Journals watch: Cardiovascular risk in those whose parents smoke and support following TOP

Too busy to read all of the journals? Dr Louise Newson selects the latest papers of interest to GPs.

Pic: SPL
Pic: SPL

Risk of cardiovascular disease in those whose parents smoke

Circulation 2015 doi: 10.1161/CIRCULATIONAHA.114.013485

There is a known established association between passive smoking exposure in childhood and adverse cardiovascular health in adulthood. However, the association is not well understood.

This research paper was a 26-year follow-up study to examine whether childhood exposure to passive smoking was associated with the development of carotid atherosclerotic plaque in young adults.

The study involved nearly 2,500 participants from the Cardiovascular Risk in Young Finns Study.

Information on childhood exposure to parental smoking was collected in 1980 and 1983. Carotid ultrasound data were collected in adulthood, in 2001 or 2007. Childhood serum cotinine levels from 1980 were measured from frozen samples in 2014.

The study showed that 84% of children from households where neither parent smoked had non-detectable cotinine levels, compared with 62% of children from households where one parent smoked and 43% of children from households where both parents smoked.

Irrespective of adjustment for potential confounding and mediating variables, the RR of developing carotid plaque in adulthood increased among those where one or both parents smoked (RR = 1.7, 95% CI = 1-2.8, P = 0.04).

Although children whose parents exercised good 'smoking hygiene' (smokers whose children had non-detectable cotinine levels) had increased risk of carotid plaque compared with non-smoking parents (RR = 1.6, 95% CI = 0.6-4, P = 0.34), children of smoking parents with poor smoking hygiene (those whose children had detectable serum cotinine levels) had substantially increased risk of plaque as adults (RR = 4, 95% CI = 1.7-9.8, P = 0.002).

Support following elective termination of pregnancy

J Fam Plann Reprod Health Care 2015; 41(2): 84-9

Following termination of pregnancy (TOP), women should have the opportunity to discuss their preferred method of disposal of the fetal tissue.

This may involve burial or cremation and when disposal is by the healthcare provider, separating fetal tissue from other clinical waste before incineration.

UK regulations on managing fetal tissue after pregnancy loss, including TOP, are underscored by the concept of 'sensitive disposal'.

In this study, 23 women who had undergone one or more TOPs were interviewed about their understanding and experiences of, and attitudes to, fetal tissue disposal and 'sensitive disposal'.

Before the procedure, most of the women admitted that they had not given any consideration to disposal methods because their focus was on ending the pregnancy.

Some women undergoing early medical abortion reported anxiety about how to manage disposal at home.

In general, women favoured separation of fetal tissue from other clinical waste and approved of incineration as a means of destruction.

However, ceremonial disposal was approved of following the loss of a wanted pregnancy, but not following elective TOP.

Most women said that they wanted the opportunity to access information about disposal, but did not want to be asked or required to make decisions about it.

Muscle-building supplement use and risk of testicular cancer

Br J Cancer 2015; 112 Suppl: 1247-50

There are numerous risks associated with taking muscle-building supplements, but many young men are unaware of them.

This US population-based case-control study was undertaken to examine the relationship between use of muscle-building supplements and testicular germ cell cancer risk.

The study found that the OR for ever having used muscle-building supplements in relation to risk of testicular germ cell cancer was significantly elevated (OR = 1.65, 95% CI = 1.11-2.46).

The associations were significantly stronger among early users, men who used more types of supplements, and longer periods of use.

The authors conclude that the consumption of muscle-building supplements is a potentially modifiable risk factor that may be associated with testicular germ cell cancer.

Men should be educated more about the potential risks of using these supplements.

Postpartum dyspareunia and mode of delivery

BJOG 2015; 122(5): 672-9

Dyspareunia, for which there are various causes, is underrecognised and underdiagnosed in primary care.

This study was undertaken to investigate the relationship between mode of delivery, perineal trauma and dyspareunia. Questionnaires were given to 1,507 nulliparous women during their pregnancy and then at three, six, 12 and 18 months, to determine the self-reported rate of dyspareunia at 18 months postpartum.

