A Risky Business

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Science  05 Sep 2003:
Vol. 301, Issue 5638, pp. 1293
DOI: 10.1126/science.301.5638.1293c

Almost all of us know of someone who has suffered a heart attack despite leading a healthy lifestyle. Cardiologists continue to debate the extent to which conventional risk factors such as smoking, diabetes, high cholesterol levels, and high blood pressure precede the development of coronary heart disease (CHD). In independent studies, Greenland et al. and Khot et al. address this issue by examining the prevalence of these four factors among patients with CHD. Compiling data from 14 clinical trials and three large cohort studies, they conclude that 80 to 90% of patients with clinically significant CHD had at least one of these modifiable risk factors, a finding that supports previous research emphasizing the predictive value of these factors and the lifestyles underlying them.

For the millions of people who experience heart attacks, immediate treatment to restore coronary blood flow is imperative. In a study of over 1500 patients in Denmark, Andersen et al. compared two treatments: emergency balloon angioplasty, which requires transfer of patients to specially equipped hospitals; and on-site administration of fibrinolytic (“clot-busting”) drugs, a procedure that is more widely available and therefore more commonly used throughout the world. Angioplasty was found to reduce the risk of death and major complications by about 40% in comparison with drug therapy, provided that hospital transfer occurred within 2 hours. — PAK

J. Am. Med. Assoc. 290, 891; 898 (2003); N. Engl. J. Med. 349, 733 (2003).

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