Meds are not a ‘free pass’ to start or maintain bad habits

OnMedica | February 2020 | Meds are not a ‘free pass’ to start or maintain bad habits

Healthy lifestyle habits are still vitally important after starting medicines to control blood pressure or cholesterol, doctors have warned in the latest edition of  the Journal of the American Heart Association. The research  shows that people at risk for heart disease and stroke who started taking antihypertensives or statins gained weight and took less exercise than those not on the drugs.

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The researchers reported that compared with non-initiators, BMI increased significantly more in people who initiated medication, physical activity declined, and they were significantly more likely to become obese and physically inactive. However, medication initiation was also associated with greater decline in average alcohol consumption and higher odds of quitting smoking (via OnMedica).

Read the full article from the American Heart Association 

Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study

Sheffield research: Improvements in care could save the lives of more acute bowel obstruction patients

University of Sheffield | January 2020 | Improvements in care could save the lives of more acute bowel obstruction patients

Matt Lee, an NIHR Clinical Lecturer in General Surgery at the University of Sheffield Medical School, led a National Audit of Small Bowel Obstruction in 2017. 

The study identified the key causes of delays to treatment, finding that in a little over a fifth of cases, there was a delay in providing a CT scan of the patient. In these cases, 61 per cent of patients were then subsequently delayed in being diagnosed.

This compared to just six per cent if there was no delay in diagnostic imaging. Following diagnosis, around 20 per cent of patients saw a delay to their surgery, which in all cases was either due to an operating theatre not being available, or there being no anaesthetist.

Delay in Transit, published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), reviewed 686 cases of patients aged 16 and over, in an attempt to improve the high mortality rates for the condition which are currently at around 10 per cent in cases where surgery is needed.

Lee said: “There are over 22,000 admissions for bowel obstruction in England and Wales each year, of whom 6.4 per cent will die within 90 days.

  • A study by the National Confidential Enquiry into Patient Outcome and Death has discovered “significant opportunities” to improve patient care for those with acute bowel obstruction
  • Around 6.4 per cent of patients admitted each year die within 90 days
  • The report identified recurring delays at every stage of the treatment process
  • It also found room for improvement in post discharge care
  • A new report has shared recommendations to improve the chance of survival for patients with acute bowel obstruction.

There was also found to be room for improvement in clinical care, with only 55 per cent of patients being subject to an “adequate” risk assessment, and only 38 per cent having a nutrition assessment when they were discharged.
Delay in Transit makes a series of 11 new recommendations for caring for those with acute bowel obstruction, including:

  • Undertaking a CT scan with intravenous contrast promptly to ensure timely diagnosis.
  • Undertaking a consultant review in all patients with acute bowel obstruction as soon as clinically indicated, and within 14 hours of admission at the latest
  • Measure and document the hydration status of those presenting with symptoms of acute bowel obstruction to minimise the risk of acute kidney injury
  • Ensure local policies are in place for the escalation of patients requiring surgery to enable rapid access to an operating theatre.
  • Minimise delays to diagnosis and treatment by auditing the time taken between each step in the patients’ treatment (Source: University of Sheffield)

Full news release here 

Finding a life-changing treatment for dementia

Alzheimer’s Research UK has called on government to invest in six priority research areas, which will help to deliver a life-changing treatment for dementia

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Image source: https://www.alzheimersresearchuk.org/

In their 2019 manifesto, the Conservative party pledged to launch a “Dementia Moonshot” to find a cure for dementia – doubling research funding and speeding up trials for new treatments.

Alzheimer’ Research UK are now calling for action to deliver on those commitments. In this publication, Alzheimer’s UK puts forward the steps government must take to deliver its Moonshot ambition of finding a life-changing treatment for dementia.

 

 

These are:

  1. Find ways to detect the diseases that cause dementia 10-15 years earlier, to broaden the search for new treatments and intervene with those most at risk of developing dementia.
  2. Find ways to more effectively validate novel targets in early drug development to maximise chances of successful clinical trials.
  3. Make the UK the best place to conduct clinical dementia research.
  4. Expand research infrastructure to maintain the UK’s position as a world leader in dementia research.
  5. Further our understanding of dementia risk reduction and prevention and dementia in the context of multi-morbidities.

Full document: Delivering the Dementia Moonshot: A plan to find life-changing treatments 

Pregnancy research review

This study examines the evidence base on UK pregnancy research needs and priorities and how it compares to the current funding landscape. The report indicates the NHS spends significantly less on pregnancy-related research compared with other health conditions.

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Image source: https://www.rand.org/

 

Funding for pregnancy research totalled £255 million from 2013 to 2017, or about £51 million a year. As pregnancy care costs the NHS £5.8 billion annually, this means that for every £1 spent on pregnancy care, less than 1 penny is spent on research.

The study found that this investment is much lower than for conditions such as heart disease – 7p for every £1 spent on care – and cancer – 12p for every £1.

