Journals Watch - Stroke, eczema and dementia

Too busy to keep up with the journals? Let Dr Simon Hunter summarise the latest research for you

A calcium-rich childhood diet appears to have a protective effect, lowering stroke risk
A calcium-rich childhood diet appears to have a protective effect, lowering stroke risk

Childhood calcium and stroke risk Heart 2009; 95: 1600-6
High calcium intake in children is associated with a lower childhood BP, but as calcium is primarily obtained from dairy products that are high in fat, there might be a counterbalancing effect of a poorer lipid profile.

Between 1937 and 1939, 5,000 Scottish children had their diets studied in detail.

This group were tracked and the amount of childhood calcium was compared with cardiovascular disease risk.

While there was no association between calcium and heart disease, high calcium in childhood did seem to protect against stroke and childhood diets rich in dairy products and calcium had a lower overall mortality.

Hand eczema and Staphylococcus aureus Br J Derm 2009; 161: 772-7
Hand dermatitis is often a chronic condition with a poor outlook for permanent remission, which can be endogenous or an allergic contact condition. There is uncertainty as to the cause of the variability of eruption frequency and severity.

This paper looked at the relationship between hand eczema and its severity and the presence of Staphylococcus aureus.

They found S aureus was six times more likely to be found on the hands of those with hand eczema than controls and also its presence was related to the severity of the condition.

They could not say whether there was a causative relationship and did not comment on treatment, but it is worth bearing in mind that half of your patients with hand eczema will have S aureus colonising it.

Predicting cardiovascular risk in type-2 diabetics Am J Cardiol 2009; 104: 1041-6
The presence of type-2 diabetes confers a substantial increase risk of coronary artery disease, which is why we treat all patients with type-2 diabetes as if they have had an MI when it comes to CHD prevention. This study examined whether there was a way of assessing cardiovascular health.

The researchers measured the carotid artery intima-media thickness by ultrasound in type 2-diabetic patients who were around 50 years old and had no cardiovascular symptoms, and compared it to their coronary artery state as determined by non-invasive multislice CT coronary angiography.

They found a high degree of correlation between the carotid ultrasound findings and the CT angiographic findings in relation to arterial narrowing.

They postulate this could be a way of targeting preventive treatment more selectively.

Duration of dual antiplatelet therapy Heart 2009; 95: 1579-86
Current guidelines state that dual antiplatelet therapy (ie clopidogrel and aspirin) should be continued for 12 months following percutaneous coronary intervention (PCI) and then the clopidogrel stopped.

This guidance is based on the CREDO and CURE-PCI trials, which indicated that nine to 12 months of clopidogrel is better then one month's worth.

What the benefits are of continuing beyond 12 months are unclear, until now.

This study followed patients on dual therapy for three-and-a-half years and found the continuation of dual therapy for more than 12 months did not confer long-term protection from death or MI.

MMR in the media Arch Dis Child 2009; 94: 831-3
This could probably be seen as more of a moan than a study.

Using MMR as the subject, the researchers looked at the number of medical journal editorials and the flavour of them during key moments in the vaccine's history, namely its introduction in 1988, the mass immunisation campaign 'Operation Safeguard' in 1994, Wakefield's now infamous 1998 Lancet paper and Tony Blair refusing to divulge Leo's MMR status in 2001.

They found that the editorials were surprisingly absent or neutral in their approach in the two years following Wakefield, despite the general scientific agreement that MMR was safe and Wakefield's research was not robust.

The authors of this paper felt that at times of controversy such as this, medical editors should do more to steady the ship and lend leadership and reassurance to frontline practitioners, rather than holding back to see how the consensus develops.

This of course could be countered that editorials should not be for establishment propaganda, but I agree that, under the onslaught we faced over MMR from press, all and any help would have been welcome.

Migraine and stroke risk BMJ 2009; 339: b3914
This study was a meta-analysis investigating associations between migraine and cardiovascular risk.

Migraine, while being incompletely understood, is a neural condition with vascular associations such as endothelial dysfunction and hypercoagulability as well as a pathological vascular reactivity.

The authors found that while there was no real correlation between migraine and cardiovascular disease, there was a correlation with ischaemic stroke. It was only apparent with migraine with an aura and this doubled the risk of stroke.

This was predominantly in women, especially if under 45, a smoker and on the combined contraceptive Pill.

This really does confirm the recommendation that women with migraine with aura should not go on the Pill. They should also be counselled strongly about smoking.

  • Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly review the journals.

The Quick study

  • Stroke risk is reduced in patients who had a diet high in calcium in their childhood.
  • Hand eczema is likely to be colonised with S aureus.
  • Cardiovascular risk in type-2 diabetes can be estimated by carotid ultrasound.
  • Dual antiplatelet therapy is not beneficial more than 12 months post PCI.
  • Medical editorials post MMR controversy were not sufficiently supportive of the safety of the vaccine.
  • Migraines with aura in women are twice as likely to lead to an ischaemic stroke, especially if a smoker, under 45 and on the pill.

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