Journals Watch - Statins, obesity and MI

Not had time to read the journals? Dr Louise Newson brings you up to date on the latest research.

A systematic review found no association between statins and intracerebral haemorrhage (above) (Photograph: SPL)
A systematic review found no association between statins and intracerebral haemorrhage (above) (Photograph: SPL)

Statins and intracerebral haemorrhage
Circulation 2011; doi: 10.1161/CIRCULATIONAHA.111. 055269

A recent large randomised trial suggested that statins may be associated with an increased risk of intracerebral haemorrhage. This systematic review was performed to see if there was an association of statins with intracerebral haemorrhage in other studies.

Randomised trials, cohort studies and case-control studies were analysed, including published and unpublished data from 23 randomised trials and 19 observational studies. The complete dataset comprised 248,391 patients and 14,784 intracerebral haemorrhages.

The review found no evidence that taking statins was associated with an increased risk of intracerebral haemorrhage. Statins are widely prescribed in primary care, so the results of this study are very reassuring.

Care of elderly patients after acute coronary syndrome
Eur Heart J 2011; doi: 10.1093/eurheartj/ehr381

The care of elderly patients has been criticised heavily in the press. This study looked at the risk of patients with an MI dying in hospital over the past seven years. The study included 616,011 cases at 255 hospitals across England and Wales.

Their results were reassuring in that the risk for MI patients dying in hospital almost halved across all age groups.

However, those patients aged over 85 years were less likely to receive reperfusion therapy (including primary percutaneous coronary intervention or thrombolysis) and medications (including prescribed aspirin, clopidogrel, beta-blockers, statins, or ACE inhibitors) on discharge compared with younger patients.

Older patients had greater lengths of stay (p <0.001) and higher in-hospital mortality (p <0.001). We should all try to ensure that elderly patients receive appropriate medication after an admission for MI.

Moving house may reduce obesity and diabetes rates
N Engl J Med 2011; 365: 1509-19

The incidence and prevalence of obesity are increasing at an alarming rate, so any interventions to reduce obesity are important and likely to be worthwhile. This study in the US assessed whether a person's neighbourhood environment contributes to their development of diabetes and obesity.

In the study, nearly 4,500 women and children who were living in public housing in high-poverty urban areas were followed up; some of them were given the opportunity to move to an area of less poverty. Those people who moved had modest but potentially important reductions in the prevalence of diabetes and obesity. However, I am not sure we can suggest to obese patients that they might move rather than diet.

Association of autoimmine diseases with IBD in children
Arch Dis Child 2011; 96: 1042-6

There are established associations between inflammatory bowel disease (IBD) and other autoimmune conditions in adults. However, these associations are not so well established in children.

This study was undertaken to evaluate whether paediatric IBD is associated with the occurrence of other immune-mediated diseases. More than 700 children with Crohn's disease and nearly 500 children with ulcerative colitis were involved in this study. The results showed that children with IBD, especially Crohn's disease, have an increased risk of other immune-mediated conditions, such as asthma, eczema, rheumatoid arthritis and diabetes.

Use of mobile phones and the risk of brain tumours
BMJ 2011; 343: d6387

Many people are concerned about the possibility of a relationship between using mobile phones and the development of brain tumours. This study in Denmark was undertaken to investigate the risk of tumours of the CNS in those who used mobile phones. More than 358,000 people were included in this research.

During the study period, there were 10,729 cases of tumours of the CNS. There was no increased association of tumours in those who used mobile phones.

Interestingly, there was no indication of dose-response relation either by years since first subscription for a mobile phone or by anatomical location of the tumour - that is, in regions of the brain closest to where the handset is usually held to the head.

Hypertension linked to poor health-related quality of life
J Hypertens 2011; 29(11): 2070-4

Studies in the past have shown that patients with hypertension have poorer health-related quality of life than normotensive individuals. This study included more than 900 people aged 45 to 70 years with increased cardiovascular risk.

Hypertension was diagnosed in 55% of these patients. Before their diagnosis was made, the patients completed the short-form health survey (SF-36) to assess their health-related quality of life.

The results of this study showed that patients who were aware of their hypertension had lower scores in physical functioning and general health than those without hypertension and those who were unaware of their hypertension.

There were no differences for mental components of SF-36 between these study groups. The prevalence of obesity and newly diagnosed type-2 diabetes was higher in patients with known hypertension than among other study groups.

The researchers concluded that impaired health-related quality of life in hypertensive patients might be secondary to the awareness of hypertension, adverse drug effects, newly diagnosed type-2 diabetes or obesity, not high BP per se.

  • Dr Newson is a GP in the West Midlands 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.

  • Present the findings from the research into statins and intracerebral haemorrhage to colleagues at a practice meeting.
  • Perform an audit of your elderly patients who have had an MI in the past year. Review their drugs to ensure they are being prescribed optimal medication.
  • Carry out a search of children in your practice who have inflammatory bowel disease. Determine if any of these patients also have any autoimmune diseases.

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