Journals watch - CHD, heart failure and depression

No time to read the journals? Allow Dr Louise Newson to be your guide to the latest findings.

ANOTHER RISK FACTOR FOR CHD

BMJ 2006; 332: 1,426-9

It is well known that patients with renal disease have a higher risk of cardiovascular disease (CVD). This study assessed whether patients with proteinuria and low GFR have a higher mortality.

Perhaps unsurprisingly, the results showed that both were associated with a high risk of mortality and the risk associated with both conditions was additive.

The big unanswered question is whether or not reducing this proteinuria with medication such as ACE inhibitors leads to a reduction in CVD. In the future we may all be advised to use dipstick testing of urine as part of our regular assessment of hypertensive patients.

IMPROVED OUTCOMES HEART FAILURE

Eur Heart J 2006; 27: 1,447-58

More treatments are still needed to improve clinical outcomes in patients with heart failure. The CHARM study has previously shown that the addition of the angiotensin II receptor blocker (ARB) candesartan to standard heart failure medication reduces both morbidity and mortality in patients.

This study has shown that adding candesartan is also very cost-effective as hospital admissions are significantly reduced. It might well be that ARBs are used for most of our heart failure patients in the near future.

CHD NOT LINKED TO PERSONALITY

Ann Intern Med 2006; 144: 822-31

It has always been presumed that people with type-A personality traits have a higher risk of CHD. This appears to not be so, according to a US study.

More than 6,500 people of different ethnic backgrounds and with no history of clinical CHD had their coronary calcium assessed by CT scans. Coronary calcium levels are used to predict cardiovascular events in previously asymptomatic people. The researchers also looked at four psychosocial factors - depressive symptoms, anger, anxiety and chronic stress - which were assessed via a questionnaire with validated scales.

The study found that coronary calcium was not associated with any of the classical type-A patterns of behaviour.

DEPRESSION IN DIABETIC CHILDREN

Diabetes Care 2006; 29: 1,389-91

Depression is very common in most chronic diseases. This US study of 145 young people and their parents has shown that depressive symptoms are very common in both children and adolescents with type-1 diabetes. The incidence of depression was high - 15 per cent - and those with depression had higher HbA1c levels. If we have a lower threshold for screening for depression in these patients, then effective treatment might well help their diabetes control.

THE RISKS OF FOOTBALL

BMJ 2006; 332: 1,376-8

I wonder if the England football team are aware that footballers can also suffer from toxic shock syndrome (TSS)?

This paper from Birmingham describes two cases of TSS in children who developed friction blisters over the area of calcaneal insertion of the Achilles tendon from wearing new football boots. Both blisters contained Staphylococcus aureus.

One was a 13-year-old girl playing competitive football who developed an erythematous coalescent rash over her trunk, back and limbs the day after the game. The other was an 11-year-old boy who developed the generalised rash two days after a game. Both children made a full recovery.

It is worth noting that TSS is, however, very rare in children.

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

INFORMING PATIENTS

Renal disease increases the risk of CHD.

Heart failure mortality is reduced by adding the ARB candesartan to treatment.

Type-A personality is not linked to CHD.

Diabetic control in children might be improved by treating symptoms of depression.

Friction blisters from football boots can cause TSS.

RESEARCH OF THE WEEK

Is 24-hour BP monitoring a waste of time?

Am J Hypertens 2006; 19: 468-76

Twenty-four hour BP monitoring is possibly a waste of time. Many of us are still confused as to whether we should be performing 24-hour monitoring on some of our patients with hypertension. Most patients do not like the procedure and it is often very time-consuming to set up.

This study is therefore reassuring as it has shown that BP taken at home gives very similar results to 24-hour ambulatory BP monitoring. Obviously it is important that validated automated devices are used by patients at home.

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