Abstract
Ischaemic heart disease and cerebrovascular disease remain the top two killers in middle- and high-income countries. In the fifth edition of this textbook, Professor Scott Grundy, the eminent cardiovascular physician from Southwestern Medical Centre at the University of Texas, together with a number of leading international researchers in cardiovascular medicine, provides a comprehensive update in the field of atherosclerosis and cardiovascular risk. The book covers various aspects relevant to cardiovascular disease, including diabetes mellitus, obesity, lipid subfractions, new cardiovascular risk factors, lifestyle, ethnic and gender differences in cardiovascular risk factors, and important clinical trials conducted in all of these areas. The 300-page text is divided into 12 chapters, each dealing with a topic relevant to cardiovascular risk, and it contains over 500 diagrams, charts and illustrations to convey important points.
The layout of the book is slightly unusual with each chapter starting with a few pages of text introducing the topic of the chapter, followed by lengthy lists of diagrams, charts, tables and figures relevant to the chapter, each with a very detailed legend. There is sometimes no clear link between adjacent diagrams, underlining the point that this is not a book which one will sit and read from cover to cover. Rather it is a book that one is likely to use as reference material to look up specific topics, to provide summaries of issues and perhaps for preparation of presentation slides (with the appropriate acknowledgements of course). The major difference between the fifth edition and its predecessor, the Atlas of Atherosclerosis as it was previously known, is the introduction of numerous chapters dealing with the metabolic syndrome. Indeed, the metabolic syndrome dominates the early part of the book. While proponents of the metabolic syndrome will find these additions valuable, those who find the metabolic syndrome of questionable clinical value will question whether this has actually led to an improvement in this edition of the book. It is apparent that some chapter authors are proponents of the metabolic syndrome while others retain a healthy suspicion thereof, presenting arguments both for and against its clinical relevance. The introduction of the topic of the metabolic syndrome to the text has also led to much repetition in the different chapters of, for example, metabolic syndrome criteria. While this could potentially bother those reading the entire book, the fact that it is likely to be used as reference material means that this is probably not a major weakness. Excellent sections of the book include the chapters on diabetes mellitus and trials of lipid-modifying agents. In other places, the content is weaker, such as presentation of data showing numerous associations between new cardiovascular risk factors and incident vascular events, while failing to present data on the key question of whether measuring these new markers adds anything to what can already be discerned from measurement of the well-known classical cardiovascular risk factors. Future editions will also be strengthened by including the highest quality data for many risk factors now available from the various recent publications of the Emerging Risk Factors Collaboration, data which were largely absent from this edition.
In summary, the Atlas of Atherosclerosis and Metabolic Syndrome is likely to appeal to the many researchers and clinicians interested in cardiovascular risk, including lipidologists, cardiologists, biochemists and diabetologists, who often find themselves looking for a good source of information when specific questions arise or when they would like to brush up on selected aspects of cardiovascular risk.