Of the 83% of women who completed the questionnaire, most (98%) had resumed vaginal intercourse by 18 months postpartum. However, a quarter of these women reported dyspareunia.

Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section, vacuum extraction or elective caesarean section had increased odds of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other potential confounders. This shows that obstetric intervention is associated with persisting dyspareunia.

LUTS and benign prostatic hyperplasia

BJU Int 2015; 115(4): 508-19

Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are becoming more common in the ageing population. They can often affect the patient's quality of life.

This review was undertaken to determine the burden of LUTS/BPH on patients and society, particularly in the UK.

Data from 34 studies were included in the review. The papers showed that LUTS are common in the UK, affecting about 3% of men aged 45-49 years, rising to >30% in men aged ?85 years.

European and US studies have reported the major impact of LUTS on quality of life for the patient and their partner. LUTS are associated with high personal and societal costs, both in direct medical costs and indirect losses in daily functioning.

Although treatment costs in the UK are relatively low compared with other countries, the burden on health services is still substantial.

LUTS/BPH have a major impact on men, their families, health services and society.

The authors conclude that men with LUTS secondary to BPH should not simply accept their symptoms as part of ageing, but should be encouraged to consult their doctor if they have troublesome symptoms.

Antidepressants in patients with IHD

Br J Psychiatry 2015; 206(4): 297-301

Some studies have shown that patients with serious cardiac disease, especially heart failure and coronary artery disease with a recent history of acute MI, who have depression are at increased risk of death.

The use of antidepressant drugs in patients with IHD is still controversial, mainly because of a scarcity of data and conflicting results regarding the effect of these drugs on mortality. This study was undertaken to evaluate the association between adherence to antidepressant therapy and all-cause mortality in a population-based cohort of patients with IHD.

Nearly 63,500 patients with IHD who had taken antidepressants at least once during 2008-2011 were retrospectively followed for all-cause mortality over four years.

Their results showed that moderate and good adherence groups had significantly reduced adjusted mortality hazard ratios of 0.83 (95% CI = 0.78-0.88) and 0.86 (95% CI = 0.82-0.9) respectively, compared with the non-adherence group.

The conclusion of this study is that adherence to antidepressant medication is associated with reduced all-cause mortality in a population-based large sample cohort of patients with IHD. It is therefore important that we improve our efforts to encourage patients with IHD who have depression to take their antidepressant medication appropriately.

Impact of a GP-led walk-in centre on NHS emergency departments

Emerg Med J 2015; 32(4): 295-300

Emergency departments (EDs) in the UK are stretched and numerous ways of reducing their workload have been suggested.

This study involved undertaking a survey of patients visiting a Sheffield GP walk-in centre (WIC) over a three-week period. A short, post-visit questionnaire was also sent to those who agreed to complete it, to determine whether the patient had used another NHS service for the same problem.

Routine data were obtained from the adult and children's EDs and minor injuries unit in Sheffield, one year before and one year after the opening of the GP WIC. A linear model of the number of minor daytime attendances (GP type) per month was used to estimate the impact of opening the GP WIC, after controlling for seasonal variation and a linear time trend.

Only about half of the patients actually responded to this survey. However, the results showed that there was a 26% monthly reduction in GP-type attendances at adult ED, and a 7% reduction at children's ED. Reductions in GP-type attendances at the children's ED and the minor injuries unit at the time of opening of the GP WIC were also found, but were not statistically significant.

The conclusion was that there was a statistically significant reduction in GP-type daytime attendances at the adult ED after the opening of the GP WIC. It is possible the GP WIC was responsible for a reduction in patients going to the ED.

  • Dr Newson is a GP in the West Midlands and a member of our team who regularly review the journals


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

  • Ensure that all of your team are aware of the importance of parents who smoke doing so away from their children
  • Discuss with an obstetrician ways of improving education and support for women who miscarry, including disposal of fetal tissue
  • Consider having a poster or leaflets in your waiting room informing young men of the potential dangers of muscle-building supplements

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

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