Debbie Rigby takes a look at the latest in research news
Guidelines for managing atrial fibrillation recommend systemic anticoagulation for almost all patients age 65 and older, but in practice up to 50% of older patients do not receive maintenance anticoagulation therapy. The most common reason physicians cite for withholding anticoagulation in older patients with atrial fibrillation is a perception of a high risk of falling and associated bleeding, especially intracranial haemorrhage. However, for most patients, the benefits of anticoagulation outweigh the risks.
Cleveland Clinic Journal of Medicine 2017;84(1):35-40.
A 12-week clinical model of intensive lifestyle intervention has shown sustained weight loss is associated with significantly lower HbA1C for 5 years and lowers BP for 18 months. The total cohort lost 10.8kg (−9.7%) at 12 weeks and maintained −7.3kg (−6.4%) at 5 years. Over the 5 year follow-up period, weight regain is associated with rapid deterioration of HbA1C and serum triglycerides.
BMJ Open Diabetes Research and Care 2017;5:e000259.
Glucagon-like peptide-1 (GLP-1) analogues work by mimicking the incretin system to lower glucose and increase insulin. The drug class also exerts associated non-glycaemic advantages, such as weight loss. This article discusses the mode of action of GLP-1 analogues, their use in Australia and how to use and initiate GLP-1 analogues in people with type 2 diabetes, using case studies.
Diabetes & Primary Care Australia 2017;2(1):35-9.
Clopidogrel is a pro-drug that requires activation by the cytochrome P450 (CYP) enzyme system. Patients receiving clopidogrel are often treated with selective serotonin reuptake inhibitors (SSRIs) for co-existing depression. SSRIs that inhibit the CYP2C19 enzyme have the potential to reduce the effectiveness of clopidogrel. A large cohort study has confirmed that SSRIs may reduce the effectiveness of clopidogrel, with a 12% increase in the risk of ischaemic events. This increased relative risk was more pronounced in patients aged ≥65 years.
American Journal of Cardiology 2017.