The ‘metabolic’ health of younger adults is worse than that of previous generations, exposing them to greater risks of cardiovascular disease.

A large cohort study from the Netherlands found the incidence of obesity, high blood pressure and high cholesterol were much higher among adults in their twenties and thirties than formerly.

This increase in risk factors for diabetes, stroke and heart disease could offset the advantage of reduced incidence of lung cancer from the decline in smoking.

The researchers analysed data on more than 6,000 individuals in a cohort study that began in 1987, with follow-up examinations after six, 11 and 16 years, measuring body weight, blood pressure and total cholesterol level.

The subjects were divided into ten-year age groups to help determine whether there were ‘generation shifts’ in risk profile.

The results showed that while the prevalence of obesity and hypertension increased with age, the younger generations had a higher prevalence of these risk factors than those 10 years had shown at the same age. For example:

• incidence of overweight among men in their thirties had increased over 11 years from 40% to 52%

• incidence of hypertension had increased between generations in both sexes

• incidence of diabetes had increased between generations in men.

The investigators concluded that “the more recently born adult generations are doing worse than their predecessors”.

Lead study author Gerben Hulsegge commented that in terms of the prevalence of obesity, the younger generation was “15 years ahead” of the older.

He predicted: “We are likely to see a shift in non-communicable disease from smoking-related diseases such as lung cancer to obesity-related diseases such as diabetes.” As a result, he warned, increases in life expectancy could level off.

The Scottish Medicines Consortium (SMC) has accepted Eliquis (apixaban) for prevention of strokes in patients with atrial fibrillation (AF).

The drug, produced by Pfizer and Bristol-Myers Squibb (BMS), has also been provisionally recommended by NICE.

Its use in Scotland with AF patients over 40 is predicted to prevent nearly 1,000 strokes and over 300 deaths per year.

Following its EMA approval in November 2012, the SMC has accepted Eliquis for prevention of strokes in patients with non-valvular AF who have one or more risk factors (e.g. hypertension, diabetes).

Based on recent clinical trials, the SMC said Eliquis was superior to warfarin in preventing strokes and was associated with fewer major bleeds.

It also requires no monitoring and dosage adjustment, thus reducing the cost of treatment and avoiding the risks associated with poor monitoring.

AF affects over 60,000 people in Scotland over the age of 40. It causes a fivefold increase in stroke risk, resulting in 7% of all strokes. Strokes due to AF are more severe, and more likely to recur, than strokes with other causes.

Difficulties in setting the dosage of warfarin, the standard anticoagulant, mean that fewer than half of Scottish AF patients at high risk of stroke are receiving it.

Dr Derek Connelly, Consultant Cardiologist at the Royal Infirmary, Glasgow, said: “The SMC acceptance of apixaban is an important step forward for patients with atrial fibrillation in Scotland. The availability of a new treatment option that does not require [clotting time] monitoring may help decrease the impact atrial fibrillation has on the quality of life of patients, their families and carers.”

According to Amadou Diarra, BMS General Manager, UK and Ireland, the risk of stroke in patients with non-valvular AF is “a serious public health concern” that Eliquis can help to address.

NICE has provisionally recommended Eliquis in the same indication, with final guidance expected shortly.

The alliance between BMS and Pfizer to develop drugs against cardiovascular disease began in 2007.

Taking insulin to control type 2 diabetes may increase the risk of developing serious complications, a new study suggests.

An epidemiological study based on the UK Clinical Practice Research Datalink (CPRD) has shown that type 2 diabetes patients taking insulin are at higher risk of heart attack, stroke, cancer and retinopathy than those taking oral medications.

The study follows a population-based study that showed people with type 2 diabetes treated with insulin had a 50% higher mortality rate than people treated with a widely prescribed alternative.

Researchers from Cardiff University’s School of Medicine used CRPD data, which covers about 10% of the UK population, to compare the mortality rates of people whose type 2 diabetes is treated in different ways.

Lead study author Professor Craig Currie noted that the use of insulin to control blood glucose levels in people with type 2 diabetes has grown “markedly” in recent years. However, he noted, “By reviewing data from CPRD between 1999 and 2011 we’ve confirmed there are increased health risks for patients with type 2 diabetes who take insulin to manage their condition.”

Type 1 diabetes requires treatment with insulin, but type 2 diabetes – which often occurs in older and overweight people – can be treated in a number of ways depending on the patient’s characteristics.

“This study shows that we need to investigate this matter urgently, and the drug regulatory authorities should take interest in this issue,” Professor Currie added.

A previous study of UK patients taking insulin to control type 2 diabetes found a 50% higher mortality rate than with an oral drug therapy.

However, it should be noted that those patients with type 2 diabetes put on insulin are likely to have the worst diabetes control prior to insulin therapy.

