{"id":36161,"date":"2013-04-16T08:39:39","date_gmt":"2013-04-16T12:39:39","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=36161"},"modified":"2013-04-16T08:39:39","modified_gmt":"2013-04-16T12:39:39","slug":"selections-from-richard-lehmans-literature-review-april-16th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/04\/16\/selections-from-richard-lehmans-literature-review-april-16th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: April 16th"},"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 11 Apr 2013\u00a0 Vol 368<\/strong><\/p>\n

Fibrinolysis or Primary PCI in STEMI (pg. 1379):\u00a0<\/strong> When it became clear about ten years ago that immediate percutaneous coronary intervention was the treatment of choice for myocardial infarction, I advised readers to have their MI on a Thursday morning in a large city where there was a sporting chance that there might be a fully staffed cardiac catheter suite ready to receive them. The treatment of first choice remains very challenging to provide: so how much worse is the treatment of second choice\u2014immediate (prehospital) fibrinolysis, followed by PCI at relative leisure (6-24hrs later)? The answer is<\/a> that the two strategies are equally good when judged by a composite end-point of death, shock, congestive heart failure, or reinfarction up to 30 days. The only drawback was a greater incidence of cerebral haemorrhage in the primary thrombolysis group, due to their cocktail of tenecteplase, clopidogrel, and enoxaparin. Dose adjustment helped to reduce this in the later stages of the trial. Overall, this is very good news for those working out how best to provide safe MI services around the world.<\/p>\n

BMJ\u00a0 13 Apr 2013\u00a0 Vol 346<\/strong><\/p>\n

Effect of Lower Sodium Intake on Health:<\/strong> The BMJ<\/em> has published a systematic review of the effect of lower salt intake on health<\/a>. The conclusion dutifully states, \u201cLower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.\u201d In Thatcher week, should we reply \u201cRejoice!\u201d or \u201cNo, no, no!\u201d? I suggest the latter. The summary in the printed BMJ<\/em> says it all: \u201cLow and very low quality evidence suggest that lower sodium intake is associated with reduced risk of stroke, fatal stroke, and fatal coronary disease in adults.\u201d Again, there is a good response from Copenhagen. \u201cThe conclusion of the analysis is not justified by the data, but that is not the issue. The interesting question is why BMJ<\/em> use 20 pages on the publication. The answer may be that the science of salt is not scientific, but political.\u201d<\/p>\n

Effect of Increased Potassium Intake on CV Risk Factors and Disease: <\/strong>But potassium is probably good. I\u2019m not saying the evidence is perfect\u2014it never can be\u2014but this systematic review concludes<\/a> \u201cHigh quality evidence shows that increased potassium intake reduces blood pressure in people with hypertension and has no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke (moderate quality evidence).\u201d Eat bananas and tomatoes. Drink fruit juice. Accentuate the positive.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include fibrinolysis or primary PCI in STEMI, the effect of lower sodium intake on health, and the effect of increased potassium intake on CV risk factors and disease.<\/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":[1062,1055,906,302,905,257],"class_list":["post-36161","post","type-post","status-publish","format-standard","hentry","category-general","tag-cv-risk","tag-fibrinolysis","tag-potassium","tag-primary-pci","tag-sodium","tag-stemi"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36161","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=36161"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/36161\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=36161"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=36161"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=36161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}