In brief

Migraine and the risk of VTE
Researchers in Italy have assessed cardiovascular risk factors in 574 adults aged 55-94 years, including 111 patients who had a history of migraine. They found no evidence of increased atherosclerosis in the migraine patients, despite previous studies that suggested they would develop it sooner. However, the lifetime risk of VTE in those who had migraine with or without aura was 19 per cent, compared with 8 per cent in those who did not have a history of migraine. The researchers suggest that patients with a history of migraine may be more prone to coagulation disorders than those without the condition.
Schwaiger J, Kiechl S, Stockner H et al. Neurology 2008; 71: 937-43.

Lactic acidosis and metformin use
Lactic acidosis has been associated with metformin use and hypoglycaemia is a major concern when using sulphonylureas. Researchers investigated these risks using data on 50,048 patients with type-2 diabetes from the UK General Practice Research Database. Lactic acidosis was found to be rare. Incidence rates during the current use of metformin and sulphonylureas were 3.3 and 4.8 cases per 100,000 person-years, respectively. Relevant comorbidities known as risk factors for lactic acidosis were identified in all cases. Hypoglycaemia occurred in just over 4 per cent of patients and was significantly more likely in those taking sulphonylureas.
Bodmer M, Meier C, Krahenbuhl S et al. Diabetes Care 2008; doi: 10.2337/dc08-1171

Depression influences cardiac outcomes
Some symptoms of depression may be more cardiotoxic than others, research from the Netherlands suggests. Depression and clinical characteristics among 2,466 MI patients were assessed during hospitalisation and at least 2.5 years of follow up. Somatic and incident depression subtypes were associated with poor prognosis in cardiac patients; these differ from the 'typical' psychiatric depression usually characterised by cognitive and recurrent depressive symptoms. The researchers conclude it is important to distinguish between depression subtypes, because they differ in cardiotoxicity and response to treatment.
European Society of Cardiology conference September 2008.

GP hours can influence stroke care
Increasing practice opening hours could prevent more than 500 recurrent strokes a year in England, University of Oxford researchers have concluded. They assessed healthcare-seeking behaviour in 91,000 patients from nine practices in Oxfordshire from 1 April 2002 to 31 March 2006. Most patients who had a TIA or minor stroke out of hours delayed seeking healthcare until their registered practice was open. The researchers say a primary care centre open seven days a week from 8am-8pm would have offered cover to 73 patients who waited until surgery opening hours to call their GP, reducing median delay from 50.1 to 4.0 hours and increasing the number of those calling within 24 hours from 34 to 68 per cent.
Lasserson DS, Chandratheva A, Giles MF et al. BMJ 2008; 337: a1569.

Daily omega-3 reduces risk of fatal CVD
A daily dose of omega-3 fatty acids could help to reduce the risk of cardiovascular events in patients who already have chronic heart failure, research in Italy suggests. Previous research has shown that omega-3 can help to keep the heart healthy. NICE guidelines recommend 7g of omega-3 fatty acids, from two to four portions of fish, per week. This latest study involved 6,975 patients who were randomly assigned either a daily dose of 1g of omega-3 polyunsaturated fatty acids or placebo. The patients were followed up over four years, during which the primary endpoint was death or admission to hospital for cardiovascular events. Overall, the patients taking omega-3 had a 14 per cent reduction in risk of death compared to patients on placebo. This means that if 56 patients took omega-3 daily for four years, one death from cardiovascular disease would be avoided.
European Society of Cardiology conference September 2008.

Statin ineffective for heart patients
Taking rosuvastatin does not reduce the risk of cardiovascular events in heart failure patients, a study from Italy has shown. Researchers assigned 2,285 patients to receive rosuvastatin 10mg daily and 2,289 patients to placebo. At the end of the three-year study, the researchers found that 29 per cent of patients in the rosuvastatin group died from any cause, compared with 28 per cent of those in the placebo group. The results also showed that 57 per cent of patients taking rosuvastatin were admitted to hospital over the course of the study, compared with 56 per cent of those in the placebo group.
European Society of Cardiology conference September 2008.

Unmet need for primary prevention in CVD
One in three people at high risk of developing cardiovascular disease (CVD) over the next 10 years have not been diagnosed, according to a national screening project. Researchers at Oxford University conducted a CVD screening programme in 35 towns, involving 27,776 men and 43,261 women aged 18 years or more. Estimated 10-year CVD risk was calculated using the Joint British Societies' risk equation and risk categories. The results suggest that 7.9 million people have already been diagnosed with CVD or have a medically recognised risk of developing it in the next 10 years. However, a further 2.8 million men and 900,000 women at high risk have not been diagnosed. The researchers say there is a substantial unmet need for primary prevention, particularly among middle-aged men.
Neil HA, Perera R, Armitage JM et al. Int J Clin Pract 2008; 62(9): 1322-31.

Didhgeridoo could have a role in helping sleep apnoea patients
Playing the didgeridoo can improve quality of sleep in patients who have sleep apnoea, UK research suggests. According to the study, playing the instrument improved sleep quality by strengthening muscles in the throat and upper airways.
European Sleep Research Society conference, Glasgow 2008.

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