The Atrial Fibrillation Association has welcomed NICE’s recommendation in final draft guidance of Eliquis (apixaban) for the prevention of stroke and systemic embolism in certain people with non-valvular atrial fibrillation.

NICE’s independent Appraisal Committee concluded the convenient drug was more clinically effective than warfarin and resulted in fewer bleeding events.

Trudie Lobban MBE, founder and CEO of the charity Atrial Fibrillation Association, said NICE’s decision is “excellent news for patients” with AF in England and Wales.

Eliquis’ recommendation follows the recent recommendations by the Institute of Xarelto (rivaroxaban) and Pradaxa (dabigatran etexilate) for the same indication.

“Having the choice of effective new treatments which do not require INR monitoring can help reduce the impact that atrial fibrillation has on patients, their families and carers,” said Trudie Lobban.

Final draft guidance states that Eliquis can be considered a treatment option on the NHS in accordance with its licensed indications if informed discussions about the risks and benefits of the drug compared with warfarin, Xarelto and Pradaxa are conducted.

Eliquis, which only received its license for the indication in November 2012, is co-marketed by Bristol-Myers Squibb and Pfizer.

Amadou Diarra, Vice-President, BMS UK and Ireland, said the “fast-tracked recommendation” by NICE highlights the value of the drug as a cost-effective treatment. “We look forward to working with the NHS and other partners to ensure that, where clinically appropriate, patients are provided with rapid access to apixaban, which has been shown to prevent strokes, reduce bleeds and be potentially life-saving compared to the current standard of care, warfarin.”

A new drug for stroke prevention that offers a safer and more effective alternative to warfarin has been launched in the UK.

Eliquis (apixaban) from BMS and Pfizer is available for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) and one or more risk factors such as diabetes or advanced age.

Whereas patients treated with warfarin risk serious side-effects and need frequent dosage adjustment, Eliquis is taken (in tablet form) in one of two approved doses.

AF affects 1.2 million people and causes 12,500 strokes every year in the UK.

Clinical trials have shown that Eliquis is more effective than warfarin in preventing strokes and causes less bleeding, as well as presenting less challenge in terms of monitoring.

The ARISTOTLE trial evaluated apixaban versus warfarin in 18,201 patients with non-valvular AF who were suitable for warfarin. Professor John McMurray of the Institute of Cardiovascular & Medical Sciences, University of Glasgow, said that in the study “apixaban has demonstrated superiority in the reduction of stroke and systemic embolism over warfarin together with a significant reduction in major bleeding.”

In addition, he noted, “apixaban was better tolerated than warfarin, with fewer people stopping treatment.”

Trudie Lobban, CEO of the Atrial Fibrillation Association, added: “Patients being treated with warfarin have to undergo regular blood tests. Having the choice of effective new treatments which do not require monitoring provides the option to tailor therapy to the individual patient.

“This could also help to reduce the burden on the NHS to monitor INR and the associated impact on patients, their families and carers.”

BMS developed Eliquis, and since 2007 has worked in partnership with Pfizer to promote and sell the drug.

A new drug for stroke prevention that offers a safer and more effective alternative to warfarin has been launched in the UK.

Eliquis (apixaban) from Bristol-Myers Squibb (BMS) and Pfizer is available for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) and one or more risk factors such as diabetes or advanced age.

Whereas patients treated with warfarin risk serious side-effects and need frequent dosage adjustment, Eliquis is taken (in tablet form) in one of two approved doses.

AF affects 1.2 million people and causes 12,500 strokes every year in the UK.

Clinical trials have shown that Eliquis is more effective than warfarin in preventing strokes and causes less bleeding, as well as presenting less challenge in terms of monitoring.

The ARISTOTLE trial evaluated apixaban versus warfarin in 18,201 patients with non-valvular AF who were suitable for warfarin. Professor John McMurray of the Institute of Cardiovascular & Medical Sciences, University of Glasgow, said that in the study “apixaban has demonstrated superiority in the reduction of stroke and systemic embolism over warfarin together with a significant reduction in major bleeding.”

In addition, he noted, “apixaban was better tolerated than warfarin, with fewer people stopping treatment.”

Trudie Lobban, CEO of the Atrial Fibrillation Association, added: “Patients being treated with warfarin have to undergo regular blood tests. Having the choice of effective new treatments which do not require monitoring provides the option to tailor therapy to the individual patient.

“This could also help to reduce the burden on the NHS to monitor INR and the associated impact on patients, their families and carers.”

BMS developed Eliquis, and since 2007 has worked in partnership with Pfizer to promote and sell the drug.

The clinical networks set up to improve cancer care have seen their budget cut by 25% in three years, with a severe impact on their performance.

