Releases Saturday 25 November 2000
No 7272 Volume 321

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(1) HIGH CHOLESTEROL IS UNDERTREATED IN
ENGLAND

(2) BEING UNDERWEIGHT OR OVERWEIGHT REDUCES
FERTILITY IN WOMEN

(3) TRANSMISSION OF HIV REMAINS HIGH AMONG
HOMOSEXUAL AND BISEXUAL MEN



(1) HIGH CHOLESTEROL IS UNDERTREATED IN
ENGLAND

(Lipid concentrations and the use of lipid lowering drugs:
evidence from a national cross sectional survey)
http://bmj.com/cgi/content/full/321/7272/1322

(Treating dyslipidaemia in primary care)
http://bmj.com/cgi/content/full/321/7272/1299

At least a quarter of English adults have cholesterol levels
above the ideal, yet only one in 50 take cholesterol lowering
drugs, finds a study in this week's BMJ.

National guidelines recommend that cholesterol lowering drugs
should be used for people with a history of coronary heart
disease, or those with the highest risk of developing coronary
heart disease. Using data from over 13,500 English adults,
researchers in London found that only 30% of people with a
history of coronary heart disease were taking cholesterol
lowering drugs, with only one in eight reaching the
recommended cholesterol target. Among those high risk people
identified, only 3% were taking cholesterol lowering drugs.

The authors estimate that if cholesterol lowering was achieved
in the remaining 70% of untreated adults with a history of
coronary heart disease, about 7,000 fatal or non-fatal heart
attacks and about 2,500 fatal or non-fatal strokes would be
avoided each year.

Fortunately, the use of cholesterol lowering drugs is rising, say
the authors. They hope that the new NHS national service
framework will reinforce guidelines on cholesterol
management, so that the use of these drugs continues to grow
and the huge benefits in terms of preventing cardiovascular
events can be realised, they conclude.

Contact:

Paola Primatesta, Royal Free and University College Medical
School, London, UK
Email: paolap@public-health.ucl.ac.uk

(2) BEING UNDERWEIGHT OR OVERWEIGHT REDUCES
FERTILITY IN WOMEN

(Body mass and probability of pregnancy during assisted
reproduction treatment: retrospective study)
http://bmj.com/cgi/content/full/321/7272/1320

Extremes of weight are associated with reduced probability of
achieving pregnancy in women receiving assisted reproduction
treatment, finds a study in this week's BMJ.

Over 3,500 Australian women, who received assisted
reproduction treatment between 1987 and 1998, were divided
into five groups according to their weight: underweight,
moderate, overweight, obese and very obese. Fertility was
defined as the probability of achieving at least one pregnancy
throughout the treatment.

The fertility of the moderate group was almost 60% higher
than that of the very obese group, and the fertility of the
underweight group was also significantly lower than that of the
moderate group. When factors, such as age, number of
embryos transferred and type of treatment were accounted
for, the pregnancy rate among very obese women was half
that of the moderate group.

Ways in which extremes of weight can affect fertility include
menstrual disturbance and inability to ovulate, but these
problems can be overcome through assisted reproduction
treatment, say the authors. They suggest that other
mechanisms, such as disturbance to the lining of the uterus,
may cause reduced fertility.

Contacts:

Jim Wang, Department of Obstetrics and Gynaecology,
University of Adelaide, Queen Elizabeth Hospital, Australia
Email: jwang@medicine.adelaide.edu.au

Michael Davies, Department of Obstetrics and Gynaecology,
University of Adelaide, Queen Elizabeth Hospital, Australia
Email: michael.davies@adelaide.edu.au

(3) TRANSMISSION OF HIV REMAINS HIGH AMONG
HOMOSEXUAL AND BISEXUAL MEN

Serosurveillance of prevalence of undiagnosed HIV-1 infection
in homosexual men with acute sexually transmitted infection)
http://bmj.com/cgi/content/full/321/7272/1319

The level of undiagnosed HIV-1 infection among homosexual
and bisexual men did not fall between 1993 and 1998,
indicating a high level of continuing transmission, finds a study
in this week's BMJ.

Samples from over 32,000 homosexual and bisexual men,
attending 15 genitourinary clinics in England and Wales with
sexually transmitted infections, were tested for HIV-1
infection. In London, the level of HIV-1 declined among men
attending with an acute sexually transmitted infection, such as
gonorrhoea and chlamydia, from 16.5% in 1993 to 9% in 1998:
an average decrease of 9% a year. However, when samples
from men known to be HIV-1 positive were excluded, there
was no such trend. In contrast, the level decline in prevalence
of HIV-1 among men attending with a non-acute sexually
transmitted infection was significant: 17% a year overall and
11% a year when men known to be HIV-1 positive were
excluded. Outside London, the level of HIV-1 infection was
lower and, similarly, a significant decline (11% a year) was
seen only in men with a non-acute sexually transmitted
infection.

The findings suggest that men with acute sexually transmitted
infections represent a significant risk for HIV-1 transmission.
These men probably have more partners and engage in riskier
sex than those without such infections, say the authors. Health
promotion directed at this group of men should be intensified,
they conclude.

Contact:

Michael Catchpole, Consultant Epidemiologist, Public Health
Laboratory Service, Communicable Disease Surveillance
Centre, London, UK
Email: mcatchpole@phls.nhs.uk


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