 

The report, commissioned by the UK Clinical Research Collaboration, shows that the £255 million spent on pregnancy research accounts for about 2.4 per cent of all direct, non-industry health research.

Key Findings

  • £51m per year is invested in pregnancy research in the UK.
  • For every £1 spent on pregnancy care in the NHS, around 1p is spent on research.
  • Mental health research is the top priority for all stakeholders and is likely underfunded.
  • Other priority topics are varied, spanning stillbirth, preterm birth, inequalities, postnatal support, and safety of medications during pregnancy. The level of funding currently provided differs across the topics identified as priorities.

Full document:  Pregnancy research review | The RAND Corporation

Additional link: RAND press release

Bedtime hypertension treatment improves cardiovascular risk reduction, reports study

Hermida, R. C. et al|2019| Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial |Eur Heart J |doi: 10.3310/signal-000851

A new NIHR Signal spotlights the findings of a trial in Spain that reports that people with hypertension who took their blood pressure medications at bedtime were 45% less likely to experience a major cardiovascular outcome, such as heart attack or stroke, compared with people who took them in the morning. The large trial conducted across 40 general practices in Northern Spain assigned 19,084 adults to take their blood pressure medications either in the morning or at night. Over an average of six years, there was a clear, reduced risk for the combined outcome, with similar risk reductions for each event. The effect seemed to be mediated by the improved night-time blood pressure control, which supports previous theories on the topic.

 

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It may still be preferable to take diuretics in the morning, but for most blood pressure medications, this could be a potentially beneficial change (Source: NIHR Signal).

Aims: The Hygia Chronotherapy Trial, conducted within the clinical primary care setting, was designed to test whether bedtime in comparison to usual upon awakening hypertension therapy exerts better cardiovascular disease (CVD) risk reduction.
Methods and results: In this multicentre, controlled, prospective endpoint trial, 19 084 hypertensive patients (10 614 men/8470 women, 60.5 +/- 13.7 years of age) were assigned (1:1) to ingest the entire daily dose of >/=1 hypertension medications at bedtime (n = 9552) or all of them upon awakening (n = 9532). At inclusion and at every scheduled clinic visit (at least annually) throughout follow-up, ambulatory blood pressure (ABP) monitoring was performed for 48 h. During the 6.3-year median patient follow-up, 1752 participants experienced the primary CVD outcome (CVD death, myocardial infarction, coronary revascularization, heart failure, or stroke). Patients of the bedtime, compared with the upon-waking, treatment-time regimen showed significantly lower hazard ratio-adjusted for significant influential characteristics of age, sex, type 2 diabetes, chronic kidney disease, smoking, HDL cholesterol, asleep systolic blood pressure (BP) mean, sleep-time relative systolic BP decline, and previous CVD event-of the primary CVD outcome 0.55 and each of its single components, i.e. CVD death, myocardial infarction, coronary revascularization, heart failure, and stroke.
Conclusion: Routine ingestion by hypertensive patients of >/=1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e.
Full artilce available from European Heart Journal 

Leeds research could revolutionise vaccine development

University of Leeds | December  2019 |Leeds research could revolutionise vaccine development

A new approach to the polio vaccine has been developed by scientists at the University of Leeds, unlike traditional vaccines this approach uses harmless proteins called virus-like proteins (VLPs) rather than a live virus. The VLPs are created in the laboratory to imitate effects of a virus on the immune system. But they do not carry genetic material and are not infectious. 

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Over the next couple of months, scientists will investigate the yield and quality of vaccine produced with the aim of  developing a production process that can be used by low-to-middle income countries.

The vaccine development programme has been led by Professors Nicola Stonehouse and Dave Rowlands from Leeds’ Faculty of Biological Sciences (Source: University of Leeds).

Full details are available in the University of Leeds press release 

 

 

Cancer survivors have raised heart risk, reports a US population-based study of cardiovascular disease mortality risk patients with cancer

Sturgeon, K.M , et al | 2019| A population-based study of cardiovascular disease mortality risk in US cancer patients| European Heart Journal| ehz766| https://doi.org/10.1093/eurheartj/ehz766

The European Heart Journal has published research that looked at three million US patients, across 28  types of  cancers, over a period of  40 years, the experts behind this analysis found that more than one-tenth of patients died from cardiovascular diseases. The research highlights the incidence of cardiovascular disease (CVD)  in patients diagnosed with breast, prostate, or bladder cancer.  The team also observed that from the point of cancer diagnosis onward patients with cancer (all sites) are at elevated risk of dying from CVDs compared to the general US population (Source: Sturgeon, et al. 2019).

 

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The journal article is available in full from The European Heart Journal

Abstract

Aims

 

This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis.

 

Methods and results

The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3 234 256 US cancer survivors (1973–2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1 228 328 patients (38.0%) died from cancer and 365 689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at less than 35 years of age. Further, CVD mortality risk is highest within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population.

Conclusion

The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.

 

In the news:

BBC News Cancer survivors ‘have higher heart risk’