The number of peer-reviewed papers covering the vast field of preventive medicine is huge, to such an extent that it is frequently difficult for healthcare professionals to keep up with the literature. As a special service to our readers, IHE presents a few key literature abstracts from the clinical and scientific literature chosen by our editorial board as being particularly worthy of attention.
Diabetes and cardiovascular disease prevention in older adults.
Cigolle CT et al. Clin Geriatr Med 2009; 25(4): 607-41.
Cardiovascular disease is the major cause of death as well as a leading cause of disability and impaired quality of life in older adults with diabetes. Therefore, preventing cardiovascular events in this population is an important goal of care. Available evidence supports the use of lipid-lowering agents and treatment of hypertension as effective measures to reduce cardiovascular risk in older adults with diabetes. Glucose control, smoking cessation, weight control, regular physical activity and a prudent diet are also recommended, although data supporting the efficacy of these interventions are limited. While reducing cardiovascular morbidity and mortality remains a primary objective of preventive cardiology in older adults with diabetes, the impact of these interventions on functional well-being, cognition, and other geriatric syndromes requires further study.
Secondary prevention of stroke.
MacDougall NJ et al. Expert Rev Cardiovasc Ther 2009;7(9):1103-15.
Stroke and transient ischaemic attacks result from a range of mechanisms. Secondary prevention includes both conventional approaches to vascular risk-factor management (blood pressure lowering, cholesterol reduction with statins, smoking cessation and antiplatelet therapy) and more specific interventions, such as carotid endarterectomy or anticoagulation for atrial fibrillation. The relative importance of even conventional risk factors in stroke differs from coronary artery disease. Large clinical trials produce information on most aspects of stroke prevention. Stroke and transient ischaemic attacks are now recognised as medical emergencies, with a high early risk of recurrence, and evidence is accumulating to support the importance of immediate institution of secondary preventative treatments. This article reviews current literature on the secondary prevention of stroke.
A practical approach to the prevention of miscarriage: progesterone therapy.
Check JH. Clin Exp Obstet Gynecol. 2009;36(4):203-8.
Vaginal progesterone therapy was evaluated in women with a previous history of miscarriage or in women with infertility related to luteal phase defects. The results indicate that using progesterone to diminish the risk of miscarriage is beneficial. Other methods of stimulating progesterone production, e.g., human chorionic injections, are also effective. Progesterone therapy, especially when given vaginally, has few side-effects and is safe. Thus the evidence suggests that one should err on the side of over-treatment rather than under-treatment in certain circumstances, e.g., advanced woman’s age, previous history of miscarriage, or the use of follicle maturing drugs.
The role of modifiable pre-pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes.
Inkster ME et al. Acta Obstet Gynecol Scand. 2009; 88(10):1153-7.
The authors of this paper investigated the foetal outcomes of pregnancy in women with pre-existing diabetes in relation to pre-pregnancy risk factors using a community-based cohort of women in Tayside, Scotland. There were 211 pregnancies in 132 women with insulin-requiring type 1 and 2 diabetes between January 1993 and December 2005. Adverse fetal outcome was classified as spontaneous miscarriage, termination for medical reasons, stillbirth, neonatal death or congenital malformation, and occurred in 61 (29%) pregnancies. Mothers with poor glycaemic control pre-conceptually and at booking had almost a three-fold increase in adverse fetal outcome compared with mothers having fair control. Mothers who were still smoking at the booking visit had a two-fold increase in adverse foetal outcome. Further improvement in the management of diabetes and pregnancy is needed through enhanced preconception services addressing the full spectrum of modifiable risk factors.
Long-term cervical cancer prevention strategies across the globe.
Cuzick J. Gynecol Oncol. 2010 Feb 1.
Worldwide, there are several approaches for the prevention of cervical cancer, and in the near future it is likely that human papillomavirus (HPV) vaccination and HPV-based screening will be complementary strategies. In the US, professional guidelines on HPV screening recommend a co-testing approach utilising HPV DNA testing and cytology in women aged >/=30 years. However, a growing body of evidence indicates that HPV testing is more sensitive than cytology, suggesting that HPV DNA testing may be more useful as the sole primary screening modality, especially for newly implemented programmes. HPV vaccination programmes targeted at young girls have been widely implemented in several developed countries, and currently available data confirm the long-term efficacy of the VLP-based vaccines against HPV-related disease over periods of up to eight years. If these HPV vaccines continue to demonstrate sustained and durable efficacy, less frequent screening may become a reality, but screening will continue to play an important role in providing protection for disease caused by types not included in these vaccines. However, a significant HPV vaccination-induced reduction in cervical cancer burden is not likely to be realised for at least 10 to 15 years.
Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors.
Cade WT et al. HIV Med. 2010 Jan 5.
People living with HIV infection are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV infection are high priorities. This prospective, randomised, controlled study evaluated whether a yoga lifestyle intervention improves CVD risk factors, virological or immunological status, or quality of life (QOL) in HIV-infected adults relative to standard of care treatment in a matched control group. Sixty HIV-infected adults with mild-moderate CVD risk were assigned to 20 weeks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were 2-h oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4 T-cell count and plasma HIV RNA. Resting systolic and diastolic blood pressures improved more (P< 0.04) in the yoga group than in the standard of care group. However, there was no significant difference in body weight, fat mass, proatherogenic lipids, glucose tolerance or overall QOL. Immune and virological status was not adversely affected. Yoga is a low-cost, simple to administer, nonpharmacological, popular behavioural intervention that can lower blood pressure in pre-hypertensive HIV-infected adults with mild-moderate CVD risk factors.
