[Varicoses: should invasive treatment be standard?]. / Varices altijd invasief behandelen?

The new Dutch multidisciplinary guideline for diagnosis and treatment of venous pathology deals with diagnosis and treatment of varicosis, new surgical techniques in obstruction or insufficiency of the deep venous system, crural ulcers and compression therapy with hosiery or bandages. It also describes classical and new techniques for surgery and endovascular obliteration of varicose veins and evidence based criteria for choosing the optimal therapeutic strategy. Although the working party puts much emphasis on new invasive therapies it neglects to describe the results of conservative therapy such as therapeutic elastic stockings and lifestyle advice including weight loss, exercise and avoiding standing in upright position for long periods. The general advice to choose invasive therapy above conservative therapy except where the result of previous invasive therapy has been insufficient or where invasive therapy is not an option, seems somewhat over the top. Modern elastic stockings are more acceptable as they look good, are transparent and have all kinds of elegant extras and the modern fabrics are comfortable for the wearer. Class I compression stockings have been shown to be effective in uncomplicated cases and are easier to handle than class II, especially for the elderly.

[Multidisciplinary guideline 'Heart failure 2010']. / Multidisciplinaire richtlijn 'Hartfalen 2010'.

In the multidisciplinary practice guideline 'Heart failure 2010', the diagnosis of heart failure relies on a combination of signs and symptoms and on supplementary investigation with natriuretic peptides and echocardiography. Once diagnosed, it is important to detect the potentially treatable cause of the heart failure. The non-medical treatment consists of lifestyle advice, of which regular body exercise is the most important component. The medical treatment of patients with systolic heart failure consists of a diuretic, ACE inhibitor, and beta-blocker, optionally extended by an aldosterone antagonist, an angiotensin receptor blocker and/or digoxin. A restricted group of patients may require an internal cardiac defibrillator (ICD) and/or cardiac resynchronisation therapy. There is limited scientific evidence concerning treatment of patients with diastolic heart failure. It is important to coordinate the care of the patient with heart failure within a multidisciplinary team to provide optimal treatment and information for the patient.

[Cardiovascular prevention: not necessary under the age of 40]. / Cardiovasculaire preventie: niet nodig onder de 40 jaar.

Pharmacological treatment of high blood pressure and high cholesterol should not be recommended for young persons, unless their 10 year risk of cardiovascular disease mortality is > 5-10%, their blood pressure > 180/100 mmHg or their cholesterol > 8 mmol/l.