Statins, embolism and depression

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

Pregnancy and pulmonary embolism BJOG 2008; 115: 453-61

We know that pregnancy is a risk factor for venous-thromboembolism (VTE), although fortunately I have never seen a case in a pregnant woman.

Every consultant-led obstetric unit in the UK contributed data about pulmonary embolism for a period of 18 months. A total of 143 women developed an embolus antenatally - 1.3 per 10,000 maternities.

Of these, 70 per cent had identifiable risk factors for VTE, mainly multiparity and BMI >30.

Fortunately only five women died. This highlights the need to be vigilant with high risk groups in pregnancy.

GUM clinic records Sex Transm Infect 2008; 84: 67-9

Traditionally, medical information from GUM clinics has been separate from other medical data, allowing the public to attend and the information to remain completely confidential.

However, GPs are increasingly being encouraged to provide sexual health services.

But what do patients think about proposals to routinely send letters to GPs about their attendance at GUM clinics and to share GUM data on common IT systems?

A total of 527 clinic attendees completed a questionnaire about this plan and only 35 per cent agreed to GP contact. Particular worries were expressed by homosexuals and by those considering HIV testing.

A quarter of respondents said that they would be less likely to attend GUM clinics if GPs were able to access their clinic records.

Antioxidants in Down's syndrome BMJ 2008; doi:10.1136 bmj 39465.544028

Use of vitamin and mineral supplements is widespread in children with Down's syndrome in Europe and the US as a result of major marketing campaigns by companies claiming substantial benefits for their products, but is this money wasted?

Adults with Down's syndrome seem to age prematurely and neuronal changes are evident in children. Why this is so is not fully understood but it is suggested that increased activity of two genes involved.

Evidence that supplementation with folate, antioxidants or both might ameliorate the effects of Down's syndrome was evaluated in a randomised controlled trial of two by two design.

Around 150 children and young people aged between six months and 17 years were randomised to oral supplementation with antioxidants, folate, a combination or placebo.

The authors reported no significant effect of antioxidants on cognitive function or language development.

I am not surprised by these findings. It seemed unlikely that supplementation with antioxidants or folate would improve function in a syndrome caused by a chromosomal abnormality.

Statins use in chronic kidney disease BMJ; doi: 10.1136/bmj.39472.580984

Increasing numbers of people are being affected by chronic kidney disease (CKD), and within this population of patients cardiovascular disease accounts for the largest proportion of fatalities.

In the general population there is a consistent link between reducing lipid concentrations, primarily of LDL-cholesterol, and the risk of all cause and cardiovascular mortality; however, data in patients with CKD has been inconsistent.

Results of a recent meta-analysis have shown statins to be safe in patients with CKD and to reduce lipid concentrations and cardiovascular endpoints. Fifty trials were included.

Compared with placebo, statins were shown to reduce total cholesterol, LDL cholesterol and proteinuria, but did not improve glomerular filtration rate.

The role of statins in primary prevention of CKD is still to be established. Ongoing clinical trials should shed light on this and on the efficacy of statins in reducing all cause mortality.

Exercise in postnatal depression Br J Gen Pract 2008; 58: 178-83

Women diagnosed with postnatal depression are reluctant to take antidepressants or receive counselling, and other types of psychological support are often only available to a limited extent.

Meta-analyses of studies have concluded that exercise may be effective in reducing depression in the general population and therefore it may also be useful in postnatal depression.

Recruitment to this study was poor, at only 23.1 per cent and so only 38 women were studied. They were randomised to receive exercise intervention or usual care and both groups were followed up at 12 weeks.

Exercise intervention involved two one-to-one exercise consultations over the 12-week intervention period, during which uptake of exercise was discussed, as were activity goals, and a pedometer supplied. The aim was for patients to achieve moderately intensive exercise 30 minutes daily for five days of the week, usually in the form of 'pram-pushing'.

I had envisaged the women doing strenuous exercise in the gym, not just pushing a pram.

Exercise participation over the 12-week period was not increased in the exercise group, possibly due to the difficulty of motivating women with postnatal depression, and depression scores in both treatment and usual care groups did not differ.

Dr Lewis is a GP in Windsor, Berkshire, and a member of our team who regularly review the journals.

The quick study

  • Venous-thromboembolism may occur during pregnancy.
  • GUM clinic data being shared with GPs may deter patient attendance at clinics.
  • Down's syndrome children do not seem to benefit from antioxidant or folinic acid supplements
  • Statins significantly reduce lipid concentrations in patients with chronic kidney disease.
  • Postnatal depression patients do not appear to benefit from exercise.

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