Diabetes and post-MI depression

Too busy to keep up with the journals? Allow Dr Elizabeth Croton to be your guide to the latest findings.

LIPID LOWERING TREATMENT WORKS FOR DIABETIC PATIENTS

BMJ 2006; 332: 1,115-8

Diabetes is an independent risk factor for cardiovascular disease, with as many as 80 per cent of patients with type-2 diabetes dying from cardiovascular complications.

This study selected 12 randomised, placebo-controlled, double-blind trials with at least three years of follow-up and evaluated lipid-lowering treatment in patients with and without type-2 diabetes. Primary outcomes were a composite of major coronary events including death and non-fatal MI. The studies incorporated patients with and without previous coronary artery disease.

In primary prevention, the risk reduction for major coronary events with therapy was 21 per cent in diabetics and 23 per cent in non-diabetics.

Both results were significant. The results were similar for secondary prevention of coronary events.

Lipid-lowering therapy in diabetics works, so all such patients should be considered for it regardless of cardiovascular history.

NON-HORMONAL THERAPIES FOR MENOPAUSAL HOT FLUSHES

JAMA 2006; 295: 2,057-76

Hot flushes are the most common menopausal symptom. Concern regarding the side-effects of oestrogens and other hormones has led to demand for other treatments.

This review selected 43 randomised, double-blind, placebo-controlled trials. The number of daily hot flushes decreased significantly compared with placebo in seven trials involving antidepressants (SSRIs and SNRIs), four trials of clonidine and two trials of gabapentin. There was no reduction in frequency in trials of red clover isoflavone or soy isoflavone extracts.

The authors conclude that these treatments work, but less well than oestrogens. The poor methodological quality of many of these trials limits the results.

These therapies may well be worth trying in women with disabling symptoms who cannot take oestrogens.

RESPIRATORY INFECTIONS IN SCHOOL CHILDREN

Arch Dis Child 2006; 91: 391-5

This study sought to assess co-morbidity and risk factors for otitis media, tonsillopharyngitis and lower respiratory infections among 3,406 school children aged 10 years and living in Oslo in 2001. A postal questionnaire asked whether the child had suffered an episode of one of these illnesses within the previous 12 months. Risk factors for infection were also sought.

Logistic regression analysis was performed. Predictably, airway infections were found to be a common problem in these children. Interestingly, home dampness was a risk factor for all infections and atopic disease was a constitutional risk factor that was particularly strong for lower airway infections. African or Asian ethnicities were also associated with airway infections.

DEPRESSIVE SYMPTOMS AFTER ACUTE MI

Arch Intern Med 2006; 166: 876-83

Depression is common among patients hospitalised with acute MI. This US-based study looked at 2,498 hospitalised patients with acute MI, of whom 1,284 were under 60 years of age.

The patients were assessed for depression at the time of hospitalisation using a standardised patient health questionnaire.

It was found that younger patients (under 60 years) had higher mean scores than older patients (over 60). Women had higher scores on the questionnaire than men. Both results were statistically significant. When stratified by age and sex, the younger women had the highest scores. The prevalence of depression was 40 per cent in women of 60 years or younger and 21 per cent in women older than 60.

Pre-existing depression predating the acute MI might have influenced these results.

- Dr Croton is a GP registrar in Northumberland and a member of our team who regularly review the journals.

RESEARCH OF THE WEEK

Factors in post-traumatic stress disorder

Br J Gen Pract 2006; 56: 349-54

Almost 50 per cent of people in the general population will experience a traumatic event.

The risk of developing post traumatic stress disorder (PTSD) increases with the type and frequency of trauma.

This single-centre Spanish study selected patients who had experienced at least one traumatic event from a random sample attending a primary care clinic. The type and frequency of the traumatic event was ascertained and patients suffering from PTSD were compared with those who were not.

The diagnosis of PTSD and any co-existent personality disorder in the patients was ascertained using validated interview scores.

Female sex, multiplicity and type of traumatic event, the presence of dissociative symptoms following the event and personality disorder were significantly associated with PTSD. Experiences involving body contact (rape or sexual abuse) were more likely to be associated with PTSD.

- Lipid-lowering therapy cuts the risk of cardiovascular events in patients with type-2 diabetes.

Non-hormonal therapies effectively reduce menopausal hot flushes.

Respiratory infection risk rises among children with a history of atopy or living in damp housing.

Women under 60 are more likely to become depressed following acute MI.

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