Journals Watch - Statins, HPV vaccine and asthma

Don't have time to catch up on the latest journals? Let Dr Louise Newson bring you up to date.

Statins use in women Circulation 2010; doi: 10.1161/circulationaha.109.906479
This analysis of the JUPITER (justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin) trial and a meta-analysis of recent trials has demonstrated that statins are effective for the primary prevention of cardiovascular disease (CVD) events in women.

The study represents the first clear evidence of the equivalent efficacy of statins for primary prevention of cardiovascular events in both men and women.

The JUPITER study was a multicentre randomised trial that involved more than 6,800 women aged 60 years or over and more than 11,000 men aged 50 years or over. They all had normal lipid levels but raised levels of high-sensitivity CRP (hs-CRP).

The combined analysis of the JUPITER study and the meta-analysis of other recent studies showed that statins reduced the risk of CVD events by 21 per cent and mortality by 14 per cent.

Statin therapy resulted in a one-third relative reduction in primary CVD in women; a similar benefit to that seen in previous meta-analyses of men.

These results strengthen the evidence base for statin therapy in asymptomatic middle-aged and older women with CVD risk factors. They also suggest hs-CRP should be routinely tested in the UK to identify those at risk of CVD.

Risk of miscarriage with HPV vaccine BMJ 2010; 340: c712
With the introduction of the HPV vaccination programme in the UK, many questions have arisen with regards to its safety.

As the HPV vaccine is an inactivated vaccine there is no known risk associated with giving it during pregnancy, although, as a precaution, HPV vaccine is not advised.

However, it can be given to girls at any time of their menstrual cycle.

This pooled analysis of two multicentre phase III masked RCTs assessed whether vaccination against HPV with the bivalent vaccine increases the risk of miscarriage.

More than 26,000 women aged 15-25 years were involved.

Reassuringly, there was no significant increase miscarriage among women who had received the HPV vaccine.

Vaginal birth after three or more previous caesarean sections BJOG 2010; 117: 422-7
I have always been under the impression that it is a brave woman who decides to go for a vaginal delivery after having a previous caesarian section.

This paper caught my eye as it looked at the rate of success and risk of maternal morbidities in women who had at least three or more prior caesareans who then attempt vaginal birth.

Women who attempted vaginal delivery after three or more prior caesareans were compared with those who attempted after one and two prior caesareans.

The results were not what I had expected - those women who attempted vaginal delivery after three or more caesareans were as likely to have a successful vaginal delivery as those women with only one previous caesarean.

Maternal morbidity rates were also similar between these two groups.

However, women in both groups were actually 10 times more likely to have another caesarian section.

Patients with diabetes need better education regarding driving with diabetes Br J Diabetes Vasc Dis 2010; 10: 31-4

It has been estimated that around one in 20 motor vehicle accidents involving diabetic patients are related to hypoglycaemia. This survey was undertaken to determine diabetic patients' knowledge regarding details of the driving regulations set by the DVLA.

Surprisingly, only 89 per cent of the patients had notified the DVLA and 79 per cent had notified their insurance company of their insulin treatment.

Around one-third of the patients were not aware that driving was not permitted for a minimum of 45 minutes after a hypoglycaemic episode had resolved.

These findings highlight we should improve our education to patients regarding the legal and safety issues of driving at diabetic review appointments.

Step-up treatment for children with asthma N Engl J Med 2010; doi: 10.1056/NEJHoa1001278
In children who have uncontrolled asthma despite the use of low-dose inhaled cortico-steroids (ICS), evidence to guide step-up therapy is still lacking.

This study involved giving children with uncontrolled asthma (currently receiving 100 micrograms of fluticasone twice daily) three different treatments in random orders over a 16-week period.

These treatments were: 250 micrograms of fluticasone twice daily; 100 micrograms of fluticasone plus 50 micrograms of a long-acting beta-agonist twice daily; or 100 micrograms of fluticasone twice daily plus five or 10mg of a leukotriene-receptor antagonist daily.

Those who had received the additional long-acting beta-agonist had the best response.

However, nearly all the children had a differential response to each step-up treatment.

Children differed in their optimal response, which highlights the need for children to be monitored regularly and appropriate adjustments made to their treatment depending on their responses to treatment change.

Despite step-up in daily therapy, there were still many exacerbations which needed the use of oral corticosteroids and none of the step-up treatments completely prevented asthma exacerbations.

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

The quick study

  • Statins for primary prevention of CVD are equivalent in women and men.
  • Bivalent HPV vaccine does not increase the risk of miscarriage.
  • Vaginal birth after three or more caesarian sections carries the same risks as after only one previous caesarian section.
  • Diabetes patients need better education regarding driving with diabetes.
  • Asthma step-up treatment is not beneficial for all children.

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