{"id":34494,"date":"2013-02-04T15:39:33","date_gmt":"2013-02-04T20:39:33","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=34494"},"modified":"2013-02-04T15:50:24","modified_gmt":"2013-02-04T20:50:24","slug":"selections-from-richard-lehmans-literature-review-february-4th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/02\/04\/selections-from-richard-lehmans-literature-review-february-4th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: February 4th"},"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 Intern Med\u00a0 28 Jan 2013\u00a0 Vol 173<\/strong><\/p>\n

Blood Transfusion and Increased Mortality in MI (pg. 132):<\/strong>\u00a0 One treatment that we are learning to be meaner with is blood transfusion. Several studies in different contexts over the last year have shown that a restrictive transfusion policy is often associated with better survival than a liberal transfusion policy. In this systematic review<\/a>, the authors look at the literature on transfusion at the time of myocardial infarction. The trials are of variable quality but in terms of all-cause mortality, the message is that less blood is more beneficial.<\/p>\n

NEJM\u00a0 31 Jan 2013\u00a0 Vol 368<\/strong><\/p>\n

Proteotoxicity and Cardiac Dysfunction (pg. 455):\u00a0<\/strong> How nice to read another article about organ failure in old age<\/a>. Mechanisms of Disease: Proteotoxicity and Cardiac Dysfunction\u2014Alzheimer\u2019s Disease of the Heart? If you trespass beyond the age of 75, your heart may well begin to fail for reasons that are little to do with ischaemia but much to do with stiffening and the general clogging up of cardiomyocytes with defunct protein. At the same time, your brain may be forming plaques and tangles. Bah. Ripe old age means ripe old proteins and time to pack up.
\nCome Fate with thine abhorr\u00e8d shears
\nAnd take them to my telomeres.<\/p>\n

Lancet\u00a0 2 Feb 2013\u00a0 Vol 381<\/strong><\/p>\n

Combined Fitness and Statin Treatment on Mortality Risk in Veterans with Dyslipidaemia (pg. 394):<\/strong>\u00a0 Ten thousand American veterans with dyslipidaemia in their late fifties were observed for a mean period of 10 years in this cohort study<\/a>. As expected, those who took a statin had a lower mortality over this period of 9.2% in absolute terms, or in relative terms one third. Fitness, as based on peak metabolic equivalents (MET) achieved during exercise test, demonstrated even larger mortality benefits in this highly selected male population. So although I am not a black American army recruit, I can\u2019t altogether ignore the message that keeps coming back from every observational and interventional study: even quite modest amounts of exercise in older men can lead to big gains in survival.<\/p>\n

BMJ\u00a0\u00a0 2 Feb 2012\u00a0 Vol 346<\/strong><\/p>\n

Benefits of \u03b2 Blockers in Patients with HF and Reduced EF:<\/strong> After the first trials using bisoprolol and carvedilol in heart failure with reduced ejection fraction appeared, great efforts were made to change stable heart failure patients over from other beta-blockers to these particular \u201cevidence-based\u201d agents. I believe this still goes on throughout the UK, consuming the time and effort of numerous heart failure specialist nurses. Desist, dear ladies: several observational studies and now this network meta-analysis<\/a> have shown that there are probably no mortality differences whatever between different \u00df-blockers in systolic HF, or if there are, they may even favour atenolol. Nor is the up-titrating of doses based on firm evidence. I have seen no hard data to persuade me that heart failure patients benefit significantly from more than a smallish dose of any ACE inhibitor and a smallish dose of any \u00df-blocker.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include blood transfusion and increased mortality in MI, proteotoxicity and cardiac dysfunction in the elderly, combined fitness and statin treatment on mortality in veterans with dyslipidemia, 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":[312,1659,1661,1576,1579,749,287,1314,1660,584],"class_list":["post-34494","post","type-post","status-publish","format-standard","hentry","category-general","tag-beta-blockers","tag-blood-transfusion","tag-cardiac-dysfunction","tag-dyslipidemia","tag-ejection-fraction","tag-exercise","tag-heart-failure-2","tag-myocardial-infarction","tag-proteotoxicity","tag-statins"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34494","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=34494"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34494\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=34494"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=34494"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=34494"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}