ORONARY HEART DISEASE (CHD) is the leading cause of death worldwide. 1 Inflammation plays a key role in the pathogenesis of CHD at every stage from initiation to progression and rupture of the atherosclerotic plaque. 2 Creactive protein (CRP), an acutephase protein synthesized primarily by the liver, is currently the most widely used biomarker of inflammation. 3 Ob-servational studies have consistently demonstrated that higher plasma levels of CRP are associated with higher risk of CHD, 4,5 and measurement of CRP has been advocated as a means of improving risk prediction. 6 There is See also pp 49 and 92.

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The Institute of Child Health/Southampton study is the largest cross-sectional survey of lead exposure and children's intelligence. 402 six year olds in London with tooth lead concentration in three pre-defined ranges were selected for neuropsychological testing. This paper presents new findings on the relationship between child IQ and tooth lead levels which build on previous findings in four respects: Rather than simply classifying children into high, medium and low lead groups the actual concentrations of lead in each child's tooth have been used to provide a more powerful assessment of the association between IQ and body lead burden. The influence of parental and social factors on child IQ is explored in detail in order to see if any residual lead-IQ association exists after allowance for such confounders. The methods of multiple regression, including an 'optimal' statistical policy, are more fully described. The possibility of interactions between lead and confounders is explored. Findings are that parental IQ is the most important influence on child IQ, though several other factors (eg: family size, social class and quality of marital relationships) were also significantly related. There was no overall evidence that tooth lead concentrations were related to child IQ once these other factors were taken into account. However, a significant interaction between tooth lead and sex of child indicates that the lead-IQ association appears much more pronounced in boys. This unexpected finding needs cautious interpretation and further exploration in other studies.

Contact with smokers is associated with increased risk of MD in adolescents. This is more likely to be due to higher carriage rates in smokers than to exposure to smoke and emphasizes the importance of public health measures to stop smoking. In epidemiological studies that assess risk from passive smoking, exposure to smoke should be differentiated where possible from contact with smokers.

Recent advances in cardiovascular magnetic resonance (CMR) now allow the accurate and reproducible measurement of many aspects of cardiac and vascular structure and function, with prognostic data emerging for several key imaging biomarkers. These biomarkers are increasingly used in the evaluation of new drugs, devices and lifestyle modifications for the prevention and treatment of cardiovascular disease. This review outlines a conceptual framework for the application of imaging biomarkers to clinical trials, highlights several important CMR techniques which are in use in randomised studies, and reviews certain aspects of trial design, conduct and interpretation in relation to the use of CMR.