Journals Watch - Heart failure and contraception

Not had the time to read the journals? Let Dr Gwen Lewis bring you up to date on the latest research.

CT-PET scan of a patient with heart failure; overweight type-2 diabetics were not at greater risk of death (Photograph: SPL)

Weight issues for heart failure in type-2 diabetics
Am J Med 2011; 124: 834-40

It is already known that type-2 diabetes is an important risk factor for heart failure. But does the weight of a patient with diabetes have any impact on prognosis after hospitalisation for heart failure?

This US study looked at all-cause mortality in relation to weight in patients with type-2 diabetes hospitalised for heart failure between 1995 and 2000.

Of the 1,644 patients included, 65% were overweight or obese (BMI >25kg/m2) and 3% were underweight. Underweight patients had 50% increased risk of all-cause mortality after admission compared with normal weight patients. Patients with BMI 30-35kg/m2 and those with BMI 35-40kg/m2 had 20% and 40% lower odds of dying, respectively. Those with BMI 25-30kg/m2 and >40kg/m2 had no increased risk of mortality.

Effect of manual lymph drainage on lymphoedema
BMJ 2011; 343: d5326

This Belgian study sought to determine the effect of manual lymph drainage on the development of lymphoedema in 160 consecutive patients with breast cancer and unilateral axillary lymph node dissection.

Patients were randomised to one of two groups; the intervention group followed guidelines on prevention of lymphoedema, undertaking exercise therapy and manual lymph drainage, while the control group performed the same programme but without manual lymph drainage.

Twelve months after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention group (24%) and the control group (19%). In addition, the time taken to develop arm lymphoedema was similar in both groups.

This study shows that manual lymph drainage in addition to guidelines and exercise therapy after surgery for breast cancer is unlikely to have a positive effect and lymphoedema is just as likely to occur.

Effect of shift work on pregnancy outcome
BJOG 2011; doi: 10.1111/j.1471-0528.2011.03066x

It has been suspected that varying work schedules increase the risks for pregnant women. Two previous meta-analyses have reported a small adverse effect of shift work on the risk of preterm delivery.

The authors of this meta-analysis included a total of 23 relevant studies. Pooled estimates of relative risk were calculated in random-effect meta-analyses.

It was found that the pooled relative risk for preterm delivery was 1.16, but when five reports of poor methodological quality were excluded, this relative risk diminished to 1.03.

Relative risk for low birthweight was 1.27 and for small for gestational age, 1.12. The authors concluded that any increased risk of preterm delivery, low birthweight and small for gestational age with shift work is small.

Is chocolate good for your cardiovascular system?
BMJ 2011; 343: d4488

This systematic review and meta-analysis looked at the association between chocolate consumption and development of cardiometabolic disorders, involving seven studies and more than 114,000 participants.

Large variations in measurement of chocolate consumption, methods of study and outcomes were observed among the seven studies. Five of the studies reported a beneficial association between levels of chocolate consumption and cardiometabolic disorders.

The highest levels of chocolate consumption were associated with a 37% decreased risk of cardiovascular disease and a 29% decreased risk of stroke, compared with the lowest levels of consumption.

Based on these observational data, it would seem that the level of chocolate consumption is associated with a substantial reduction in risk of cardiometabolic disorders.

Hormonal contraception and type-specific HPV detection
Sex Transm Infect 2011; 87: 385-8

Increased duration of hormonal contraception use has been thought to increase the risk of invasive carcinoma of the cervix.

This US study was a secondary analysis from the HPV sentinel surveillance study in which the association between type-specific HPV detection and current hormonal contraceptive use among 7,718 women attending 26 clinics was investigated.

The researchers found an association between hormonal contraceptive use and HPV 16. The prevalence rate was 1.34 for oral contraceptive use and 1.41 for those using depot medroxyprogesterone acetate. There was no association between hormonal contraceptive use and other HPV types.

It was concluded that further studies are needed to define the clinical significance of these findings.

STI screening in New York high schools
J Adolesc Health 2011; 49: 252-7

In 2006, education, screening and treatment for chlamydia and gonorrhoea was introduced in New York public high schools. The results of this programme, including sex, race/ethnicity, age, sexual activity and screening status, were analysed, as was the relationship between STI positivity and sexual activity.

During a three-year period, 57,418 students were educated, of whom 47.6% were screened. A total of 1,736 (6.4%) tested positive for either infection.

Those participants who were screened positive were more likely to be female (8.9%), black (8.3%) and aged 16 or over. Screening rates were 70.6% for students who were sexually active, in whom positivity was 7.2%, while 47.3 per cent who did not respond to the sexual activity question were tested and of these, 6.1% were positive.

Screening programmes should be offered to all students, and should target older black teenagers.

  • Dr Lewis is a GP in Windsor, Berkshire, 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.

  • Review all of your patients with type-2 diabetes and identify how many have been hospitalised for heart failure.
  • At a clinical meeting, discuss the link between hormonal contraception use and HPV.
  • Increase awareness of STIs for teenage patients, with leaflets and posters.

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