Doctor ’ s notes
HealthTalk
Dr Rik Heymans is a general practitioner in Nerja and writes on developments in the world of medicine
Heart attack risk
Infections have been found to be associated with a higher risk for heart attack - myocardial infarction ( MI ) in previous studies . A newly published study assessed rates of MI not only after systemic respiratory infections , but after routine vaccinations as well .
Vaccination against influenza , tetanus , and pneumococcus did not increase the risk for MI . However , there was a significant increase in the risk for MI in the first three days after the diagnosis of a systemic respiratory tract infection . The respective incidence ratio for stroke higher was as well . Researchers also evaluated the risk for cardiovascular events after urinary tract infections , and these infections did not seem to increase this risk to the same degree as the respiratory tract infections . Patients with laboratory-confirmed influenza were approximately six times as likely to be admitted to the hospital for acute MI in the following seven days of this influenza , compared with previous and following years when no such infections were present .
The risk was especially pronounced in older patients and was independent of influenza vaccination status , or history of previous hospitalisations for MI . There was also an indication that other forms of respiratory tract infections can similarly raise the risk for suffering a MI . The study seems to strengthen familiar public health messages about getting influenza vaccinations and taking measures to prevent the spread of respiratory viruses , especially for patients with cardiovascular risk factors . Despite such messages , vaccination rates may be low even in such high-risk groups . This stays surprising because these are people who are clearly at risk and would clearly benefit from vaccination . Furthermore , even when the effectiveness of the season ’ s influenza vaccination has been questioned , such as the current influenza season , getting some protection is better than getting no protection at all . Something to bear in mind for the next vaccination campaign : patients with heart disease don ’ t question taking aspirin , they don ’ t question taking beta-blockers , they don ’ t question taking blood pressure medications or statins . But a lot of patients question the value of getting a flu shot .
Menopause and depression
During perimenopause and early post menopause , women are at a 2- to 4-fold increased risk for clinically significant depressive symptoms . Some evidence suggests that hormone therapy may be effective to manage existing perimenopausal depression . However , no previous research has examined whether hormone therapy can prevent depressive symptoms during this period . A study has clearly found that hormone therapy can prevent the onset of symptoms of depression during the menopause transition . During a 12-month period , fewer women who used hormone replacement therapy developed symptoms of depression than those receiving matching placebos . Women who had experienced more recently some or other stressful life event showed greater benefit from receiving hormone therapy , as did those in the earlier phase of the menopause transition : during the study period , 43 women ( 25 %) developed clinically significant depression . That would be consistent with what you would expect . However , the risk was “ cut in half ” in women who received hormone therapy , it was noted . Current guidance is to consider hormone therapy for the treatment of bothersome hot flashes in women within 10 years of the onset of menopause , but not for preventive indications . The authors ’ conclusion was that more information is needed before hormone therapy should be considered for the prevention of symptoms of depression : while results of this randomized clinical trial are provocative and illustrate the potential role of these hormones in the regulation of mood , they do not , at this stage , support a change in clinical guidance for the use of HT in women traversing menopause .
Exercise for arthritis
Exercise has proven benefits for patients with arthritis , as evidenced in a systematic review . The researchers evaluated one of the most common forms of arthritis : osteoarthritis of the knee .
Researchers looked at the results from high-quality randomized controlled trials of exercise therapy among adults with knee osteoarthritis . They found that exercise had modest effects in improving both pain and function . Quality of life was improved in the exercise intervention groups overall , although to a less significant degree than pain and function . Twelve studies evaluated the efficacy of the program after the active intervention , and the positive effects on pain and function were attenuated but remained significant in the post-treatment period .
There were no major adverse events associated with the exercise programs . A minority of participants complained of knee and low back pain related to the exercise itself . Approximately 54 million Americans have arthritis . Many of these people also have common comorbidities , such as diabetes , heart disease , and obesity , for which exercise is recommended to improve disease control . However , arthritis pain can be a barrier to exercise for people with these conditions .
At the same time , exercise can decrease the pain of arthritis . The American College of Rheumatology recommends exercise as the first-line nonmedication therapy for managing osteoarthritis symptoms . One of the goals of the Healthy People 2020 initiative is to increase awareness about the benefits of exercise for people with arthritis .
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© Dr RIK HEYMANS c / Angustias 24 , Nerja . Tel : 95 252 6775