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Hong Kong Med J 2007;13:421-6

Hong Kong men who go to see their doctors for urinary problems often have hidden heart disease risk factors that have never been treated, a study published in the December edition of the Hong Kong Medical Journal has found.

In The prevalence of cardiovascular risk factors in male patients who have lower urinary tract symptoms the authors, a team led by Professor C.F. Ng from the Chinese University of Hong Kong, describe how they tested 617 men attending a urology clinic at the Prince of Wales Hospital and found that 86 per cent of them had at least one risk factor for heart disease.

The reason for testing men with urinary symptoms is that this is a common problem that makes men seek medical help, whereas heart disease may remain silent until it becomes severe or fatal.

“We found a very high level of risk from cardiovascular disease in our patients,” the authors report.

Half of the men found to have risk factors for heart disease had raised blood fats, blood sugars and/or high levels of uricaemic acid, all things that can damage the heart and blood vessels. They are also conditions that, if detected early and treated effectively, may cause only limited, or even no, damage.

The authors point out that “cardiovascular disease is one of the leading causes of non-cancer death in adult males. Although better management of ischaemic heart disease, heart failure, and stroke has significantly improved patient outcomes, prevention is still the best approach to minimising the morbidity and mortality of these conditions.”

Detecting risk factors for heart disease is a crucial part of preventing heart disease but men are less likely to have regular check-ups that can pick up these problems early. “The fact that men under-use the health care systems probably accounts for the higher risk they face compared to females and their higher morbidity and mortality from a variety of individual diseases.”

“The common barriers to health care advice that men face include personal concepts of traditional male social roles, and the systemic barriers they encounter in relation to time and ease of access. Yet this situation could be resolved by influencing individual behaviour or modifying health care services to more easily suit the ‘average’ man.”

The authors suggest that doctors should take the opportunity to look for heart disease risk factors when men attend with urological problems, as this is a common thing that will make most men go to see a doctor.

“As urological symptoms are among the most common for which men seek medical advice, physicians managing these problems (in primary care or as specialists) have the opportunity to actively promote their general health.”

Hong Kong Med J 2007;13:430-5

A private hospital audit of prescriptions for proton pump inhibitors, (drugs used to treat gastric ulcers), has found that only one out of 105 doctors is giving the correct instructions for their use.

According to “Dosing of proton pump inhibitors in a private hospital in Hong Kong” published in the December edition of the Hong Kong Medical Journal, most doctors failed to make certain the drugs were taken at the correct time, thus making the treatment much less effective.

“From the above audit, it is apparent that most doctors, including gastroenterologists, were not specifying dosing for the audited PPIs (proton pump inhibitors) and therefore most patients were very likely not taking them before meals”, say the authors, Alan CW Mui and Titus CY Fan, from Baptist Hospital.

“Not surprisingly, sub-optimal dosing has been shown to be prevalent among poor responders to treatment. Diminished effectiveness of acid suppression due to sub-optimal dosing inevitably means reduced cost-effectiveness.”

“This is because affected patients may require additional medication, such as antacids, as well as larger doses and more prolonged use of medications.”