Journals Watch

CHD, sciatica, ADHD and yoga

Too busy to catch up on research? Let Dr Louise Newson update you.

Preventive care for high-risk CHD patients Lancet 2008; 371: 1,999-2,012
This European trial investigated whether a multidisciplinary cardiology programme co-ordinated by nurses led to healthy lifestyle changes and improvements in other risk factors for patients with CHD or at high risk of cardiovascular disease.

The programme involved at least eight weekly meetings at which patients were assessed by a nurse, dietician and physiotherapist for lifestyle, risk factors, medications, health beliefs, anxiety and depression and illness perception. They also attended a supervised exercise class and a group workshop, and were given a personal record card for lifestyle and risk factor targets.

The primary endpoints were family-based lifestyle change, prescription of cardioprotective drugs and management of BP, lipids and blood glucose to target concentrations.

The results were very impressive: at one year those in the intervention group had made significant lifestyle changes, such as increasing fruit and vegetable intake by nearly 40 per cent, and over 10 per cent of patients with CHD achieved lower BP and cholesterol.

St John's wort is not effective for treating ADHD JAMA 2008; 299: 2,633-41
As nearly one child in three with attention-deficit/hyperactivity disorder (ADHD) does not respond to standard pharmaceutical medications or have adverse effects such as nausea, insomnia or weight loss, many parents are keen to find alternative treatments for their child's ADHD.

St John's wort (Hypericum perforatum) is commonly used. This American study found that treatment with St John's wort in ADHD over an eight-week period did not improve symptoms compared to placebo. There was no greater incidence of adverse events in those taking St John's wort.

Although this was a small study and only performed over a short period, it does seem likely that St John's wort cannot be recommended as a treatment option for children with ADHD.

Intensive glucose lowering for type-2 diabetes N Engl J Med 2008; 358: 2,545-59
It is both well accepted and established that reduction in HbA1c levels leads to a reduction in cardiovascular events in patients with type-2 diabetes.

The Action to Control Cardiovascular Risk in Diabetes trial was designed to determine whether using treatment to reduce HbA1c levels to below normal (less than 6 per cent) in patients with type-2 diabetes was beneficial compared with HbA1c levels of 7 to 7.9 per cent.

A total of 10,251 patients with a median glycated haemoglobin level of 8.1 per cent received either intensive therapy (targeting a glycated haemoglobin level below 6 per cent) or standard therapy (targeting a level from 7 to 7.9 per cent).

However, this study was terminated early (after 3.5 years) as results showed those receiving the more intensive glucose-lowering treatments had a higher mortality. In addition, there was no reduction in major cardiovascular events in the more intensively treated group.

Surgery for sciatica BMJ 2008; 336: 1,355-8
Many studies in the past have failed to demonstrate great benefits in early surgery for those with sciatica caused by a prolapsed disc.

In the majority of sciatica cases, symptoms improve within six weeks of initial presentation, but many of those with persisting symptoms see their GP to enquire about surgery to cure their symptoms.

This Dutch randomised, controlled trial looked at patients with six to 12 weeks of persistent sciatica and attempted to determine whether early surgery led to better outcomes than conservative treatment.

The results showed no differences in outcomes between the two treatment groups after one and two years, even though early surgery achieved more rapid relief of sciatica. Interestingly, the authors conclude that 'well-informed' patients should decide whether and when to have surgery.

Fluid intake in patients with overactive bladder BJU Int 2008; 102: 62-6
It is often difficult to know how to advise patients with overactive bladder how to manage their fluid intake.

Caffeinated drinks are to be avoided, but severe fluid restriction can often be unhelpful as very concentrated urine also irritates the bladder.

This prospective crossover trial from Bristol shows that a reduction of fluid intake by 25 per cent led to improvements in urgency, frequency and nocturia episodes in women with overactive bladder.

Reducing intake by 50 per cent or increasing by 25 per cent resulted in worsening daytime frequency. This 25 per cent reduction equated to approximately 300ml of fluid input. Moderate fluid restriction is therefore a safe and cheap treatment to be considered in these patients.

Yoga is a good alternative to HRT BJOG 2008; 115: 991-1,000
In view of recent publicity about HRT, many women are seeking alternative treatments for menopausal symptoms.

In this randomised, controlled study, the effects of regular yoga on cognitive abilities were assessed in 120 perimenopausal women with climacteric symptoms and compared with performing simple exercises.

The results were encouraging - there was a significant reduction in hot flushes, night sweats and sleep disturbance in the yoga group. There was also a significant improvement in cognitive tests. However, the commitment was one hour of yoga a day for five days a week, which may not appeal to some patients.

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

The quick study

  • CHD risk factors were reduced in patients with CHD as a result of a nurse-led cardiology programme.
  • St John's wort was not found to significantly improve ADHD symptoms in children.
  • Intensive glucose lowering in patients with type-2 diabetes was associated with a higher mortality compared with standard therapy.
  • Sciatica outcomes were not significantly different after two years for patients receiving surgery or conservative treatment.
  • Overactive bladder can be effectively managed by reducing fluid intake by 25 per cent.
  • Yoga led to a significant reduction in symptoms in menopausal women.

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