Arch Intern Med 27 Nov 2006

This meta-analysis of statins for the primary prevention of cardiovascular disease looks at seven major trials which included people without known cerebral, coronary or peripheral artery disease. A variety of statins all produced a reduction in major coronary and cerebrovascular events, but no significant reduction in mortality.

This meta-analysis of collaborative care for depression finds that in the USA, patients do better when given interventions in addition to primary care. Unfortunately these are so heterogeneous that it’s difficult to know why they were lumped together. The questions I want answered are whether cognitive behavioural therapy is better than the rest, and when can my patients get some.

At the top of the great monastic complex on Mont St-Michel you will find a treadmill which was worked by prisoners in Napoleonic times and throughout the nineteenth century. Nowadays you are more likely to find Frenchmen on treadmills in cardiac investigation or rehabilitation units. How often do they drop dead? Alas, say the investigators with a Gallic shrug, we do not know. The rate of cardiac arrest was 1.3 per million hours of exercise but the outcomes were not available. With laconic charm they conclude that “The frequency of major cardiovascular complications during supervised exercise in France is quite low