Asthma, breast cancer and CVD

Short of time to catch up on research? Let Dr Louise Newson guide you through the latest journals.

Research of the Week

Effectiveness of herbal medicine
Postgrad Med J 2007; 83: 633-7

The evidence supporting the use of individualised 'herbal medicine', in which combinations of different herbs are tailored by the herbalist for the patient, is very sparse.

In this systematic review, the authors were able to locate only three randomised clinical trials of individualised herbal medicine in any indication, despite and extensive search.

The results of these three studies led to the conclusion that there is presently no convincing evidence to support the use of individualised herbal medicine in any indication. 

ECG and the Diagnosis of LVH
BMJ 2007; 335: 711

I had always thought that an ECG was a fairly sensitive and useful investigation to diagnose left ventricular hypertrophy (LVH) in patients. In addition, patients with LVH are defined as having end-organ disease and their cardiovascular risk is greater than those without LVH. I was therefore surprised to learn from this study that this is not the case. This systematic review provided interesting results. It found that the power of some of the more commonly used electrocardiographic criteria to rule out the diagnosis of LVH in patients (including patients in primary care) with hypertension is poor. The authors conclude that electrocardiographic criteria should not be used to rule out LVH in patients with hypertension.

So, is there any point in us performing ECGs on our newly-diagnosed hypertensive patients?

Breast Cancer Link to High Cardiovascular Risk
J Am Coll Cardiol 2007; 50: 1,435-41

It is already difficult for patients to accept a diagnosis of breast cancer and go through a course of chemotherapy and or radiotherapy, and the results of this study provide more bad news. It has found that women who have received treatment for breast cancer have an increased risk of cardiovascular disease.

This increased risk does not seem to be related to one form of chemotherapy; virtually all of the chemotherapeutic agents used in breast cancer management were associated with cardiovascular injury.

Anthracycline-based therapy increases the long-term risk for heart failure. Radiotherapy, aromatase inhibitors, trastuzumab and angiogenesis inhibitors have been reported to increase cardiovascular risk. Also, unfavourable lifestyle changes such as reduced physical activity and weight gain are common among breast cancer patients.

Prescribing for Asthma in Children
Arch Dis Child 2007; 92: 847-9

Although we are all familiar with the British Thoracic Society (BTS) guidelines for asthma, it seems that many of us are not adhering to the guidelines when it comes to managing children. This study estimated community paediatric prescribing figures for asthma medications in the UK from 2000 to 2006.

Although the numbers of prescriptions for bronchodilator syrups decreased by 60 per cent, there were still over 120,000 prescriptions for them in 2006, despite minimal recommendations for their use.

The percentage of steroid inhalers prescribed as combination inhalers of a steroid and a long-acting beta-agonist increased from 2.6 per cent in 2000 to 20.6 per cent in 2006. This is surprising as this increase in use of combination inhalers is not consistent with the guideline recommendations. Prescription of combination inhalers as controller medication was only recommended for those patients with asthma not controlled on adequate doses of inhaled steroids.

Boxing and Traumatic Brain Injury
BMJ, doi:10.1136/bmj.39342.690220.55 (4 October 2007)

There is currently a campaign for a complete ban on boxing (amateur and professional), mainly because of the alleged risk of cumulative brain injury (chronic traumatic brain injury).

The results of this systematic review of observational studies produce some controversial results for those proposing the ban.

The review found no strong evidence to associate chronic traumatic brain injury with amateur boxing. The authors did note that the quality of evidence supporting the risk of chronic traumatic brain injury with boxing is poor.

Dr Newson is a GP in the West Midlands, and a member of our team of GP research reviewers.

The Quick Study

LVH in hypertension Patients may not be ruled out by ECG.

Breast cancer patients may be at increased risk of CVD following treatment.

Combination inhalers should only be prescribed to children with asthma not controlled by adequate doses of inhaled steroids.

Brain injury is not strongly associated with amateur boxing based on current evidence.

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