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Practices failing to target warfarin therapy at those who need it most

Celecoxib may increase CV risk

The cox-2 inhibitor celecoxib may increase the risk of cardiovascular events, a study suggests. Researchers analysed cardiovascular events among 2,035 patients with a history of colorectal cancer, who were enrolled in a trial of 200mg or 400mg celecoxib twice daily for the prevention of colorectal adenomas.

Patients on 200mg celecoxib twice daily were 2.3 times as likely to suffer an event as those on placebo. Patients on 400mg twice daily were at 3.4 times the risk on placebo.

News of the study first emerged late last year and prompted new advice on the use of cox-2s.

New England Journal of Medicine 2005

early online publication February 15

Air pollution contributes to stroke

Reducing air pollution could help cut the risk of stroke, according to a UK study.

University of Sheffield researchers matched the number of strokes in 1,030 census enumeration districts with modelling data on air pollution.

Stroke mortality in patients over 45 was 37 per cent higher in areas with the highest levels of nitrogen oxide than in areas with the lowest levels and 26 per cent higher in areas with the greatest levels of carbon monoxide. Researchers estimated that 13 per cent of hospital admissions for stroke were related to nitrogen oxide and 11 per cent to carbon monoxide.

Stroke 2005;36:239-243

ACE inhibitors cut pneumonia risk

ACE inhibitors appear to substantially reduce the risk of pneumonia in elderly patients recovering from stroke, Japanese research suggests.

The study examined 1,190 stroke and hypertension patients, of whom 430 were on ACE inhibitors, 409 on calcium channel blockers and 351 on diuretics. It compared their pneumonia rates with those of 160 stroke patients not being treated for hypertension.

After 35 months, pneumonia was diagnosed in 2.8 per cent of the ACE inhibitor group compared with 8.8 per cent of controls. Results for calcium channel blockers and diuretics did not differ significantly from controls.

Neurology 2005;64:573-574

Less Parkinson's in active men

Men who exercise regularly early in their adult life have a reduced risk of developing Parkinson's disease, a US study finds.

Researchers from the Harvard School of Public Health in the US followed 48,000 men and 77,000 women who were free of Parkinson's disease, cancer or stroke, from 1986 every two years through to 2000.

Men who were most physically active at the start of the study had a 50 per cent lower risk of developing Parkinson's disease than those who were least active. In women strenuous physical activity appeared to lower risk, but the reduction was not statistically significant.

Neurology 2005; 64: 664

Cardiac rehab cuts admissions

Cardiac rehabilitation is effective for reducing hospital admissions in elderly patients with heart failure, a UK study shows.

Researchers studied 200 patients aged 60 to 89 with heart failure. Some received standard care, while interventions for the experimental group included exercise prescription, education, dietetics, occupational therapy and psychosocial counselling. The experimental group had fewer admissions and spent fewer days in hospital.

European Journal of Heart Failure 2005 March 16;7(3):411-7

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