Debbie Rigby takes a look at the latest in research news

Fall risk and anticoagulation for atrial fibrillation in the elderly

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.

Commentary

 

Long-term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes

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 analogues –a practical guide to initiation

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.

 

Impact of an Interaction Between Clopidogrel and Selective Serotonin Reuptake Inhibitors

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.