Journals Watch - Cardiovascular events and UTI

A review of this week's medical research. By GP Dr Alison Glenesk

MI: statin therapy was found to be equally effective in secondary prevention in both sexes (Photograph: James Cavallini/SPL)
MI: statin therapy was found to be equally effective in secondary prevention in both sexes (Photograph: James Cavallini/SPL)

Statin therapy in recurrent cardiovascular events
Arch Intern Med 2012; 172(12): 909-19

The aim of this meta-analysis was to determine whether the benefit of statins in preventing cardiovascular events was seen equally in both sexes. Similar studies have been attempted, but these did not look at sex differences or stroke.

Randomised, double-blind, placebo-controlled trials evaluating statins for secondary prevention of cardiovascular events were included.

In total, 11 trials, with 43,193 patients, were found. Overall, statin therapy was associated with a reduced risk of cardiovascular events in all outcomes for women (RR 0.81) and men (RR 0.82); however, they did not reduce all-cause mortality in women versus men (RR 0.92 versus RR 0.79) or stroke (RR 0.92 versus RR 0.81).

The conclusion is that statin therapy is as effective in secondary prevention in both sexes, but there is no benefit for stroke or all-cause mortality in women.

Childhood attention and socioeconomic status
Br J Psychiatry 2012; 201: 20-5
We usually think of attention problems improving with age, although the condition may not resolve. This study from France attempts to quantify this longitudinal relationship by following a group of children aged 6-14 years through to the age of 22-35 years.

The original sample, of 1,103 children, was followed from 1991 to 2009, and associations between attention problems and socioeconomic status at age 22-35 were studied, adjusting for possible childhood and family confounders.

It was found that children with high levels of attention problems were three times as likely to experience socioeconomic disadvantage as children without this condition (OR 3.44), even after adjusting for factors such as low family income, or parental divorce or alcohol problems.

The authors suggest that taking ADHD into account could help to reduce the associated socioeconomic burden of the disorder.

Cranberry products for the prevention of UTI
Arch Intern Med 2012; 172(13): 988-96
Although I encourage self-help in patients, I have always considered the supposed benefits of cranberry juice to be a myth. It seems I was wrong.

The aim of this study was to determine whether cranberry products can help to prevent UTIs and to examine factors affecting their effectiveness.

A search was carried out for RCTs comparing prevention of UTIs in users of cranberry products with controls. A total of 13 trials were identified and 10 analysed, giving 1,494 subjects.

The random effects pooled risk ratio (RR) for cranberry users versus non-users was 0.62. On further analysis, subgroups particularly susceptible to cranberry effects were women with recurrent UTIs (RR 0.53), female populations (RR 0.49), children (RR 0.33), cranberry juice drinkers (RR 0.47) and subjects using cranberry products more than twice daily (RR 0.58).

The mechanism of action, put simply, is the ability of cranberry products to inhibit the adherence of Escherichia coli to the epithelial cells. It appears cranberry products are effective, but the authors warn of inevitable heterogeneity between trials.

Atypical femoral fractures and bisphosphonate use
Arch Intern Med 2012; 172(12): 930-6
There is evidence that there is a higher incidence of 'atypical' femoral fractures in patients taking bisphosphonates. These are radiologically distinct from other fractures and often occur with minimal trauma. The aim of this study from Switzerland was to quantify this risk.

A total of 477 patients aged 50 or over who had sustained a subtrochanteric or femoral shaft fracture were admitted to a university hospital between 1999 and 2010.

Radiographs were examined and patients classified into typical and atypical groups. A sample of 200 healthy patients with no fractures was also identified. Statistical techniques were used to assess the association between bisphosphonate use and atypical fractures, and the incidence of each type of fracture over time.

There were 39 patients with atypical and 438 with classic fractures. Of the atypical group, 32 had been taking bisphosphonates, compared with 28 of the classic group. Bisphosphonate use was associated with a 47% reduction in risk of classic fracture.

Compared with no use, the ORs for atypical fractures in bisphosphonate users ranged from 35.1 for under two years of use to 175.7 for over nine years of use. Contralateral fractures were also much more common in the atypical group.

The researchers conclude that although the incidence of atypical fractures increases with duration of bisphosphonate therapy, these fractures are still uncommon.

Lay views on hypertension and drug adherence
BMJ 2012; 345: e3953
This study addressed how patients' understanding of hypertension affects their medication use. Many qualitative studies have tried to explain poor control of hypertension, particularly in ethnic minority groups.

A systematic review of qualitative evidence was carried out using a variety of data sources. Patients had hypertension, but those with cardiovascular disease (over 50%) were excluded. The primary outcome was patient understanding and experiences of hypertension and medication use.

A total of 59 papers from 16 countries were included.

A large proportion of patients thought their hypertension was caused by stress and produced symptoms such as sweating, headache and dizziness.

Many stopped their medication when they perceived they were not stressed, thinking it was not needed. Many did not like taking tablets and feared side-effects or addiction. There were also many external factors preventing adherence, such as difficulties finding time to make appointments. These findings were remarkably consistent across ethnic groups.

It appears that there are still widespread misconceptions related to hypertension.

  • Dr Glenesk is a GP in Aberdeen and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved

  • Revise further advice for preventing recurrent UTIs and ensure you present self-care options to patients with recurrent UTIs.
  • Find out what support is available in your area for families with chldren with ADHD. Communicate your findings to the practice.
  • Perform an audit of patient compliance with antihypertensive medication and try to determine the reasons for any patients who exhibit poor compliance.

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