reduce the risks of heart disease. [ABSTRACT FROM AUTHOR]

Comments on several issues related to medicine in Great Britain. Importance of enhancing the professional status of midwives; Association of photosensitivity to vitiligo; Complications of central venous cannulation.