Projects such as accelerating cancer diagnosis – the kind of efficiencies praised by Sir David Nicholson in his NHS review – may not be possible in future.

Clinical networks to improve stroke and heart disease treatment have also been cut back, though less dramatically.

The 28 cancer networks and 28 cardiovascular networks will be amalgamated into 24 larger networks (12 of each type) after April 2013, with the cardiovascular networks also covering diabetes.

Funding for the cancer networks has been cut by 25%, with loss of 73 staff. The heart and stroke networks have lost 12% of their funding and 38 staff.

Shadow Care Minister Liz Kendall said the feedback from clinical networks revealed them to be “in chaos”.

She noted: “Ministers have repeatedly promised to protect the funding for clinical networks.”

The clinical networks guide and support service redesign to increase clinical effectiveness and efficiency – which, NHS Confederation leader Mike Farrar argued this year, is a principle to which the NHS only pays lip service.

The clinical networks reported the cancellation of programmes that have successfully supported doctors and nurses in the past, providing specialist input into challenging areas of NHS care.

A cancer specialist from Yorkshire commented that the new Yorkshire and Humber cancer network “will be too big to be able to reflect local capabilities and needs, yet too small to have the authority of national guidelines”.

Professor Sir Mike Richards, the National Director for Cancer, said the next few weeks would be unsettling and difficult for the cancer networks as services were cancelled and staff made redundant.

Health Secretary Jeremy Hunt has said it’s “not possible to make a prediction” on whether the NHS budget will remain protected.

In his first interview in his new role, Hunt said that whether Lansley’s promise to ‘ring-fence’ the NHS budget could be honoured would depend on “the eurozone”.

Hunt also said the Government was trying to decide whether there was “any way at all” of following the Dilnot recommendations on social care reform, including cheaper variations on it.

Speaking to The Spectator, a strongly Conservative journal, he said his aim as Health Secretary was to “safeguard Andrew Lansley’s legacy”.

The shift in leadership at the DH was due to a need for it to communicate how the reforms will “make a difference to patients”, he said – confirming speculation that Hunt’s more ‘personal’ presentation style was a key factor.

While he said his “instinct” was to protect the NHS budget, Hunt insisted that it could no longer be a commitment due to economic “uncertainty”.

Asked whether the Dilnot proposals might be realised from the NHS budget (as the Treasury is said to favour), he said that would be “extremely difficult”. However, he said, “other versions” of the Dilnot plan with a lower cost would be considered.

In clinical terms, Hunt stated his priorities to be: care for the elderly and those with long-term conditions, dementia care and achieving “the best cancer, heart and stroke survival rates in Europe”.

Finally, he expressed the aspiration of delivering a “measurably better” NHS that patients would recognise as such.

NICE has recommended the use of Boehringer Ingelheim’s Actilyse (alteplase) in final guidance for the treatment of acute ischaemic stroke.

Actilyse has been recommended as an option for use on the NHS as long as it is administered as early as possible within 4.5 hours after the onset of stroke symptoms and once bleeding on the brain has been ruled out with a scan.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said the benefits of Actilyse in reducing long-term disability are “well recognised”.

The UK Stroke Association estimates there are more than 130,000 people in England and Wales who have a stroke each year. Ischaemic strokes are believed to account for around 80% of all strokes.

The recommendation follows an update to Actilyse’s license which allows an extension in the time period it can be used – from three hours to within 4.5 hours of the onset of symptoms.

“Today’s guidance recommending the use of alteplase within the extended time frame for which it is now licensed has the potential to have a significant impact on the treatment of thousands of patients,” said Professor Longson.

Dudley PCT has declared a surplus of £5.9m prior to its handover to NHS Dudley CCG, which is in wave 1 of the approval process.

The CCG, a former ‘Pathfinder’ formed in 2010, has confirmed the appointment of its Accountable Officer and Chief Financial Officer.

Since April 2012, it has worked in ‘shadow’ form as a subcommittee of Dudley PCT with a budget of £388m – 95% of the budget it will hold from April 2013.

NHS Dudley CCG, which will have 52 member GP practices, has said it expects to save £500,000 per year by rationing procedures of ‘limited clinical value’ such as hip replacements and cataract surgery.

It claims recent success in reducing the mortality rate from stroke, accelerating the assessment of dementia patients, improving paediatric triage and reducing the incidence of C. difficile infections.

Paul Maubach, former Director of Commissioning Development at West Mercia PCT Cluster, has been appointed as the CCG’s Accountable Officer.

The acting Chief Financial Officer, Matt Hartland, has been confirmed as CFO. Steve Wellings and Julie Jasper have been appointed as lay board members.

Dr Mary Heber, consultant cardiologist at the Princess Royal Hospital in Telford, is the board’s secondary care doctor.