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Pancreatic islet isolation and transplantation are complicated procedures, indicated for a carefully selected group of patients. After isolation from the pancreas, the islets are infused into the portal vein. Allogeneic islet transplantation is performed in patients with diabetes mellitus, who suffer from severe hypoglycaemic events and/or progressive complications. One or more donor pancreases are used, which necessitates immunosuppressive treatment. In autologous islet transplantation, which is performed in patients in whom the pancreas has to be removed due to a non-malignant disease, the patients' own islets are isolated and reinfused. No immunosuppressive treatment is required. Reconstitution of endogenous insulin production in allogeneic islet transplantation leads to marked improvements in glycaemic regulation, protection against severe hypoglycaemic episodes and fewer diabetes-related complications. Autologous islet transplantation allows for preservation of endogenous insulin production, which prevents (unstable) diabetes from occurring. This article describes the indications, procedure and pitfalls of islet isolation and transplantation, including three representative cases.

Statins safely and effectively reduce the morbidity and mortality due to cardiovascular disease. In the trials conducted so far, which have been carried out predominantly on high-risk patients, the observed risk reduction is probably completely attributable to the reduction of the cholesterol level. However, statins also influence the atherosclerotic disease process in a lipid-independent way. This includes beneficial effects on the early pathogenetic components of atherosclerosis, such as endothelial dysfunction and inflammation. These effects are probably not visible in the large clinical trials that usually follow up cohorts of patients with late stages of atherosclerosis during a relatively short period of time. These cholesterol-independent effects do affect intermediate factors in the atherosclerotic process, such as endothelial dysfunction. In clinical practice, where not only short-term effects in patients with manifest vascular disease but also the prevention of the long-term complications of atherosclerosis in high-risk patients is an important goal, these so-called pleiotropic effects may contribute to risk reduction.

It was recently proposed that people with a high absolute cardiovascular risk, for example those aged 55 years and over, might considerably benefit from a combined pill that includes proven treatments such as a statins, antihypertensives, antiplatelet therapy and folic acid. Although conceptually attractive, certain negative effects need to be considered. A strategy to treat the population aged 55 years and over might yield large benefits in high-risk patients with fairly normal values for risk factors that are currently often left untreated. It may, however, also lead to the undertreatment of patients with abnormally high values of individual risk factors and to the overtreatment of low-risk patients. In these low-risk patients, the side effects of aspirin and blood-pressure lowering treatment might outweigh the benefits. Due to the high costs and also the availability of generic drugs, it is difficult to envision trials that will address these issues. Therefore, the acceptance and implementation of this intriguing concept by health authorities and insurance companies remains doubtful.