{"id":33060,"date":"2012-11-12T10:17:10","date_gmt":"2012-11-12T15:17:10","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=33060"},"modified":"2012-11-12T10:22:43","modified_gmt":"2012-11-12T15:22:43","slug":"selections-from-richard-lehmans-literature-review-november-12th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/11\/12\/selections-from-richard-lehmans-literature-review-november-12th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: November 12th"},"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

JAMA\u00a0 7 Nov 2012\u00a0 Vol 308<\/strong><\/p>\n

Multivitamins in the Prevention of CVD in Men (pg. 1751):<\/strong> Vitamins are vital amines; you need them to stay healthy; therefore the more you take, the healthier you will be. It\u2019s amazing how pervasive this delusion is: it led even Linus Pauling, three times Nobel prizewinner, to make an ass of himself. And it sells billions of dollars\u2019 worth of useless tablets. Did I really see a two-storey emporium called Ye Olde Vitamin Shoppe in New York City, or had someone slipped some absinthe into my Starbucks? Anyway, you are a doctor, so you should know better than to take this rubbish: here is the Physicians Health Study II<\/a>. \u201cAmong this population of US male physicians, taking a daily multivitamin did not reduce major cardiovascular events, MI, stroke, and CVD mortality after more than a decade of treatment and follow-up.\u201d Antioxidants, antischmocksidants.<\/p>\n

Platelet Function During Extended Prasugrel and Clopidogrel Therapy for ACS Treated Without Revascularization:<\/strong> Of course there are sound mechanistic reasons why antioxidants should prevent cardiovascular disease; it is entirely perverse that that they don\u2019t. And there are sound mechanistic reasons why prasugrel should lead to better outcomes than clopidogrel when used with aspirin to prevent ischaemic outcomes following ACS without ST-elevation. In the TRILOGY ACS trial<\/a>, patients who had not undergone revascularization had their platelet reactivity measured, and sure enough prasugrel was uniformly more effective than clopidogrel at inactivating platelets. But O perversity! \u201cAmong those in the platelet substudy, no significant differences existed between prasugrel vs clopidogrel in the occurrence of the primary efficacy end point through 30 months and no significant association existed between platelet reactivity and occurrence of ischemic outcomes.\u201d Sound mechanistic reasons count for nothing in real life, yet again.<\/p>\n

NEJM\u00a0 8 Nov 2012\u00a0 Vol 367<\/strong><\/p>\n

Statin Use and Reduced Cancer Mortality (pg. 1792):<\/strong> \u201cStatin use in patients with cancer is associated with reduced cancer-related mortality. This suggests a need for trials of statins in patients with cancer.\u201d Denmark stars again: the investigators assessed mortality among patients from the entire Danish population who had received a diagnosis of cancer between 1995 and 2007, with follow-up until December 31, 2009<\/a>. They found a 15% reduction in overall mortality in people with 13 types of cancer taking statins of any kind and any dose, driven by a reduction in cancer-related mortality. So their conclusion is absolutely spot-on: we need trials of statins in cancer.<\/p>\n

Ann Intern Med\u00a0 6 Nov 2012
\n<\/strong><\/p>\n

Comparative Effectiveness of Sulfonylurea vs. Metformin Monotherapy on Cardiovascular Events in Type 2 Diabetes (pg. 601):<\/strong> After the fall of the Roman Empire, the developed world entered centuries of intellectual darkness marked by minimal scientific progress, a period often called the \u201cDark Ages.\u201d After many centuries, progress resumed and eventually accelerated during the Renaissance. In a similar fashion, knowledge about the comparative effectiveness of drugs to treat type 2 diabetes is finally beginning to emerge from 40 years of stagnation. This period of darkness and the current reawakening provide critically important lessons for contemporary medicine about the use of surrogate end points in drug development, regulatory oversight, and the hazards associated with reliance on commercial funding for pivotal clinical trials. OK, that\u2019s the standard Lehman rant about diabetes trials. But it wasn\u2019t written by me: there should be quotation marks around those opening sentences, which were actually written by Steve Nissen. That\u2019s slightly ironic, given how much commercial funding he has received for conducting pivotal trials: but his editorial<\/a> is still well worth reading. He is commenting on a large cohort study<\/a> which compares the effects of sulfonylureas and metformin on CVD outcomes (acute myocardial infarction and stroke) or death. It\u2019s nothing so ground-breaking as a randomized trial, and it simply confirms that use of sulfonylureas compared with metformin for initial treatment of diabetes was associated with an increased hazard of CVD events or death, of about 20%. It doesn\u2019t tell us if metformin is beneficial, or sulfonylureas are harmful, or a bit of both. And these drug classes appeared half a century ago\u2026<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include multivitamins for the prevention of CVD in men, the TRILOGY ACS trial, statin use and reduced cancer mortality, and more.<\/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":[1557,787,1519,977,584,1558,1556,469],"class_list":["post-33060","post","type-post","status-publish","format-standard","hentry","category-general","tag-cancer-mortality","tag-metformin","tag-multivitamins","tag-prevention-2","tag-statins","tag-sulfonylurea","tag-trilogy-acs-trial","tag-type-2-diabetes"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/33060","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=33060"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/33060\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=33060"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=33060"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=33060"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}