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Statins & Stroke / Bipolar Disorder in Youth / Vaginal Cosmetic Surgery / Adolescent Immunizations

Physician's First Watch is editorially independent and does not endorse any
company, publication, product, or service.

PHYSICIAN'S FIRST WATCH for September 4, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief

– Stopping Statins After Stroke Increases Risk of Death
– Bipolar Diagnosis in Youth Increases Dramatically
– ACOG Advises Against "Vaginal Rejuvenation" Procedure
– Adolescent Vaccination Coverage Below Target Levels

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stopping Statins After Stroke Increases Risk of Death

Discontinuing statin therapy in the year after a stroke is associated with a
significant increase in the risk for death, according to an Italian study
published in the journal Stroke.

The researchers followed 631 stroke survivors at their institution who had
no clinical evidence of coronary heart disease. Within a year of discharge,
39% stopped statin therapy. In a multivariate analysis, female sex and older
age were each associated with greater likelihood to discontinue statin use.
Statin discontinuation was an independent predictor of all-cause mortality
(hazard ratio, 2.78). The earlier the discontinuation following discharge,
the higher the risk.

The authors conclude: "To the best of our knowledge, this is the first
evidence linking discontinuation of statins to increased mortality in stroke
survivors without any clinical evidence of CHD."

Neither physicians nor patients offered a medical reason for stopping
statins in 71% of cases.

Link(s):
Stroke article (Free abstract; full text requires subscription)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2Bv7M
xW6dRAv8dODKpH9K1Oo%3D
Advisory statement on use of statins after stroke from Stroke Council, AHA,
and American Stroke Association (Free PDF)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BmV9
QL67sKmDdODKpH9K1Oo%3D
Guideline on lipid management from AHA (Free PDF)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BkVV
tuNepFf2dODKpH9K1Oo%3D

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bipolar Diagnosis in Youth Increases Dramatically

Diagnosis of bipolar disorder among youth increased 40-fold over nine years
while the diagnosis in adults nearly doubled according to analysis of
National Center for Health Statistics data presented in the Archives of
General Psychiatry.

Diagnosis of bipolar disorder as a percentage of office visits increased
from 0.01% in 1994-1995 to 0.44% in 2002-2003 among individuals aged 19 or
younger. The percentage of office visits involving a diagnosis of bipolar in
adults increased from 0.31% to 0.5% during the same period. Two-thirds of
the youth with bipolar disorder were male, compared with one-third of the
adults.

The authors comment that these data indicate "a shift in clinical diagnostic
practices" and add that "either bipolar disorder was historically
underdiagnosed in children and adolescents and that problem has now been
rectified, or bipolar disorder is currently being overdiagnosed in this age
group."

Link(s):
Archives of General Psychiatry article (Free abstract; full text requires
subscription)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2Bgkg
ZRijYJXXdODKpH9K1Oo%3D
New York Times story (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BhBK
fSy74iz5dODKpH9K1Oo%3D

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ACOG Advises Against "Vaginal Rejuvenation" Procedure

Vaginal cosmetic surgeries such as "vaginal rejuvenation" or "designer
vaginoplasty" have not been proven safe or effective, warns the American
College of Obstetricians and Gynecologists in Obstetrics & Gynecology.

The surgeries — purported to enhance sexual gratification and genital
appearance altered by childbirth and aging — are growing in popularity,
according to the Wall Street Journal.

Some of these cosmetic procedures are variations of surgeries for recognized
medical conditions, including pelvic prolapse, vaginal relaxation with
symptoms, female circumcision, and treatment for labial hypertrophy or
asymmetrical labial growth. However, patients undergoing the cosmetic
versions should be aware of possible complications: infection, altered
sensation, pain, adhesions, and scarring.

Abbey B. Berenson, a member of ACOG's Committee on Gynecologic Practice,
says, "An honest discussion about the wide variation in the appearance of
normal genitalia could reassure women who are insecure about the look of
their own genitalia."

Link(s):
ACOG statement (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BlqP
e2E75dngdODKpH9K1Oo%3D
Obstetrics & Gynecology article (Subscription required)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BgxR
7X2MZrT7dODKpH9K1Oo%3D
Wall Street Journal story (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2Bkny
O0rqPfUMdODKpH9K1Oo%3D

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adolescent Vaccination Coverage Below Target Levels

The National Immunization Survey finds that government goals for at least
90% coverage of children aged 13 to 15 years were not met for any vaccine as
of 2006.

The results, published in MMWR, show that coverage in adolescents aged 13 to
17 was 12% for meningococcal conjugate vaccine (MCV4); 81% for three or more
doses of hepatitis B vaccine; 87% for two or more doses of measles, mumps,
and rubella (MMR) vaccine; and 60% for one or more doses of tetanus and
diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap)
vaccines.

An editorial note says routine healthcare visits should be encouraged for
all adolescents, especially those aged 11 to 12, and vaccinations should be
provided. In a media briefing, the CDC's Dr. Melinda Wharton said, "It is
going to take a lot of work to get the levels of coverage in adolescents
that we currently have in childhood, but we think it's possible to do it,
and there'll be a big payoff."

Link(s):
MMWR article (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BoST
DRA7ekq6dODKpH9K1Oo%3D
CDC media briefing transcript (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BsCe
2tP0NcuJdODKpH9K1Oo%3D
Associated Press story (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BtoS
0n7b0%2F9zdODKpH9K1Oo%3D
ACIP vaccination schedule for adolescents and children (Free)
http://click2.nejm.org/cts/click?q=227%3B298385%3BEx8zHzyTsiy4cx8pJImd%2BsSw
JX9f0goBdODKpH9K1Oo%3D

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