Arch Intern Med 28 May 2007 Vol 167

A thousand patients have now taken part in 18 studies of bone-marrow derived cells for cardiac repair. This meta-analysis shows definite evidence of a repair effect, such as decrease in infarct size and increase in ejection fraction, but nothing that could yet be described as a “hard” end-point, such as increased exercise capacity or reduced mortality. Promising then, but not yet miraculous.

Two Canadian studies explore how coronary disease management often paradoxically delivers the most treatment to the lowest-risk patients. This applies in the hospital management of non-ST-elevation acute coronary syndromes but also to the use of statins following coronary angiography. It seems that the biggest determinants of non-compliance with statin treatment are depression and poor exertional capacity. Whether these data apply to the UK is another matter.

We saw from the NEJM review of osteopenia that about a third of postmenopausal women ought to be on vitamin D and calcium supplements, and here’s a study suggesting that this will have the additional benefit of protection from breast cancer. But in the postmenopausal group of 20,000 this just failed to reach statistical significance, whereas there seemed to be a stronger effect in premenopausal women.

Soy products are also widely used by postmenopausal ladies, though evidence of symptomatic benefit is slight. However, the stuff is probably cardioprotective and this may be due to lowering of blood pressure and LDL-cholesterol, as observed in this trial of soy substitution for animal-derived protein.

Are you heading for type2 diabetes? There is now a score from the Framingham Offspring Study which is highly predictive for diabetes within 7 years: there are also very similar scores from San Antonio and other places. The clinical factors are simple: fasting blood sugar, lipid profile, blood pressure, BMI and family history. I had better go out and do some exercise.