End of the road for the diet-heart theory?

A personal account of the diet-cholesterol-heart hypothesis during the last sixty years, from its start with Jeremiah Stamler and Ancel Keys, its rapid rise and progressive fall during the last years. It is pointed out that the clinical picture of a heart attack is not synonymous with atherosclerotic changes in the coronary arteries. Special emphasis is given to the repeat publication of the results with the MRFIT screenees that have been used to obscure the negative results of the randomized multifactorial trials MRFIT in the US and The Gothenburg preventive trial in Sweden.

Does off-pump coronary surgery endanger long term survival?

In this issue Ibrahim and co-authors report on technical hazards of off-pump (without heart lung machine) coronary surgery 1. Their findings are in line with meta-analyses of randomized trials which indicate that under-grafting and graft-failures are more common after off-pump than after standard operations. The risk that the objectives of coronary bypass surgery are endangered is discussed in relation to evidence based medicine.