Randomized clinical trials and observational studies suggest that several elements of a stroke center would improve patient care and outcomes. Key elements of primary stroke centers include acute stroke teams, stroke units, written care protocols, and an integrated emergency response system. Important support services include availability and interpretation of computed tomography scans 24 hours everyday and rapid laboratory testing. Administrative support, strong leadership, and continuing education are also important elements for stroke centers. Adoption of these recommendations may increase the use of appropriate diagnostic and therapeutic modalities and reduce peristroke complications. The establishment of primary stroke centers has the potential to improve the care of patients with stroke. JAMA. 2000.

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Gamma‐glutamyl transferase (GGT) is a second‐generation enzymatic liver function test available for several decades, initially used as a sensitive indicator of alcohol ingestion, hepatic inflammation, fatty liver disease, and hepatitis. Longitudinal and cross‐sectional investigational studies since 1990 have associated GGT with an increase in all‐cause mortality, as well as chronic heart disease events such as congestive heart failure and components of the metabolic syndrome (abnormal body mass index and levels of high‐density lipoprotein cholesterol, glucose, triglycerides, and systolic and diastolic blood pressure). In the upper reference range, GGT was found to be an independent biomarker of the metabolic syndrome, with a 20% per GGT quartile trend rise. Additionally, GGT was positively correlated with an 18% per quartile risk of cardiovascular events and a 26% per quartile increased risk of all‐cause mortality. Furthermore, it may be considered a biomarker for “oxidative stress” associated with glutathione metabolism and possibly a “proatherogenic” marker because of its indirect relationship in the biochemical steps to low‐density lipoprotein cholesterol oxidation. GGT is becoming an important addition to the multimarker approach to cardiovascular risk evaluation. It should be considered a valuable adjunct in stratifying patient risk and in assessing the aggressiveness of appropriate treatment, with hopes of preventing unnecessary cardiac events and deaths in future years. Prev Cardiol. 2010;13:36–41.©2009 Wiley Periodicals, Inc.

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Eur J Clin Invest 2004; 34(3): [245][246] Sir, Coronary heart disease (CHD) remains the leading cause of mortality throughout Europe [1]. The cornerstone of comprehensive management of patients with CHD is lifestyle intervention, which has been shown to be effective in reduction of progression of coronary artery disease [2]. We have recently published a prospective trial investigating the effects of a 12-month intensified lifestyle intervention on the need for further revascularization procedures in patients with established CHD after successful PTCA [3]. Here we report on the occurrence of cardiovascular events in the original cohort after a long-term follow up of 110 (range 102 -115) months.Data were obtained by a structured interview by telephone contact, from hospital files and for patients who died, from the civil status office of the patient's birthplace.The primary outcome variable was the combined end-point from need for further revascularization, fatal or nonfatal myocardial infarction and other cardiovascular events.Analyses were carried out on an intention-to-treat basis. Kaplan-Meier estimates of the probability of event-free survival were performed to create survival curves. Comparison of survival curves was carried out by a log-rank test using the SAS statistic package (version 6·04, SAS Institute Inc., Cary, NC); 95% confidence intervals for the relative risk were calculated on the basis of the chi-square test by Pearson, Mantel and Haenszel. Categorical data were compared by the chi-square test, parametrically distributed measurements by a Student's t -test and nonparametrically distributed measurements by Wilcoxon's signed ranks test (all two-sided).In the long-term follow up a total 19 events (eight myocardial infarctions, 10 revascularizations, one heart transplantation owing to ischaemic cardiomyopathy) occurred in the control group compared with seven events in the intervention group (Table 1). Log-rank testing revealed a highly significant difference in the probability of all events between the control and intervention groups [RR (95% CI): 0·42 (0·19 -0·87), P = 0·009]. Combining the follow up of the initial study with the long-term follow-up resulted in a total observation period of 110 months. In this period, RR for any cardiovascular event was 0·49 (0·27-0·83, P = 0·003).The major limitation of our observation is the fact that angioplasties in our initial study were performed in the present era and none of our patients received a coronary stent. Stents, however, only reduce the rate of restenosis [4] and do not influence the process itself. Therefore we suggest that our observations might also be applicable to patients undergoing angioplasty plus stent implantation, although possibly with a smaller effect.The protective effect of the intensified lifestyle intervention was maintained over a long-term period and extended evidence of long-term improvements, as reported earlier [5], also to patients who underwent successful coronary angioplasty. Based on these evidences, strong advise with r...