Clinical reviews

Both high levels of alcohol consumption and abstinence raise the risk of a broad spectrum of cardiovascular disorders, a UK study has shown.

Non-major bleeding was substantially less in patients on apixaban compared with those on warfarin in the Apixaban for Reduction in Stroke and other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. 

Stopping concurrent benzodiazepine and opioid prescribing could reduce the risk of inpatient admissions for opioid overdose and attendance at emergency departments by 15%, a study from the US has found.

Stress echocardiography is a safe and effective first-line test for suspected coronary artery disease in patients over 80, a UK study, published in Heart, has found.

Around 60% of people living with HIV would choose GP care in preference to an HIV clinic, a UK study has found.

Antepartum stillbirth is a complex syndrome associated with a range of risk factors, a prospective observational study has concluded.

A third of patients with mild cognitive impairment also suffer from depression, a meta-analysis has found.

Sexually transmitted infection (STI) rates are increasing in the over 45 age group. However, feelings of guilt, embarrassment about age and stigma attached to STIs may deter middle-aged people from consulting sexual health services, a UK study has found.

A large cohort study has found that lower systolic blood pressure (BP) is associated with reduced cardiovascular risk in type 2 diabetes patients with no previous cardiovascular disease (CVD). However, there was evidence of a J-shaped relationship between systolic BP and heart failure, and also all cause mortality.

Women who use hormonal contraception are more likely to become depressed, a large Danish prospective cohort study has found. The cohort comprised all adolescents and women aged between 15 and 34 who were resident in Denmark and without a previous history of depression, antidepressant use, other major psychiatric diagnosis, cancer, venous thrombosis or infertility treatment. Data were obtained from national registers of dispensed prescriptions and secondary care psychiatric diagnoses.

Providing teenage girls with an infant simulator doll for a few days appeared to increase rather than decrease the risk of pregnancy, in a study from Western Australia.

The traditional gender difference in alcohol misuse and alcohol-related harm, where men have been at much higher risk than women is changing, a recent study has confirmed.

Cancer patients have an increased risk of developing common mental health disorders from 10 months prior to their cancer diagnosis, with a peak incidence during the first week after diagnosis,a Swedish 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.'