There has not been enough reviews to know what cools best. The setgen just came out.
THE r3/r3 protrude out over the top of the card. Case should close, if its of standard size.
The best review I have seen was a german site that reviewed like 8 GPU coolers on a 5850.
The Twin Turbo Pro came out on top over all because:
1. It was one of the top 2-3 coolers of the 8.
2. It was the cheapest price of the top coolers.
3. It cooled the VRMS best, because you can leave the plate on, and those 2 big fans cool the stock plate very well.
4. It was near silent, and you didnt have to buy another fan to make it more silent.
5. It plugged right into the fan header on the 5850.
If you buy a setgen, and a VR4, your looking at like $80. I got the Twin Turbo Pro for $38.