Arch Intern Med 11 Jun 2007 Vol 167

The kidney is really just a sophisticated extension of the cardiovascular system, and in end-stage cardiac disease, measures of renal function provide the strongest prognostic markers (apart from B-type natriuretic peptide). Might this apply much earlier in the course of cardiovascular disease? Yes, says the KEEP study, a big simple cohort analysis measuring eGFR, microalbuminuria anaemia and self-reported heart disease and stroke in 37,153 volunteers. The more of the first three you have, the more of the last two you get.

It works the other way round too: this study looked at the decline in renal function observed in two cohorts of people with cardiovascular disease. Sure enough, the guys with bad arteries got bad kidneys.

Does the prospect of getting type 2 diabetes depress you? It should, and having the condition is also depressing, as this study of depression in 70-79 year olds discovers.

In fact diabetes knocks about 8 years off your life expectancy, according to this Dutch analysis of data from Framingham. The same goes for the amount of life you can expect free of cardiovascular disease.

People tend to have clusters of unhealthy behaviour, e.g. smoking, lack of exercise, and (perhaps) too much salt. So should we pick away at these gently on the basis of one thing at a time, or blast away at the whole lot, like a revivalist preacher condemning a sinner? The latter may in fact be the better strategy according to this study, which sagely concludes that “long-term multiple behaviour change is difficult in primary care”.

Another vitamin gets linked with cardiovascular risk – 25-hydroxyvitamin D
in 15,000 adults from NHaNES 3. “Prospective studies to assess a direct benefit of cholecalciferol (vitamin D) supplementation on cardiovascular disease risk factors are warranted.” Perhaps we will eventually find a vitamin that really prevents heart disease.

In our practice, we call in patients ourselves from the waiting room, and we are periodically assessed using a questionnaire which includes a grading for “warmth of greeting”. Our registrar, who shakes hands with his patients, scores highest. Here’s a study which evaluates American patients’ expectations of appropriate greeting at medical encounters. Call in the patient using both names, and identify yourself in similar fashion: shake their hand unless the patient’s body language signals otherwise.