In brief

Happy countries have fewer BP problems
A BP-based happiness league of 15 European countries has been devised by economists, with Germany and Portugal at the bottom. Some 15,000 people were interviewed about all aspects of their lives, including hypertension problems and their level of satisfaction with life. Happy countries were found to have fewer BP problems, and the league was topped by Sweden, followed by Denmark and the UK. Oswald AJ, Blanchflower DG. NBER Working Paper No 12934; Feb 2007

SIGN launches five heart guidelines
The Scottish Intercollegiate Guidelines Network (SIGN) believes more than 7,000 deaths and 27,000 cardiovascular events can be avoided over the next five years through modernisation of CVD prevention and treatment. It has published five new clinical guidelines, covering prevention and risk assessment, arrhythmias, acute coronary syndromes, heart failure and stable angina. Two of the key recommendations on prevention are that everybody in Scotland aged over 40 should have their CVD risk assessed at least every five years, and those with a 10-year CVD risk of at least 20 per cent should be considered for treatment with 40mg per day simvastatin.

Progress on CHD in England
Six years after the launch of the NSF for CHD, a DoH report has concluded that improvements in CHD services are continuing. It highlights a 35.9 per cent fall in premature deaths due to CVD since 1996 and estimates that the number of lives saved as a result of statin therapy has tripled since 2000. The report also notes that there has been a 28 per cent reduction in the gap between the worst areas for premature CVD death and the rest of the country.
DoH. Shaping the future: progress report for 2006. Jan 2007

Progress on diabetes
Two reports have assessed the state of the nation in terms of diabetes management, some four to five years after publication of the diabetes NSF. The DoH analysis concludes that diagnosis has improved, but further effort must be concentrated on the provision of care. Diabetes UK also notes that some services, such as retinal screening, are improving, but many gaps remain, especially in relation to the care of children with diabetes. It also says guidance is needed on targeted screening for diabetes.
DoH. The way ahead: the local challenge. March 2007.
Diabetes UK. Diabetes: state of the nations 2006. Jan 2007

Diabetes: the prognosis
Diabetes is likely to be a greater burden than has been predicted if other areas mirror the trend seen in Ontario, Canada. The WHO has predicted that global diabetes prevalence will rise by 39 per cent between 2000 and 2030, equivalent to a 60 per cent increase since 1995. However, data from a validated diabetes database in Ontario showed that prevalence increased 69 per cent between 1995 and 2005. Although prevalence remained higher among patients aged 50 years or more, it increased to a greater extent in those aged 20 to 49 years.
Lipscombe LL, Hux JE. Lancet 2007; 369: 750-6

Antihypertensive drugs and incident diabetes
Angiotensin receptor blockers (ARBs) and ACE inhibitors are the antihypertensive drugs least likely to result in incident diabetes, a meta-analysis has found. A systematic review identified 22 trials involving 143,153 patients free of diabetes at randomisation. The researchers ranked the drugs according to their association with incident diabetes from lowest to highest: ARBs (OR = 0.57), ACE inhibitors (0.67), calcium-channel blockers (0.75), placebo (0.77), beta-blockers (0.90), diuretics.
Elliott WJ, Meyer M. Lancet 2007; 369: 201-7

Prescribing to save money
Switching to more cost-effective cholesterol-lowering drugs and antihypertensives could save the NHS £1 billion over the next five years without compromising clinical care, UK researchers have estimated.
No adverse events were reported by the 70 patients who were switched from low-dose atorvastatin to generic simvastatin after careful screening, or the 115 switched from losartan to candesartan. The practice involved in the study saved £26,000, just under 2 per cent of its annual drug budget.
Figures from the DoH Better care, better value indicators for the second quarter of 2006 show that if every PCT prescribed generic pravastatin and simvastatin in 69 per cent of patients – the level achieved by top trusts – more than £84.7 million could be saved annually.
Usher-Smith JA, Ramsbottom T, Pearmain H, Kirby M. Int J Clin Pract 2007; 61: 15-23.
DoH. Better care, better value indicators.

Social deprivation and statin prescribing
Statin prescribing is higher in more deprived communities, according to a cross-sectional survey of general practices in England. The study also found an independent association between statin prescribing and success at achieving cholesterol targets in secondary prevention. However, the findings suggested statins were being underprescribed to elderly patients and possibly also ethnic minorities.
Ashworth M, Lloyd D, Smith RS et al. J Public Health 2007 29: 40-7

Obesity protects against suicide
Overweight and obese men are less likely to commit suicide than those of normal weight, according to a US study. It followed up 46,755 men enrolled in the Health Professionals Follow-up Study for 16 years from 1986 to 2003 or until death. Of this group, a further 1,829 subjects had their mental health related quality of life recorded. A total of 131 men died from suicide and the risk was found to be inversely related to BMI; men with a BMI <21kg/m2 had a suicide mortality rate of 52 per 100,000, while those with a BMI M30kg/m2 had a suicide mortality rate of 13 per 100,000 (95% CI, 0.84–0.95; p<0.001).
Height and physical activity levels were not found to be related to suicide risk. The authors of the study conclude that further research is needed to provide insights into effective methods of suicide prevention.
Mukamal KJ, Kawachi I, Miller M, Rimm EB. Arch Intern Med 2007; 167(5): 468-75.

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