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Since the founding of the People’s Republic of China in 1949, many changes have taken place in China over the past half century. Whereas China has made phenomenal strides both economically and geopolitically, it has also undergone dramatic changes in the prevalence of coronary heart disease (CHD). People in China used to be known for their lean body build, low plasma cholesterol levels and low incidence of CHD [1]. Now all has changed; CHD in China has climbed from the fifth most common form of heart disease in 1949–1957 (6%) to the second most common in 1958–1968 (16%) and rising again in 1969–1979 (26%) to become the most common in 1980–1989 (27%) where it remains until today [1]. What are the risk factors responsible for this drastic change in modern China?

Sir, Despite a high level of risk factors such as elevated serum cholesterol level, diabetes, hypertension and a high intake of saturated fat, French males display the lowest mortality rate from coronary heart disease and cardiovascular diseases in Western industrialized nations (36% lower than the USA and 39% lower than the UK).1 It has been suggested that regular consumption of red wine may explain this phenomenon, which has been dubbed the ‘French paradox’,2 i.e. the coexistence of a high‐fat diet and a low incidence of coronary artery disease. Of course, as was pointed out by Yarnell and Evans in their …

Sir, The relationship of sodium intake to blood pressure and prevalence of hypertension has remained somewhat controversial for many years, despite a large body of evidence from experimental and epidemiological studies across populations supporting a positive correlation between sodium and blood pressure. The report by Cheung et al .1 of a positive correlation between diastolic blood pressure and urinary sodium excretion in 70 hypertensive Hong Kong Chinese patients tends support to the findings of an earlier and much larger nationwide survey of blood pressure, hypertension and sodium intake in 950 356 men and women carried out in mainland China in 1991.2 A positive within‐population relationship between sodium intake and blood pressure has been demonstrated in several studies in mainland China, using values …

In the editorial published in the October 2003 issue, Lewington1stated that‘... lower threshold such as 4mmol/l for total cholesterol... …

Cardiologists and generalists have been reported to diverge in terms of their self-reported use of angiotensin-converting enzyme (ACE) inhibitors, but information on their actual use of ACE inhibitors has been lacking. In order to assess ACE inhibitor use in patients with heart failure in a teaching hospital and any differences between specialties we studied all patients in the Western Infirmary of Glasgow between 1 April and 1 October 1996 with an echocardiogram showing moderate or severe left ventricular systolic dysfunction (n = 236). We found that most patients were on an ACE inhibitor (66%), 12% had been tried but found to be intolerant, 10% had not been tried because of a contraindication, but 12% had not been tried despite no contraindication. Of those on treatment, 58% were on a dose used in a major survival study (38% of all patients). Most patients were treated by a cardiologist (64%). Of these, more were on an ACE inhibitor (77% vs 53%, p0.01), fewer had been tried but found intolerant (11% vs 18%), and fewer had never been tried (11% vs 29%, p0.01), irrespective of whether they had a contraindication (5% vs 18%, p0.01) or not (6% vs 12%). More were on a dose used in a major survival study (48% vs 31%, p0.05). We conclude that, despite improvements over time, ACE inhibitors are still under-used, sometimes without good reason. There are also differences in the use of ACE inhibitors between cardiologists and generalists which may affect outcome, and could affect resource utilisation.