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Atrial fibrillation puts patients at more risk of death after first stroke
THE LANCET
SCIENCE AND MEDICINE
Atrial fibrillation puts patients at more risk of death after first stroke compared with only 14·4% of the he results of a study of nearly non-AF group. 1 year later, the mor7000 Finnish patients who had tality difference was maintained— had an ischaemic stroke show that 30·5% of the AF group had died but those with atrial fibrillation (AF) only 21·8% of the non-AF group. have a higher mortality both during At 28 days cardiac the first 28 days after causes of death were the stroke and during more than twice as the subsequent year. common in the AF AF is well known as group. After a year the a major risk factor for distributions of causes stroke but what is not of death were the same so clear is whether the in both groups. short-term and long“The results are term risk of death after hardly surprising in the their first stroke differs What will happen next? sense that AF is due to between patients with heart disease and by definition if and without AF. you’ve had a stroke with AF you’ve In the study, 6912 patients aged also got heart disease”, says Martin between 35 and 74 who had been Brown, a reader in neurology at St entered into the FINMONICA George’s Hospital, Tooting, UK. He stroke register (part of the World comments that the study might have Health Organisation Monitoring yielded more information if data Trends and Determinants in on other factors like smoking and Cardiovascular Disease Project) diabetes had been included. The between 1982 and 1992 were folshorter life expectancy at 1 year, he lowed up (Stroke 1997; 28: 311–15). says, might have been due to diabetOf these, 642 patients had AF. ics being more likely to have AF. Minna Kaarisalo (Department of “The important message to come Neurology, University of Turku, out of this paper is that to prevent Helsinki) and colleagues found that reoccurrence or subsequent myoby 28 days after their stroke, 19·5% cardial infarction among patients of the patients with AF had died, Science Photo LIbrary
T
A drink a day keeps the doctor away
M
oderate alcohol consumption may reduce peripheral arterial disease (PAD) risk in healthy men (Circulation 1997; 95: 577–80). Carlos Carmargo (Massachusetts General Hospital, Boston, USA) and co-workers documented 433 PAD cases occurring over 11 years follow-up of 21 759 Physicians Health Study participants. At the start of the study participants answered questions about alcohol consumption. After controlling for smoking, daily drinkers (88% of whom reported an intake of one drink per day) had a relative risk for PAD of 0·68 compared with the reference group (less than one drink per week). The authors stress that “The reduced PAD risk of drinkers was easily overwhelmed by smoking . . . the most important independent predictor of PAD”, and suggest that physicians and patients discuss the risks and benefits of drinking habit changes on an individual basis.
Jane Bradbury
Vol 349 • February 15, 1997
with AF, anticoagulation should be considered”, says Brown. “Such patients should also stop smoking and have their cholesterol controlled.” Janet Fricker
Stroke symptoms poorly known Worrying data on public awareness of stroke symptoms and risk factors were reported at the 22nd International Joint Conference on Stroke and Cerebral Circulation (Anaheim, USA; Feb 6–8). Rashmi Kothari and co-workers (University of Cincinnati, USA) interviewed 163 patients presenting with acute stroke symptoms. 39% of them could not identify a single warning sign for stroke, 35% could not name any risk factors. In a separate study, 27% of a general population (n=1880), agematched for the population at risk for stroke, could not identify any warning signs. The researchers called for better public education to ensure that patients get to hospital as rapidly as possible after a stroke since tissue plasminogen activator has to be given within 3 hours of symptom onset to be effective.
Increase reported in UK HIV-1 infections in 1996 he annual rate of newly diagnosed HIV-1 infections continues to rise in the UK, according to the 1996 figures from the Communicable Disease Surveillance Centre. In 1996 there were 2896 new HIV-1 infections reported, compared with 2683 in 1995, the highest annual total since reporting began in 1984. This brings the total number of reported HIV-1 infections to 28 447. The largest exposure category for HIV-1 infection remains sex between men, with reports of new HIV-1 diagnoses rising by 11%, from 1474 in 1995 to 1634 in 1996. There were 779 heterosexually acquired infections in 1996, mainly in the “exposure abroad” category, with a further 257 currently allocated to “other or investigation continuing/closed”. 1862 AIDS cases were reported in 1996, an increase of 18% over 1995 figures. The rise is attributed to the large number of late reports received by CDSC in early 1996, resulting from active follow-up of reporting doctors. The increase in newly reported
T
HIV-1 infections in 1996, particularly in gay men, may be partly attributable to more people having HIV-1 tests. Barry Evans, consultant epidemiologist, Public Health Laboratory Service HIV and STD Division, notes, “Data from the Vancouver conference showed that combination therapies are more effective, and part of the increase in 1996 may be that more people are getting diagnosed because they perceive there are better treatments for HIV”. Evans points out that, since 1991, on average about 2500 new HIV-1 infections a year have been reported in the UK. “Within the 15 214 newly diagnosed HIV-1 infections since 1991 there are likely to be significant numbers of newly acquired infections, in spite of prevention programmes, and that is the distressing fact.” He suggests that preventive measures, such as needle-exchange programmes for injecting drug users, are effective but stresses that “efforts must be kept up”. Kelly Morris
