Arch Intern Med 9 Jul 2007

The richest woman in Elizabethan England, Bess of Hardwick, conceived the idea that unless she kept building houses, she would die. Hence the two Hardwick Halls on a hilltop in Derbyshire, one left uncompleted while she ordered work to begin on the other. When freezing weather threatened a stoppage, she had hot beer poured down the walls, pour encourager les artisans. I sometimes wonder if Harlan Krumholz, a professor of medicine at Yale, harbours similar fears about what would happen if a paper of his did not appear in a leading journal every week. He and his team do fantastic work on the unglamorous aspects of US medicine, especially the care of cardiovascular disease in the elderly and in ethnic minorities. Here, typically, he looks at the treatment of myocardial infarction in “America’s Best Hospitals”. Most of it is good enough, but the majority of the best care goes on elsewhere. Now on to the next paper, team! The beer’s on Harlan.

People with diabetes are at fivefold risk of myocardial infarction and at further risk of doing badly afterwards. What they need is primary percutaneous coronary intervention; compared with fibrinolysis, this reduces mortality by at least 30%, according to this pooled analysis of individual patient data from 19 randomised trials.

A fascinating study of lipid profiles in older men shows that total cholesterol is not predictive of ischaemic heart disease in this group (mean age 77). The main finding is that high HDL-cholesterol levels and apolipoprotein A1 levels are inversely related to ischaemic heart disease in these men, who were followed up by the Oxford Clinical Trials Support Unit.

By and large (large especially) we know that waist circumference is a better predictor of outcomes than body mass index, but this study from Finland shows that this does not apply to stroke in women.

Another not very important fact comes from the other side of the Baltic in Norway, where smoking is found to protect against hypothyroidism. On the other hand, smoking is associated with a higher incidence of hyperthyroidism. Just let’s bin the fags and forget about it.