Journals Watch - Palpitations, CVD and obesity

Too busy to catch up on the latest research? Let Dr Louise Newson update you on recent papers.

Patients need greater reassurance on palpitations Br J Cardiol 2008; 15: 249-52
Palpitations are a common cause for referral to a cardiologist, even though often it is likely that there is no underlying cardiac cause. In many patients their palpitations are caused by anxiety.

This qualitative study explored how patients felt before and after referral to a cardiologist with respect to their palpitations and mental state.

Credit: Science Photo Library/ Dr P Marazzi

Patients with heart palpitations with no underlying cardiac cause would benefit from more reassurance

Even after seeing a cardiologist, six out of 20 people - with no cardiac cause for their palpitations - still thought that a serious cause for their palpitations may have been missed. These health concerns persisted after three months.

It was reported that cardiologists did not address the role of psychological factors, including anxiety, with any of the patients in this study. Not receiving a diagnosis or explanation led patients to feel that there was no resolution to the problem.

The authors suggest that even giving a simple written explanation about the cause of the palpitations may be very beneficial and reassuring.

Patient perceptions of multiple medications Diabet Med 2008; 25: 1,204-10
Patients with both type-2 diabetes and cardiovascular disease (CVD) often have numerous drugs to manage. Many trials in the past have shown that compliance with medication is an issue in patients with chronic co-morbid diseases.

In this small qualitative study, patients with type-2 diabetes and CVD were interviewed to explore perceptions towards multiple medicines.

Many patients were sceptical and thought that their doctors prescribed drugs that were unnecessary. Patients thought that their drugs for diabetes were more important than those for CVD and that if they modified their lifestyle they would no longer need to take some of their CVD medication.

Lipid-lowering therapies were often thought to be the least important CVD medication prescribed.

This research highlights the importance of exploring patients' beliefs about their prescribed medications. This should improve compliance in these patients.

Eating behaviour and being overweight BMJ 2008; 337: a2002
We are all acutely aware of the huge increase in incidence of obesity in the UK, which is only set to worsen. Eating quickly and binge eating have been shown in many studies in the past to be associated with an increased intake of food, which is very likely to lead to obesity.

This cross-sectional survey from Japan examined whether eating until full and eating quickly are associated with being overweight in a large population-based sample of adults. They also examined the combined effect of eating until full and speed of eating on being overweight, using BMI as the outcome measure.

Eating until full and eating quickly were significantly associated with being overweight in Japanese men and women, even after adjusting for total energy intake and other potential confounding factors.

In addition, the combination of the two eating behaviours had a cumulative effect on being overweight.

Although the study was in Japan, it is very likely the results would be comparable in people from the UK.

Many patients may be well advised to eat more slowly and not eat too much.

High cholesterol levels can predict hypertension Eur Heart J 2008; 29: 2,561-8
Over the past few years there has been an increase in younger healthy people having their cholesterol levels checked, often as part of a 'well person' check. It is often hard to reassure those with high cholesterol levels who still have a low 10-year CVD risk because they are still concerned about the abnormal results.

This study from Finland has actually shown that elevated cholesterol and LDL-cholesterol levels can predict hypertension in men over a seven-year period.

This may mean that we need to be more aggressive in adjusting other CVD risk factors in those patients with elevated cholesterol levels.

Depressed diabetics should take more exercise Diabet Med 2008; 25: 1,133-41
It is known that both physical inactivity and a depressed mood are associated with a higher risk of diabetes-related complications.

This review assessed the impact of depression-specific management and physical interventions on both mood and activity levels in overweight adults with type-2 diabetes.

The results found that in adults with type-2 diabetes, those patients who did less than 30-90 minutes of exercise per week were up to 75 per cent more likely to be depressed than those who were more active.

Studies need to be done to assess whether or not increasing activity levels in diabetic patients improves their depression. It makes sense though to encourage depressed, type-2 diabetic patients to increase their exercise.

No beta-blockers for simple hypertension J Am Coll Cardiol 2008; 52: 1,482-89
Beta-blockers have had a lot of poor publicity recently and this study adds to it.

This meta-analysis evaluated the role of heart-rate reduction with beta-blockers on the risk for cardiovascular events and death in patients with hypertension treated with these drugs.

Unexpectedly, it was found that after one year of treatment with a beta-blocker (most commonly atenolol) a lower heart rate was correlated with a greater risk for all-cause mortality, cardiovascular mortality, MI, stroke and heart failure.

These results support the argument that beta-blockers are no longer an appropriate treatment for primary uncomplicated hypertension.

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

THE QUICK STUDY

  • Palpitations may improve if a patient's anxiety is addressed and the patient is reassured.
  • Medication compliance can be improved in patients with diabetes and CVD.
  • Overweight has an association with eating until full and eating quickly.
  • Elevated cholesterol levels are associated with an increased risk of developing hypertension in future.
  • Depression is associated with reduced physical activity in those with type-2 diabetes
  • Beta-blocker treatment for uncomplicated hypertension was associated with an increased risk of cardiovascular events and death.

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