479
SCIENCE AND MEDICINE
Atrial fibrillation puts patients at more risk of death after first stroke compared with only 14·4% of the he results of a study of nearly non-AF group. 1 year later, the mor7000 Finnish patients who had tality difference was maintained— had an ischaemic stroke show that 30·5% of the AF group had died but those with atrial fibrillation (AF) only 21·8% of the non-AF group. have a higher mortality both during At 28 days cardiac the first 28 days after causes of death were the stroke and during more than twice as the subsequent year. common in the AF AF is well known as group. After a year the a major risk factor for distributions of causes stroke but what is not of death were the same so clear is whether the in both groups. short-term and long“The results are term risk of death after hardly surprising in the their first stroke differs What will happen next? sense that AF is due to between patients with heart disease and by definition if and without AF. you’ve had a stroke with AF you’ve In the study, 6912 patients aged also got heart disease”, says Martin between 35 and 74 who had been Brown, a reader in neurology at St entered into the FINMONICA George’s Hospital, Tooting, UK. He stroke register (part of the World comments that the study might have Health Organisation Monitoring yielded more information if data Trends and Determinants in on other factors like smoking and Cardiovascular Disease Project) diabetes had been included. The between 1982 and 1992 were folshorter life expectancy at 1 year, he lowed up (Stroke 1997; 28: 311–15). says, might have been due to diabetOf these, 642 patients had AF. ics being more likely to have AF. Minna Kaarisalo (Department of “The important message to come Neurology, University of Turku, out of this paper is that to prevent Helsinki) and colleagues found that reoccurrence or subsequent myoby 28 days after their stroke, 19·5% cardial infarction among patients of the patients with AF had died, Science Photo LIbrary
T
A drink a day keeps the doctor away
M
oderate alcohol consumption may reduce peripheral arterial disease (PAD) risk in healthy men (Circulation 1997; 95: 577–80). Carlos Carmargo (Massachusetts General Hospital, Boston, USA) and co-workers documented 433 PAD cases occurring over 11 years follow-up of 21 759 Physicians Health Study participants. At the start of the study participants answered questions about alcohol consumption. After controlling for smoking, daily drinkers (88% of whom reported an intake of one drink per day) had a relative risk for PAD of 0·68 compared with the reference group (less than one drink per week). The authors stress that “The reduced PAD risk of drinkers was easily overwhelmed by smoking . . . the most important independent predictor of PAD”, and suggest that physicians and patients discuss the risks and benefits of drinking habit changes on an individual basis.
Jane Bradbury
Vol 349 • February 15, 1997
with AF, anticoagulation should be considered”, says Brown. “Such patients should also stop smoking and have their cholesterol controlled.” Janet Fricker
Stroke symptoms poorly known Worrying data on public awareness of stroke symptoms and risk factors were reported at the 22nd International Joint Conference on Stroke and Cerebral Circulation (Anaheim, USA; Feb 6–8). Rashmi Kothari and co-workers (University of Cincinnati, USA) interviewed 163 patients presenting with acute stroke symptoms. 39% of them could not identify a single warning sign for stroke, 35% could not name any risk factors. In a separate study, 27% of a general population (n=1880), agematched for the population at risk for stroke, could not identify any warning signs. The researchers called for better public education to ensure that patients get to hospital as rapidly as possible after a stroke since tissue plasminogen activator has to be given within 3 hours of symptom onset to be effective.
Increase reported in UK HIV-1 infections in 1996 he annual rate of newly diagnosed HIV-1 infections continues to rise in the UK, according to the 1996 figures from the Communicable Disease Surveillance Centre. In 1996 there were 2896 new HIV-1 infections reported, compared with 2683 in 1995, the highest annual total since reporting began in 1984. This brings the total number of reported HIV-1 infections to 28 447. The largest exposure category for HIV-1 infection remains sex between men, with reports of new HIV-1 diagnoses rising by 11%, from 1474 in 1995 to 1634 in 1996. There were 779 heterosexually acquired infections in 1996, mainly in the “exposure abroad” category, with a further 257 currently allocated to “other or investigation continuing/closed”. 1862 AIDS cases were reported in 1996, an increase of 18% over 1995 figures. The rise is attributed to the large number of late reports received by CDSC in early 1996, resulting from active follow-up of reporting doctors. The increase in newly reported
T
HIV-1 infections in 1996, particularly in gay men, may be partly attributable to more people having HIV-1 tests. Barry Evans, consultant epidemiologist, Public Health Laboratory Service HIV and STD Division, notes, “Data from the Vancouver conference showed that combination therapies are more effective, and part of the increase in 1996 may be that more people are getting diagnosed because they perceive there are better treatments for HIV”. Evans points out that, since 1991, on average about 2500 new HIV-1 infections a year have been reported in the UK. “Within the 15 214 newly diagnosed HIV-1 infections since 1991 there are likely to be significant numbers of newly acquired infections, in spite of prevention programmes, and that is the distressing fact.” He suggests that preventive measures, such as needle-exchange programmes for injecting drug users, are effective but stresses that “efforts must be kept up”. Kelly Morris
479