{"id":31647,"date":"2012-09-06T12:53:01","date_gmt":"2012-09-06T16:53:01","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=31647"},"modified":"2012-09-06T12:53:01","modified_gmt":"2012-09-06T16:53:01","slug":"selections-from-richard-lehmans-literature-review-september-6th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/09\/06\/selections-from-richard-lehmans-literature-review-september-6th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: September 6th"},"content":{"rendered":"

CardioExchange is pleased to reprint selections from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

NEJM\u00a0 30 Aug 2012\u00a0 Vol 367<\/strong><\/p>\n

Aspirin Plus Clopidogrel in Patients with Recent Lacunar Stroke (pg. 817):<\/strong> Aspirin is an annoyingly good drug, which may have made Bayer\u2019s fortune over a century ago but makes nobody much money now. Nonetheless, drug companies continue to seek for a marketable antiplatelet drug to replace or complement aspirin, and clopidogrel has been a very nice little earner during the period of its patent. This trial<\/a> sought to establish whether combining clopidogrel with aspirin would reduce recurrent stroke after recent lacunar stroke. The aspirin dose was set high at 325mg, and adding clopidogrel to this made no difference to stroke recurrence but did cause more intracranial haemorrhage and was associated with higher mortality.<\/p>\n

Lancet\u00a0 1 Sep 2012\u00a0 Vol 380<\/strong><\/p>\n

Risk of Coronary Events in Patients with CKD or Diabetes (pg. 807):<\/strong> In my last two weekly reviews, I\u2019ve railed against the use of the expression chronic kidney disease without further explanation of what is actually meant. This paper<\/a> adds a new twist to the crime: it uses a cut off eGFR of less than 60 in some places, and an eGFR of 45 in others. It refers to 3 grades of proteinuria, and finds that only the top level is predictive; but elsewhere the authors freely use the word \u201cproteinuria,\u201d without specifying its precise meaning or its relationship to eGFR. Most annoyingly of all, the authors talk about CKD in terms of how it compares with type 2 diabetes as a risk for myocardial infarction, usually without adjustment for age. As a result, this analysis of data from the Alberta Kidney Disease Network and the National Health and Nutrition Examination Survey (NHANES) 2003-06 manages to be exceedingly cumbrous while failing to convey any clear clinical message. It will no doubt be used by advocates of universal screening for CKD\u2014ignoring the fact the mean age of the \u201cat-risk\u201d group here was 71, an age at which most people should have been taking statins for 20 years if they wish to reduce their odds of cardiovascular disease\u2014irrespective of their kidney function, or indeed their blood sugar.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics includes studies on aspirin plus clopidogrel in patients with recent lacunar stroke and the risk of coronary events in patients with either CKD or diabetes.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[364,453,334,1444,200,1443],"class_list":["post-31647","post","type-post","status-publish","format-standard","hentry","category-general","tag-aspirin","tag-chronic-kidney-disease","tag-clopidogrel","tag-coronary-events","tag-diabetes","tag-lacunar-stroke"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31647","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=31647"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31647\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=31647"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=31647"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=31647"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}