Gout, cardiovascular risk and MI

Short of time to catch up on research? Let Dr Louise Newson guide you through the latest journals.

GOUT IS A RISK FACTOR FOR CARDIOVASCULAR DISEASE
Circulation 2007; 116: 894-900

We are aware of diseases that are associated with a higher risk for cardiovascular disease, including hypertension and diabetes. This study prospective demonstrated that men with gout had a higher risk of non-fatal MI than those without gout, over a 12-year study period. Over the follow-up, the relative risks in men with history of gout but no history of CHD compared with those with no history of gout or CHD at baseline were 1.28 for all-cause mortality, 1.38 for cardiovascular disease deaths and 1.55 for fatal CHD. Further research is needed before management of cardiovascular risk factors in patients with gout can be advocated.

HIGH/NORMAL BP INCREASES CARDIOVASCULAR RISK IN WOMEN
BMJ 2007; 335: 432-6

There has been a move to diagnose and treat 'prehypertension' (130-/9/85/9mmHg). This study has shown that women with prehypertension have a substantially higher risk of developing hypertension or experiencing a major cardiovascular event than women with normal BP.

Multivariable analysis revealed that, using the high/normal group as reference, women with normal BP levels had a 39 per cent lower relative risk for major cardiovascular events.

In addition, in those women who progress to hypertension, the cardiovascular risk increases shortly after hypertension has been diagnosed.

MI IS A RISK FACTOR FOR PRE-DIABETES
Lancet 2007; 370: 667-75

Although it is well established that patients with diabetes have a higher risk of cardiovascular disease, the reverse relationship is less clear.

However, this study has demonstrated that patients who have had a recent MI are at a higher risk for developing both new-onset diabetes and impaired fasting glucose (IFG) than the general population.

Of the 7,533 patients without IFG at baseline, 33 per cent developed new-onset IFG or diabetes over a three-year follow-up period. Those patients who were older, hypertensive or were taking beta-blockers had the greatest risk. These results therefore support the theory that an MI could be a risk factor for pre-diabetes.

IMPACT OF SINGLE VACCINES FOR MMR ON IMMUNITY
Arch Dis Child 2007; 92: 786-9

This study obtained information on the use of the single antigen vaccines for measles, mumps and rubella in England and Wales. The proportion of children receiving the single vaccine was estimated to be small but not insignificant in 2001 and 2002.

Although the use of single vaccines is contributing to increased measles immunity, the total level of immunity is still too low to sustain elimination of measles.

IS SCREENING FOR AF WORTHWHILE?
BMJ 2007; 335: 383-6

AF is common in the elderly population, affecting approximately 5 per cent of people over 65 years. The risk of serious outcomes, such as stroke, can be reduced by treatment, so the diagnosis of AF is important in primary care. This study tested whether screening was more effective than routine care in detecting AF in the community.

The results found that active screening for AF detected more cases when compared with current practice.

It is recommended that patients should have their pulse taken and if it is irregular, an ECG should be performed as a confirmatory test.

Dr Newson is a GP in the West Midlands, and a member of our team of GP research reviewers.

THE QUICK STUDY
Gout in men is a risk factor for non-fatal MI and might need to be managed aggressively.

Prehypertension in women is a risk factor for cardiovascular disease, and the risk increases shortly after hypertension is diagnosed.

Recent MI is linked to an increase in the risk of patients developing diabetes.

Single antigen vaccines for MMR are contributing to overall immunity against measles, but the level of immunity is still too low to eliminate the disease.

AF screening detects more cases than routine care, and patients should have their pulse taken opportunistically.

RESEARCH OF THE WEEK
Antioxidants do not offer cardiovascular protection
Arch Intern Med 2007; 167: 1,610-8

Antioxidant-rich diets and antioxidant supplements have been recommended for the prevention of a range of serious diseases including cancer and Parkinson's disease, all of which are associated with free radical damage. But randomised trials have failed to support an effect of antioxidant vitamins on the risk of cardiovascular disease (CVD).

The Women's Antioxidant Cardiovascular Study tested the effects of ascorbic acid, vitamin E and beta carotene on the combined outcome of MI, stroke or CVD death among 8,171 female health professionals at increased risk of CVD. The results showed that there were no overall effects of ascorbic acid or vitamin E on cardiovascular events among these women, providing yet more evidence for patients that they need not waste money on supplements.

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