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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, University of Oxford
 Oxford, UK

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    Hardening of the arteries is a popular expression which sounds a bit old fashioned now, but it certainly still happens—just as in the 1920s when Bertie Wooster complained to Jeeves that one of his fearsome aunts had banned him from smoking or drinking, and the wise butler replied that doctors held this to be the secret of preventing hardened arteries. “Well, you can tell them next time you see them that they are silly asses,” replied Bertie. At the same time as P G Wodehouse was writing this story, the German physiologist Otto Frank was doing brilliant work on arterial dynamics using a simple manometer. Nowadays we use piezoelectric pressure transducers, but the conclusion is the same—aortic pulse wave velocity can be used as an index of arterial stiffness in the general population. A Danish population study (

    ) shows that this predicts cardiovascular outcomes above and beyond traditional cardiovascular risk factors. For everyday use, however, the office pulse pressure is a reasonable surrogate measure.
 
 Cholesterol lowering agents were beginning to get a bad name until the arrival …

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