{"id":37648,"date":"2013-07-29T16:56:06","date_gmt":"2013-07-29T20:56:06","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=37648"},"modified":"2013-07-29T16:56:06","modified_gmt":"2013-07-29T20:56:06","slug":"selections-from-richard-lehmans-literature-review-july-29th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/07\/29\/selections-from-richard-lehmans-literature-review-july-29th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: July 29th"},"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 25 July 2013\u00a0 Vol 369<\/strong><\/p>\n

Riociguat for the Treatment of Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension (pages 319 and 330):<\/strong> There are still some life-shortening conditions where there are so few therapeutic options that everybody with them should be invited to take part in randomized trials of new interventions. One such is chronic thromboembolic pulmonary hypertension. Progression leads to reduced walking distance and ultimately to death, and is accompanied by an inexorable rise in B-type natriuretic peptide. So when a drug comes along that leads to an improvement in walking distance and a decrease in BNP over 16 weeks, it could mark a potential breakthrough, though we cannot be certain without longer trials. The drug is riociguat, a member of a new class of compounds, the soluble guanylate cyclase stimulators. The two trials reported here<\/a> and here<\/a> are very similar and encouraging. Yet the accompanying editorial <\/a>contains a pretty explicit warning:
\n\u201cAnother caveat, which is not unique to PATENT-1 and CHEST-1, is the relationship to the sponsoring company. The study was supported by Bayer HealthCare, and although the manuscript was drafted by the first author, editorial assistance was provided by a company supported by the sponsor (Adelphi Communications). In addition, although the authors had access to the complete database, the statistician was employed by Bayer HealthCare. Riociguat is poised for examination by the Food and Drug Administration as a therapy for pulmonary hypertension and, if approved, has the potential to generate substantial revenue for the sponsor. In light of the financial stakes, both real and apparent investigator autonomy remain key to ensuring the delivery of new drugs for pulmonary hypertension for patients.\u201d So where does the buck stop\u2014with the NEJM<\/em> which printed these studies, and will presumably get reprint income from Bayer, or with the FDA? Which impartial body is going to conduct the necessary replication studies and long-term mortality studies? Do we get to see the full data set?<\/p>\n

Mechanisms of Hypoglycemia-Associated Autonomic Failure in Diabetes (pg. 362):<\/strong>\u00a0 This week\u2019s NEJM<\/em> review article<\/a> is about hypoglycaemia\u2014something that we all need to take more account of when piling on treatments for diabetes. This paper deals with the detail of autonomic regulation of hypoglycaemia awareness, and why awareness tends to diminish with each hypoglycaemic episode. The wider clinical relevance of hypoglycaemia is the subject of a brilliant article by Kasia Lipska and Victor Montori in this week\u2019s JAMA Internal Medicine<\/em>.<\/a><\/p>\n

BMJ\u00a0 27 July 2013\u00a0 Vol 347<\/strong><\/p>\n

Renal Outcomes Associated with Invasive vs. Conservative Management of ACS:<\/strong> It\u2019s the end of July and there is sleepiness in the air; even people who aren\u2019t on holiday feel as if they should be; e-mails go unanswered, and jobs get postponed. Perhaps this accounts for the lack-lustre contents of the journals at this time of year too. A Canadian register<\/a> was trawled for evidence that renal outcomes after acute coronary syndrome might be influenced by invasive versus conservative management: they found that early invasive management of acute coronary syndrome is associated with a small increase in risk of acute kidney injury, but not dialysis or long term progression to end stage renal disease.<\/p>\n

JAMA Intern Med\u00a0 22 July 2013\u00a0 Vol 173<\/strong><\/p>\n

Association Between Hypoglycemia and Dementia in Older Adults with Diabetes Mellitus (pg. 1300):<\/strong> The more you look at what we are incentivized to do with elderly diabetic patients, the scarier it gets. Are we reducing beta-cell decline, or accelerating it? Are we reducing cardiovascular risk, or increasing it? When we tighten control, are we preventing cognitive decline or inducing it? For every treatment beyond metformin, we simply don\u2019t know. But there is increasing evidence that by inducing hypoglycaemia, commonly with sulfonylurea drugs or insulin, we are in danger of damaging the elderly brain, and elderly people with dementia then become more prone to hypoglycaemia. It\u2019s a bidirectional disaster area, as this study shows<\/a>. In an elderly diabetic cohort followed for 12 years<\/a>, \u201cthose who experienced a hypoglycaemic event had a 2-fold increased risk for developing dementia compared with those who did not have a hypoglycaemic event\u2026 Similarly, older adults with DM who developed dementia had a greater risk for having a subsequent hypoglycaemic event compared with participants who did not develop dementia.\u201d<\/p>\n

Statins and Musculoskeletal Conditions, Arthropathies, and Injuries (pg. 1318):<\/strong> Statins are great. And the initial randomized trials showed no increase in muscle aches<\/a> in the treated group. Now that is really strange, because every GP has encountered many patients who are desperate to continue taking a statin but cannot because of muscle pains which recur whenever they do. Nor do we quite know the full range of muscle effects which statins can produce: this retrospective cohort study with propensity score matching concludes that \u201cmusculoskeletal conditions, arthropathies, injuries, and pain are more common among statin users than among similar nonusers.\u201d But let\u2019s not get carried away: the odds ratios in the study were pretty small (1.07-1.1).<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include riociguat for chronic thromboembolic pulmonary hypertension, renal outcomes associated with invasive vs. conservative management of ACS, statins and musculoskeletal conditions, arthropathies, and injuries, 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":[1566,1894,1898,200,818,471,1902,1901,1895,584],"class_list":["post-37648","post","type-post","status-publish","format-standard","hentry","category-general","tag-acute-coronary-syndrome","tag-chronic-thromboembolic-pulmonary-hypertension","tag-dementia","tag-diabetes","tag-elderly","tag-hypoglycemia","tag-muscle-pain","tag-renal-outcomes","tag-riociguat","tag-statins"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/37648","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=37648"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/37648\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=37648"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=37648"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=37648"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}