Journals watch - Cardiovascular risk, UTI and H pylori

Recent research selected for GPs by Dr Lizzie Croton

Walking more everyday may help to reduce cardiovascular risk
Walking more everyday may help to reduce cardiovascular risk

Activity, cardiovascular risk and high risk of type 2 diabetes

Lancet 2013, doi:10.1016/S0140-6736(13)62061-9

Walking an extra 2,000 steps per day appears to reduce the risk of cardiovascular events in people with impaired glucose tolerance.

This large, international, prospective study incorporated 9,306 adults with impaired glucose tolerance and either existing cardiovascular disease (CVD) or a risk factor for CVD.

They were followed up for six years and results were adjusted for confounding factors (BMI, smoking status, diet and drug use).

Every 2,000 extra steps a day at the start of the study period was associated with a 10% lower risk of cardiovascular events in subsequent years.

This was further reduced by 8% for every 2,000 steps per day increase between the start of the study and 12 months later.

Dietary fibre intake and risk of cardiovascular disease

BMJ 2013; 347: f6879

Eating more dietary fibre reduces the risk of CVD. This was the conclusion of a large systematic review and meta-analysis of 22 prospective cohort studies.

The total dietary fibre intake was inversely associated with the risk of CVD and coronary heart disease: risk ratios 0.91 per 7g per day (95% CI 0.88-0.94 and 0.87-0.94 respectively).

Effective types of fibre included insoluble fibre, cereal and vegetable fibre, and fruit fibre.

The mechanisms by which fibre reduces CHD and CVD are unclear. They may be related to the formation of gels, slowing gastric emptying, promoting satiety and the fermentation of fibre by intestinal bacteria to short-chain fatty acids, which help to reduce circulating cholesterol levels.

Treatment of childhood UTI and prevention of renal scarring

Arch Dis Child 2013; doi: 10.1136/archdischild-2013-304428

This comparison of two retrospective and prospective audits from the 1990s and the 2000s looked at children aged under eight years presenting to primary care with UTI.

Management in the 2000s was much more proactive, with earlier antibiotic treatment and earlier referral for imaging.

It was found that treating children promptly with antibiotics within three days of presentation reduces the child's risk of renal scarring.

These study results provide useful additional information to current UTI treatment guidelines, which advise prompt treatment but do not specify target times. They also highlight the usefulness of direct access renal imaging from primary care for young children with UTI.

Sequential and concomitant therapies for H pylori eradication

Gut 2014; 63: 244-9

With increasing Helicobacter pylori antimicrobial resistance, standard triple therapy regimens are achieving eradication rates of only ?80%. Non-bismuth quadruple regimens show higher eradication rates.

This study randomised 'eradication naive' patients with functional dyspepsia/peptic ulcer to sequential or concomitant quadruple therapy.

Sequential therapy consists of omeprazole (20mg per 12h) and amoxicillin (1g per 12h) for the first five days, followed by five days of omeprazole (20mg per 12h), clarithromycin (500mg per 12h) and metronidazole (500mg per 12h).

Concomitant therapy consists of the same drugs taken consistently for 10 days.

Both quadruple regimens achieved close to 90% cure rates with acceptable safety profiles and compliance. The authors propose that these results might change the first-line treatment of H pylori from standard triple to quadruple therapy.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

  • Dr Croton is a GP in Birmingham and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Add the suggestion to buy a pedometer to the practice information sheet for patients with impaired glucose tolerance and suggest that they walk an extra 2,000 steps per day to reduce their risk of CVD.
  • Design a poster for the waiting room illustrating the inverse association between dietary fibre intake and heart disease.
  • Search the records of children presenting with symptoms of UTI and positive dipstick results, and audit the time taken for them to receive antibiotics.

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