US Highlights

Abstract

It's Thanksgiving this week, which means feasting for many in the United States. In an (un)timely reminder between the association of lifestyle and disease, this week's BMJ carries various articles on heart disease. Predicting the risk of death or myocardial infarction in patients with acute coronary syndrome is challenging because of the diverse clinical presentations. To guide triage and key management decisions, however, risk assessment is essential. Fox and colleagues report a prospective multinational observational study (doi: 10.1136/bmj.38985.646481.55) of 43 810 patients in 94 hospitals in 14 countries in Europe, North and South America, Australia, and New Zealand. They developed a new and widely applicable tool, the global registry of acute coronary events (GRACE) scoring system, using nine readily identifiable variables that independently predict death or myocardial infarction. Junghans and Timmis in the accompanying editorial (doi: 10.1136/bmj.39035.509016.BE) balance the advantages against the disadvantages and come out wondering whether this new scoring system is really so very different from other attempts at refining the process of risk assessment—or whether what's really needed is a closer look at why risk assessment in general is so difficult to adopt in clinical practice. More on matters of the heart: in the analysis and comment section, Wald and colleagues (doi: 10.1136/bmj.39000.486701.68) debate the evidence from various types of study on a possible association of raised homocysteine concentrations and cardiovascular disease and on whether folic acid, which lowers homocysteine, will help reduce the risk. They take the view that, although the evidence is not conclusive, it is sufficient to support a modest protective effect of folic acid, but encourage continuing review of this position in the light of new evidence. Prostate cancer is common and potentially serious, especially as most men with the disease have no symptoms. Few established risk prevention strategies exist, and testing has a poor positive predictive value. How, then to tackle a disease that in 2002 alone was diagnosed in 32 000 men in the United Kingdom, with more than 10 000 deaths attributed to it? US authors Timothy Wilt and Ian Thompson (doi: 10.1136/bmj.39022.423588.DE) in a comprehensive clinical review discuss the evidence on risk factors and prevention, detection, and treatment, to help family doctors answer patients' questions, capture ongoing research priorities, and clarify unanswered questions. All this in an interesting and readable article that may appeal to educated patients and doctors alike.