bmj.com -- Press Releases

Releases Saturday 23 March 2002
No 7339 Volume 324

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(1) PROLONGED USE OF RAMIPRIL PREVENTS
STROKE

(2) HEAVY DRINKING BY BOTH SEXES IS A
CAUSE FOR CONCERN

(3) DEATH AFTER INSERTING HICKMAN LINE
WAS PROBABLY AVOIDABLE

(1) PROLONGED USE OF RAMIPRIL PREVENTS
STROKE

(Use of ramipril in preventing stroke: double blind
randomised trial)
http://bmj.com/cgi/content/full/324/7339/699

Patients who are at high risk of stroke should be treated
with the drug ramipril, irrespective of their initial blood
pressure levels and in addition to other preventive
treatments such as blood pressure lowering agents or
aspirin, finds a study in this week's BMJ.

Over 9,000 patients aged 55 or over and at high risk of
stroke received either ramipril or placebo. Patients were
seen after six months and then every six months for an
average of four and a half years.

Although reduction in blood pressure was modest, the
risk of any stroke was reduced by 32% in the ramipril
group compared with the placebo group. The risk of
fatal stroke was reduced by 61% and significantly fewer
patients on ramipril had mental or functional impairment.
As stroke is the leading cause of disability in developed
countries, even moderate decreases in disability would
be of global importance, say the authors.

Widespread use of a drug such as ramipril in patients at
high risk of stroke is likely to have a major impact on
public health, they conclude.

The study was sponsored by the Canadian Institutes of
Health Research in addition to Aventis Pharma,
AstraZeneca, King Pharmaceuticals, the Natural Source
Vitamin E Association, NEGMA Pharmaceuticals and
the Heart and Stroke Foundation of Ontario. The study
was coordinated in Hamilton, Canada at McMaster
University.

Contact:

Jackie Bosch, Assistant Professor, Canadian
Cardiovascular Collaboration, McMaster University,
Canada
Email: jackie{at}ccc.mcmaster.ca

(2) HEAVY DRINKING BY BOTH SEXES IS A
CAUSE FOR CONCERN

(Letter: Risky drinking by both sexes should be tackled)
http://bmj.com/cgi/content/full/324/7339/738

Heavy drinking is common and a cause for concern in
both young men and young women, according to a letter
in this week's BMJ.

Researchers at King's College London surveyed 12,361
men and 20,534 women aged 20-80 about their alcohol
consumption.

They found no evidence of different trends developing in
the drinking careers of women and men, as reported in a
previous study. In fact, they show that a consistently
greater percentage of men than women drink at high risk
levels.

They also found that 88-90% of alcohol consumed by
the 20-29 age group was consumed non-sensibly (men
more than 4 units a day, women more than 3 units a
day) and 40-48% was consumed heavily (men more
than 8 units a day, women more than 6 units a day).

It is vital that risky drinking by both men and women
should be addressed in young adults, say the authors.
Tackling risky drinking behaviour in young people
should be a key feature of the long overdue alcohol
strategy, they conclude.

Contact:

Richard Williamson, Research Worker, Institute of
Psychiatry, King's College London, London, UK
Email: Richard.Williamson{at}iop.kcl.ac.uk

David Ball, Senior Lecturer, Institute of Psychiatry,
King's College London, London, UK

(3) DEATH AFTER INSERTING HICKMAN LINE
WAS PROBABLY AVOIDABLE

(Letter: Death after inserting Hickman line was probably
avoidable)
http://bmj.com/cgi/content/full/324/7339/739/b

The death of a 15 year old girl in 1998 due to a
complication of inserting a Hickman line could have been
avoided if the length of introducers used in these
procedures was reduced, argues a consultant surgeon in
this week's BMJ.

He believes that a major factor is the design of the
equipment, and in particular the length of the introducing
dilator.

The internal jugular vein in the neck is always within easy
reach of a standard needle, which typically measures 3.5
cm in length, explains the author. However the typical
length of the dilator provided by most manufacturers for
line insertion is almost 20 cm, so when it is placed fully
within the vein in the neck as required its tip is lying
within the heart.

A dilator of this length is rarely needed, he adds. "If we
could persuade manufacturers to reduce its length to 10
cm in standard packs then the complication from which
this patient died simply could not occur."

Contact:

Stephen Nixon, Consultant Surgeon, Western General
Hospital, Edinburgh, Scotland
Email: stephen.nixon{at}ed.ac.uk

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