Journals watch: Vitamin D deficiency, smoking cessation and development of dementia

A review of medical research papers selected by GPs. By Dr Suzanne Hunter

Atherosclerosis: could low vitamin D lead to plaque destabilisation (SPL)
Atherosclerosis: could low vitamin D lead to plaque destabilisation (SPL)

Vitamin D deficiency in acute coronary syndrome

Am J Cardiol 2013; 111: 324-7

It was recently found that vitamin D deficiency was a common factor in patients with acute coronary syndrome (ACS). It was hypothesised that low vitamin D could lead to plaque destabilisation and an increased risk of heart failure, and thus a higher mortality rate following ACS.

In this study from Brazil, 206 consecutive patients admitted with ACS (unstable angina, ST-elevation MI or non ST-elevation MI) had their vitamin D levels determined on admission. Those patients with a level of <10ng/ml were deemed to have a severe deficiency.

Severe deficiency was found in 10% of patients. Overall mortality of all the patients admitted was 6.8%. In the severe deficiency group, the mortality was 24%, compared with 4.9% in the remaining patients. Perhaps we should be measuring vitamin D in our high-risk patients.

Smoking cessation in pregnancy and subsequent smoking

BJOG 2013; 120: 288-96

Pregnancy offers an ideal opportunity for a woman to change her smoking behaviour, during the pregnancy and in the long term.

It is not known whether women who give up smoking during pregnancy have a lower long-term smoking rate compared with those who do not quit.

This study from Australia examined whether those who quit smoking in pregnancy were less likely to smoke in the long term, compared with those who did not quit.

The researchers found that only 16% of mothers who smoked daily before pregnancy stopped smoking when they were pregnant and only 14% decreased the number of cigarettes they smoked. Therefore, 70% did not change their behaviour.

If a woman stopped smoking during pregnancy, she was 30 times more likely not to be smoking at six months, 4.5 times more likely not to be smoking at five years and 2.5 times more likely not to be smoking at 14 years.

The decreasing ORs reflect more people quitting as they get older.

These figures demonstrate that pregnancy is an ideal time to change long-term behaviour.

Fitness levels in midlife and later development of dementia

Ann Intern Med 2013; 162-8

Currently, there are no recommended lifestyle modifications to prevent dementia, because of limitations in the available evidence.

This study used data from the Cooper Center Longitudinal Study, involving patients at the preventive medicine Cooper Clinic in Dallas, Texas, going back to 1970. The participants were healthy individuals who attended for preventive health examinations, including a treadmill test, to determine their fitness levels.

The data, recorded at an average age in the late 40s, was compared with Medicare data on dementia in later life. Follow-up was for an average of 24 years.

The fitter participants had less cardiovascular disease, diabetes, hypertension and dyslipidaemia, but even after adjusting for previous stroke, they had a significantly lower risk of dementia. The most fit had a lower hazard of all-cause dementia (HR 0.64) compared with the least fit. This cannot prove causality, but it is worth taking note of such a large study (125,700 person-years).

Coitus to expedite labour

BJOG 2013; 120: 338-45

Sexual intercourse has long been advised as a method for naturally inducing labour. There are mechanisms behind this belief - semen contains prostaglandin E2 and orgasm stimulates uterine activity.

This study from Malaysia compared two groups of women, who at 35 weeks were either advised that intercourse at term was a safe, effective, natural way to initiate labour and avoid induction (the intervention group). The control group were simply advised that intercourse is safe.

The intervention group reported more coitus, but it had no effect on delivery date or induction levels. It looks as though this is a piece of advice based on a false premise.

  • Dr Hunter is a GP in Bishop's Waltham, Hampshire, 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

CPD IMPACT: EARN MORE CREDITS

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

  • Audit patients with low vitamin D who are now on supplementation therapy to see if there is a consistent approach in the practice.
  • Meet the local midwives to discuss the research on promoting the message to quit smoking during pregnancy.
  • Discuss with a colleague how you can promote general fitness during consultations or around the surgery.

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