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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Cholesterol associated with IHD mortality

The Lancet has published the results of a meta-analysis of prospective studies of vascular mortality. This study found that "total cholesterol was positively associated with ischaemic heart disease (IHD) mortality in both middle and old age and at all blood pressure levels".

This conclusion comes as no surprise. The data covered almost 900,000 individuals without existing cardiovascular disease including nearly 12 million patient years. Total cholesterol and blood pressure data were available for these patients and HDL-C data were available for 150,000 patients.

The study found that a reduction in total cholesterol by 1mmol/L reduced the risk of IHD mortality by a half, a third and a sixth in 40-49, 50-69 and 70-89 year age groups. It is unclear how many patients were on cholesterol lowering treatments and this finding could be indicative of lower IHD mortality being associated with healthier lifestyles.

Action: The results of this study may be used to promote the "lower is better" message for total cholesterol. As with all observational data, these results should be used to generate a hypothesis for testing in a blinded and randomised controlled trial setting.

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Catch It, Bin It, Kill It

The Department of Health has launched a respiratory and hand hygiene campaign that will encourage the public to practise correct respiratory and hand hygiene when coughing and sneezing in order to prevent the spread of viruses particularly during the colds and flu season.

The campaign is called "Catch It, Bin It, Kill It" and will run until spring 2008. It will include advertising on buses and trains and posters in shopping centres. Posters will also be distributed throughout the NHS and to libraries and police stations. A covering letter from the National Director of Pandemic Influenza Preparedness will accompany the posters.

Action: Clinicians should be aware of the aims of this campaign and support the public health message if the opportunity arises.

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November NICE Guidance

The National Institute of Health and Clinical Excellence has published new guidance for the month of November.

Included in this month's guidance are Technology Appraisals covering Asthma (in children) - corticosteroids and Hypercholesterolaemia - ezetimibe.

The Quick Reference Guide for Asthma (in children) - corticosteroids recommends the least costly product should be used within licensed indications. Combination products containing corticosteroids and long acting beta agonists are recommended as an option after consideration of therapeutic need and the likelihood of treatment adherence.

The Quick Reference Guide for Hypercholesterolaemia - ezetimibe recommends ezetimibe as monotherapy in primary hypercholesterolaemia in patients who are contraindicated or intolerant to statins. It is also recommended for coadministration with a statin where patients fail to reach nationally defined cholesterol targets despite appropriate dose titration or where dose titration is limited by intolerance.

Action: Clinicians who treat children with asthma and patients with primary hypercholesterolaemia will find these technology appraisals useful.

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Hepatitis C awareness campaign

The Department of Health has recently launched an advertising campaign to raise awareness of hepatitis C infection.

The campaign includes radio adverts giving details of the silent and damaging effects of the infection and encouraging listeners to seek further information. There is also a press advert that details how hepatitis C is transmitted and who might be at risk of infection.

Both adverts give details of the NHS FaCe It website that contains information about hepatitis C for the public and healthcare professionals. Details are also given of the free phone helpline (0800 451451); it is open from 7am to 11pm every day.

Action: Clinicians should be aware of the campaign and be able to direct patients to suitable sources of information and arrange for testing where appropriate.

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CMO Update

The Department of Health has published the winter issue of the Chief Medical Officer's (CMO) Update (PDF).

This issue covers many topics including:

  • A New Vision for the NHS - discussion of the report into the NHS compiled by Lord Darzi
  • Alcohol related harm - summary of a recent public health report into alcohol consumption and harm
  • Tackling TB - sign post to a commissioning framework for specialist tuberculosis centres and to raise awareness of TB among the public and healthcare professionals
  • Hand hygiene - announcing the extension of the National Patient Safety Agency (NPSA) campaign to improve hand hygiene to combat healthcare-associated infection
  • Carbon Monoxide Poisoning - raising awareness among healthcare professionals and sign post information compiled by the Health Protection Agency

Action: Clinicians will find some useful content in this issue of the CMO Update. Readers can opt to be notified by e-mail when future issues are published.

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