Clinical reviews

A high resting heart rate and an increase in resting heart rate over a decade are associated with a greater risk of death from cancer and other causes as well as cardiovascular disease (CVD), a study from Australia has found.

The use of a nicotine patch before quitting may have a modest effect on abstinence, a large pragmatic randomised trial has found. A total of 1,792 adults were enrolled from Nottingham, Birmingham, Bristol, and London. All were daily smokers with tobacco dependence. The investigators concluded: ‘Nicotine preloading with a 21 mg/24 hr nicotine patch for four weeks seems to be efficacious, safe, and well tolerated, but probably deters the use of varenicline, the most effective smoking cessation drug. If it were possible to overcome this unintended consequence, preloading could lead to a worthwhile increase in long term smoking abstinence.’

Onset of type 2 diabetes at a younger age is associated with increased mortality, mainly from earlier death from cardiovascular disease (CVD), a study from Australia has found.

A multicentre pragmatic randomised trial of the clinical effects of emollient bath additives (EBAs) in children with eczema has concluded that their benefits are at best limited.

The number of years that an individual has been smoking is closely linked to the degree of structural lung disease, airflow obstruction and functional outcomes in chronic obstructive pulmonary disease (COPD). It is a better measure than pack-years or the number of cigarettes smoked per day, a large study from the USA has shown.

Low levels of C-peptide were associated with greater glucose variability and hypoglycaemia in type 2 diabetes patients on insulin,a UK study has found.

A temporary four-fold increase in inhaled steroids for deteriorating asthma control reduced the incidence of severe exacerbations, in a UK study.

Opioid prescribing rates are increasing and show notable geographical variations across England. They are highest in the North and in areas of social deprivation, a study on primary care prescribing has shown. Virtually all the low prescribing areas were in the south of England and nine of the ten highest prescribing areas were northern clinical commissioning groups (CCGs).

Patients with lung cancer who stop smoking have lower all cause mortality rates compared with those who continue to smoke, a UK retrospective cohort study has found.

The risk of ovarian cancer is increased in women with endometriosis, a large cohort study from Scotland has shown. The study also found that women with endometriosis are likely to undergo more surgical procedures compared with women who do not have the condition.

Overestimation of risk of bleeding leads to underuse of oral anticoagulants in frail elderly heart failure patients with atrial fibrillation (AF) despite their increased risk of stroke, a study in Heart has concluded.

Pregnant women who went to sleep in a supine position had a two-fold increased risk of late stillbirth, a UK study has shown.

Lower vaginal swabs taken by patients are as reliable as high vaginal swabs taken by clinicians for the detection of vulvovaginal candidiasis or bacterial vaginosis, a UK study has shown.

Intensive antiplatelet therapy with three agents did not reduce the incidence and severity of recurrent stroke or transient ischaemic attack (TIA) but did significantly increase the risk of major bleeding in the TARDIS study.

Patients with non-diabetic hyperglycaemia referred by their GP to a Weight Watchers diabetes prevention programme had a significantly reduced risk of developing diabetes, a UK study has found.

Current guidelines advise treating paroxysmal AF in the same way as sustained AF but the evidence is weak, with only one retrospective analysis comparing the risk of stroke in patients with paroxysmal AF vs chronic AF (analysis of the SPAF trials, performed 15 years ago and limited to patients treated with aspirin). The ACTIVE W trial showed that warfarin is more effective than aspirin plus clopidogrel for the prevention of vascular events (stroke, embolism, MI and vascular death) in patients with AF. A recent substudy of this trial looked at the risk of stroke in 1,202 patients with paroxysmal AF compared with 5,495 with sustained AF, and the effectiveness of thromboprophylaxis in these patients. ' This substudy has shown that the risk of stroke is similar, irrespective of whether AF is paroxysmal or sustained, and that anticoagulation therapy is equally effective in both groups. Other factors, such as age and cardiovascular comorbidity, remain central to the ultimate choice of thromboprophylaxis in these patients.'