Journals Watch: CVD, smoking and head injury

Too busy to read all the journals? Let Dr Lizzie Croton bring you up to date on the latest research.

Researchers proposed an optimal CVD risk factor profile (Photograph: SPL)
Researchers proposed an optimal CVD risk factor profile (Photograph: SPL)

Lifetime risks of cardiovascular disease
N Engl J Med 2012; 366: 321-9

This was a meta-analysis using data from 18 cohort studies.

The study population was 257,384 men and women. Their risk factors for cardiovascular disease (CVD), such as BP, cholesterol level, smoking status and diabetes status, were measured at the ages of 45, 55, 65 and 75 years.

These results were then used to stratify the participants according to risk factors into five categories. The researchers then estimated the remaining lifetime risks of cardiovascular events for participants in each category.

The optimal risk factor profile for those aged 55 was total cholesterol less than 4.7mmol/L, BP less than 120mmhg systolic and 80mmhg diastolic nonsmoking status nondiabetic these individuals had substantially lower risks of death from cvd than subjects with two or more major risk factors 4 7 versus 29 among men 20-5 women this reduction was seen until the age 80.

Those with an optimal risk factor profile also had lower lifetime risks of fatal CHD or non-fatal MI and fatal and nonfatal stroke.

Depression, herpes simplex virus and sexual behaviour
Sex Transm Infect 2012; 88: 40-4

Concurrent depression has been linked to risky sexual behaviour in adolescents but there is little information about adults. This study used a cohort of 5,273 US adults between the ages of 20 and 59 years. The participants self-reported risky sexual behaviour.

Current depression was measured using the Patient Health Questionnaire-9. All participants were tested for antibodies to HSV-2, as a marker of risky sexual behaviour.

Among the study cohort, 7% had depression and 36% reported 10 or more lifetime sexual partners with 15% reporting two or more past-year sexual partners and 13% reported a first sexual experience before the age of 15.

Risky sexual behaviour was associated with depression in women but not in men. HSV-2 infection was found in 19% of the 3,940 adults aged 20-49 years and adults with HSV-2 infection were more likely to be depressed (OR 2.1 95%; CI 1.5-2.9).

The authors conclude that risky sexual behaviour is associated with depression in adult women and healthcare providers should be aware of this.

Prescriptions for smoking cessation medications
Tob Control 2012; doi:10.1136/tobaccocontrol-2011-050124

This study looked at who receives prescriptions for smoking cessation medications in UK primary care and which groups of patients are consistently failing to receive such medications. The researchers studied 282,433 patients aged 16 years or over from 419 UK general practices, who were recorded as current smokers during 2008. The outcome measure was the prescription of any type of smoking cessation medication during 2008.

Of the current smokers, 13.4% were given prescriptions for smoking cessation treatment. Women, those aged 31-60 years and people with concurrent diagnoses, such as COPD, were the groups most likely to receive treatment.

Conversely, patients with dementia, high alcohol intake, AF or chronic kidney disease were unlikely to be prescribed smoking cessation therapy.

The results suggest that there are some groups who are systematically failing to receive pharmacological support for smoking cessation in primary care.

Food fried in olive and sunflower oil and risk of CHD
BMJ 2012; 344: e363

This prospective cohort study in Spain looked at 40,757 adults aged 29-69 years and free from CHD at baseline.

The main outcome measures were CHD events (fatal or non-fatal MI or angina requiring revascularisation).

Participants were interviewed using a computerised dietary history questionnaire about food consumed in a typical week and cooking methods.

Assessment of non-dietary variables in participants included physical activity, smoking and the presence of other chronic diseases, such as diabetes, hypertension and angina.

The median follow-up period was 11 years. During this time, 606 CHD events occurred and there were 1,135 deaths from all causes.

Analysis of the results suggested that there was no statistically significant association between consumption of fried food and the risk of CHD.

The authors conclude that the consumption of fried food cooked in olive or sunflower oil does not appear to be associated with the risk of CHD.

Frying with other types of fat, re-using cooking oils or the consumption of salt-rich fried snacks may still be harmful.

Enduring symptoms after minor head injury
J Neurol Neurosurg Psychiatry 2012; 83: 217-23

Current estimates suggest that 15-30% of patients who have a mild traumatic brain injury (MTBI) are at risk of developing postconcussional syndrome (PCS).

PCS can cause symptoms that can be physical, such as headache; cognitive, such as difficulty concentrating; and emotional, such as irritability.

This study aimed to investigate the contributions of cognitive, emotional, behavioural and social factors to the development of PCS.

A prospective cohort design was used and 126 MTBI patients completed questionnaires within two weeks of the injury and 107 completed follow-up questionnaires at three and six months. The primary outcome was the ICD-10 diagnosis for PCS.

Further statistical analysis was used to detect predictors for PCS. Of the 107 MTBI patients, 24 (22%) met the criteria for PCS at three months and 22 (21%) at six months.

Negative MTBI perceptions, stress, anxiety, depression and all-or-nothing behaviour were associated with the risk of developing PCS.

All-or-nothing behaviour was the key predictor for onset of PCS at three months while negative MTBI perceptions predicted PCS at six months.

The results suggest that patients' perceptions of their head injury and their subsequent behavioural responses have important roles in the development of PCS.

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

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


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

  • Refresh your knowledge of depression screening by looking into suitable questionnaires to use in patients participating in risky sexual behaviour.
  • Perform an audit of patients receiving smoking cessation therapy in your practice versus documented smokers. Are there any groups who are not being targeted?
  • Consider incorporating the findings of the BMJ study about fried foods into a practice Healthy Heart patient information leaflet.

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