Clinical reviews

Women with a history of pre-eclampsia are three times more likely to develop vascular dementia later on, a Danish cohort study has found.

Atrial fibrillation (AF) patients with a baseline BMI = 30 kg/m² have a higher recurrence rate following catheter ablation, a  study of  an AF Ablation Long-Term Registry that included 104 centres across 27 European countries.

Compared with clopidogrel, prasugrel and, in particular ticagrelor, led to a significant reduction in risk of recurrent fatal and non-fatal myocardial infarction (MI) in patients with acute coronary syndrome (ACS), in a study from France.

Longer duration of breastfeeding appears to reduce the risk of recurrent cough in young adults, a study from the United States has found. The researchers used data from the Tucson Children’s Respiratory Study, a large non-selected birth cohort in which infant feeding practices and adult health outcomes were ascertained prospectively.

The use of sulphonylureas as a second-line substitution for metformin in type 2 diabetes is associated with increased rates of myocardial infarction (MI), all cause death and severe hypoglycaemia, a population-based cohort study has found. The study used data from the UK Clinical Practice Research Datalink (CPRD) to analyse a cohort of type 2 diabetes patients retrospectively. The CPRD contains medical records from more than 14 million patients registered at more than 680 general practices.

Sleeping for more than 8 hours a night was associated with an increased risk of mortality and poor quality sleep with an increased risk of coronary heart disease (CHD), a large meta-analysis has found.

In patients with type 1 diabetes, clinically meaningful and sustained HbA_1c improvement rarely occurs more than five years after diagnosis, a UK study has found.

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.

More than 80% of women and nearly 90% of men who reported having unsafe sex in the past year did not consult sexual health services, findings from the third National Sexual Attitudes and Lifestyles (Natsal 3) study have shown.

Active surveillance may be a suitable option in selected, particularly younger, women with CIN2, a systematic review and meta-analysis has concluded.

A general practice study has revealed a reluctance among GPs and practice nurses to fit intrauterine contraceptive devices (IUCDs). An online survey was sent to 69 practices in the south east of England and 208 individuals responded. More than two-thirds of the respondents were GPs and nearly a third were nurses. When asked about statements relating to potential barriers to providing or recommending IUCDs, respondents who were not trained to fit IUCDs were more likely to identify with more barriers than those who had been trained.

Only a quarter of patients with symptoms suggestive of heart failure are investigated and referred by GPs in accordance with NICE guidelines, a UK study has shown. Nearly 80% of heart failure patients were diagnosed in hospital. The investigators, from Imperial College, London, extracted data on patients diagnosed with heart failure between 1 January 2010 and 31 March 2013, using the Clinical Practice Research Datalink. This database contains electronic records from 7% of general practices in England.

 Lactobacillus iners-dominated vaginal microbiota was associated with increased susceptibility to Chlamydia trachomatis infection in women, in a Dutch nested case-control study.

Two years of high intensity exercise training, in previously sedentary healthy middle-aged adults, improved maximal oxygen uptake (VO2max) and reduced left ventricular (LV) stiffness, in a study from the United States. The investigators conclude that regular exercise training may protect against the future risk of heart failure with a preserved ejection fraction (HFpEF) by preventing the increase in cardiac stiffness caused by sedentary aging.

Administering a drink of sodium bicarbonate dissolved in water to women with dystocia an hour before oxytocin treatment resulted in better outcomes for both mother and child, compared with standard oxytocin treatment alone, a small trial from Sweden has found.