{"id":39580,"date":"2013-10-28T10:55:42","date_gmt":"2013-10-28T14:55:42","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=39580"},"modified":"2013-10-28T10:56:16","modified_gmt":"2013-10-28T14:56:16","slug":"selections-from-richard-lehmans-literature-review-october-28th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/10\/28\/selections-from-richard-lehmans-literature-review-october-28th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: October 28th"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection 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 24 Oct 2013 Vol 369<\/strong><\/p>\n

Thrombus Aspiration During STEMI (pg. 1587):<\/strong>\u00a0 This Swedish trial<\/a> compared thrombus aspiration during myocardial infarction with conventional percutaneous intervention. It was based on the national comprehensive Swedish Coronary Angiography and Angioplasty Registry (SCAAR). \u201cAll 29 PCI centers in Sweden as well as 1 in Iceland and 1 in Denmark participated in the trial. During the study period, 11,709 patients with STEMI in Sweden and Iceland underwent PCI and were registered in SCAAR. Of these, 7012 were enrolled in the trial. An additional 247 patients were enrolled from the center in Denmark, for a total of 7259 patients\u2026None of the patients who underwent randomization were lost to follow-up with respect to the primary end point.\u201d How about that? From start to finish the trial took less than three years, and it proves conclusively that aspirating clot at the time of PCI for ST elevation MI makes no difference to mortality.<\/p>\n

JAMA 23\/30 Oct 2013 Vol 310<\/strong><\/p>\n

Effect of Statin Therapy on Mortality in Patients with Ventilator-Associated Pneumonia (pg. 1692):<\/strong> Statins do a great deal more than just lower cholesterol, and for all we know they prevent cardiovascular disease by an entirely different mechanism, though the degree to which they do is proportional to their lowering effect on LDL-C. In particular they show strong evidence of having an anti-inflammatory action, and some studies have suggested that they can reduce mortality in sepsis. In this trial<\/a>, patients in 26 French ICUs with ventilator-associated pneumonia were randomized to simvastatin 60mg or placebo. By the time the trial had recruited 300 patients, it was stopped for futility. Statins are wonderful drugs, but they do not reduce mortality in this situation.<\/p>\n

Association Between Influenza Vaccination and CV Outcomes in High-Risk Patients (pg. 1711):<\/strong> I move among sceptics, and I am not entirely convinced that influenza vaccination does anything much, but this meta-analysis suggests that it may reduce cardiovascular events in high-risk individuals<\/a>. \u201cA large, adequately powered, multicenter trial is warranted to address these findings and assess individual cardiovascular end points.\u201d Yes indeed: and it could be done in a single flu season in the whole UK if we could just harness the same national database methods as that Swedish trial of thrombectomy in MI.<\/p>\n

Linagliptin for Patients Aged 70 Years or Older with Type 2 Diabetes Inadequately Controlled with Common Antidiabetes Treatments: A Randomised, Double-Blind, Placebo-Controlled Trial (pg. 1413):<\/strong> You can tell what\u2019s coming, can\u2019t you? Yes, \u201cinadequately controlled\u201d here means a HbA1c greater than 7%: and linagliptin reduces this over 24 weeks with a \u201csafety profile similar to placebo.\u201d Fewer than 10% of participants had an initial HbA1c level above 9%, which is where I would say it may be rational to discuss adding treatment in this age group. The reporting of this Boehringer Ingelheim funded study<\/a> reads very smoothly, as well it might: five of the six authors are employees of the company, while the sixth and principal author \u201chas received honoraria for lectures and advisory work from Boehringer Ingelheim (the manufacturer of linagliptin).\u201d Yes, and the accompanying editorial salves The Lancet<\/em>\u2019s conscience in accepting this paper by gently mentioning its defects while going on to bang a drum for the concept of \u201cfrailty\u201d as a missing element in this study. The more I read about \u201cfrailty,\u201d the more I\u2019m convinced that it is just one more misleading label, aimed more at extending the academic literature than at helping patients. But that is another matter. Just file this paper as one more example of advertising unnecessary treatment under the guise of a randomized trial.<\/p>\n

BMJ 26 Oct 2013 Vol 347<\/strong><\/p>\n

Should People at Low Risk of CVD Take a Statin?<\/strong> Statins for all? Yes, I would say, statins for all who really want them after full discussion of the harms and benefits. Just what these are is a matter for debate, and this article presents one side of that debate<\/a>, pointing out possible under-reporting of harms and overstating of benefits to people at low risk. But I would have to go to the primary literature to be sure, because these authors clearly have a definite view on the message they think should be conveyed to \u201cpatients\u201d. Yet having a risk of cardiovascular disease does not make anyone a patient: everyone has some risk, and we are talking here about free individuals. To consider that we as doctors should be \u201cgatekeepers\u201d in this situation is an affront to human rights. What we badly need is a better tool to share decision-making with those who come to us for advice on this issue, and James McCormack has recently come up with a very good and flexible web-based one<\/a>. I\u2019m going to spend a few days seeing if I can finesse it and perhaps develop an even simpler guide on one side of printed paper.<\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include thrombus aspiration during STEMI, the effect of statins on mortality in patients with ventilator-associated pneumonia, 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":[2039,825,584,257,1948,469,2038],"class_list":["post-39580","post","type-post","status-publish","format-standard","hentry","category-general","tag-influenza-vaccine","tag-linagliptin","tag-statins","tag-stemi","tag-thrombus-aspiration","tag-type-2-diabetes","tag-ventilator-associated-pneumonia"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/39580","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=39580"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/39580\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=39580"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=39580"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=39580"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}